Question

A client with bone metastasis has a calcium level of \(20.8 \mathrm{mg} / \mathrm{dL}\). The nurse should be alert for which symptom correlating with the level? A. Hyperactivity B. Oliguria C. ECG changes D. Polyphagia

Short answer

Answer: C. ECG changes

Step-by-step solution

Understanding Bone Metastasis and Calcium Level

Bone metastasis occurs when cancer cells spread to the bone from another part of the body. The movement of these cancer cells triggers an increase in bone resorption, which in turn increases calcium levels in the blood. A high calcium level, or hypercalcemia, is a common complication in patients with bone metastasis. The normal calcium level in the blood ranges from \(8.6 \mathrm{mg} / \mathrm{dL}\) to \(10.2 \mathrm{mg} / \mathrm{dL}\). A calcium level of \(20.8 \mathrm{mg} / \mathrm{dL}\) is significantly higher than the normal range, indicating hypercalcemia.

Symptom A: Hyperactivity

Hyperactivity is not a common symptom associated with hypercalcemia. In fact, hypercalcemia generally causes symptoms such as fatigue, confusion, and lethargy, which are opposite to hyperactivity. Thus, this option is not correct.

Symptom B: Oliguria

Oliguria, which is the production of abnormally small amounts of urine, can be a symptom of hypercalcemia. High calcium levels can cause dehydration, which in turn affects kidney function and leads to a reduced urine output. Thus, this option is a possible symptom associated with the given calcium level.

Symptom C: ECG Changes

ECG changes, or electrocardiogram changes, can also occur due to hypercalcemia. High calcium levels can interfere with the electrical activity in the heart, leading to abnormal heart rhythms and ECG changes. Therefore, this option is another possible symptom associated with the given calcium level.

Symptom D: Polyphagia

Polyphagia, or increased appetite, is not a common symptom of hypercalcemia. In fact, patients with hypercalcemia may experience a decreased appetite, nausea, and vomiting. Thus, this option is not correct. Based on the analysis of symptoms associated with hypercalcemia, the nurse should be alert for:

Correct Answer

C. ECG changes

Key concepts

NCLEX-PN Exam Preparation

Preparing for the NCLEX-PN exam can seem daunting, but understanding hypercalcemia and its implications is a critical component that nursing students must grasp.

To effectively prepare, students should focus on the pathophysiology of conditions like bone metastasis, which frequently results in elevated calcium levels, or hypercalcemia. Understanding the normal range of calcium levels, which is between 8.6 and 10.2 mg/dL, is essential for interpreting lab results and anticipating potential complications. For instance, a calcium level of 20.8 mg/dL, as seen in the given exercise, is significantly higher than normal and is a classic indicator of hypercalcemia.

NCLEX-PN examinees are expected to identify the symptoms associated with hypercalcemia, such as ECG changes, which brings us to the importance of understanding diagnostic tests and interventions. Simulating real scenarios and practicing with exercises similar to the one provided can strengthen a student's diagnostic skills and ensure a well-prepared entry into the nursing field. Moreover, focusing on critical thinking questions that evaluate the nurse's ability to prioritize clinical signs will lead to better exam performance and patient care.

Hypercalcemia Symptoms

Hypercalcemia is a condition characterized by an excess of calcium in the blood. Symptoms of hypercalcemia can range from mild to life-threatening and often include fatigue, confusion, and lethargy.

In the context of bone metastasis, the high level of blood calcium can indeed be symptomatic through various clinical presentations, including:

• Lethargy and fatigue, as the body's systems are overwhelmed by the excess calcium.
• Neurological symptoms like confusion or even coma in severe cases, as calcium interacts with nervous system functions.
• Renal symptoms such as oliguria, where kidneys are unable to effectively filter the excess calcium, leading to reduced urine output and potential renal failure.
• Gastrointestinal issues like nausea and vomiting, which are common as the body reacts to the chemical imbalance.
• Cardiac symptoms, which can be detected through ECG changes due to the impact of high calcium on heart's electrical activity.

While hyperactivity and polyphagia are less associated with hypercalcemia, these specifics help nurses like those preparing for the NCLEX-PN exam to prioritize care and anticipate the needs of patients.

Electrocardiogram (ECG) Changes

An electrocardiogram, or ECG, is a crucial tool in diagnosing cardiac conditions and can show significant changes in patients experiencing hypercalcemia. High levels of calcium affect the heart's electrical activity, potentially leading to a shortened QT interval and a prolonged PR interval. These alterations can result in arrhythmias, which may present as palpitations, dizziness, or even syncope for the patient.

Healthcare professionals must be vigilant in monitoring ECG changes in patients with known hypercalcemia. In severe cases, such as a calcium level of 20.8 mg/dL cited in the exercise, continuous ECG monitoring may be needed to detect life-threatening arrhythmias quickly.

Nurses and other healthcare professionals should be well-practiced in reading and interpreting ECGs, as they often provide the first indication of serious cardiac issues. Treatment for hypercalcemia might include hydration, diuretics, bisphosphonates, or calcitonin, yet the initial assessment and ongoing ECG monitoring are vital for guiding appropriate interventions.