Which of the following actions should a nurse take when managing a patient with hyperparathyroidism to prevent complications related to hypercalcemia? Select All that Apply

Rationale: A. Hyperparathyroidism, whether primary (due to parathyroid adenoma, hyperplasia, or carcinoma) or secondary (commonly related to chronic kidney disease), does not resolve spontaneously. Without appropriate management, persistent elevated parathyroid hormone (PTH) levels can lead to chronic hypercalcemia, kidney stones, bone demineralization (osteopenia/osteoporosis), and cardiovascular complications. Telling the patient it will resolve on its own is misleading and can delay necessary interventions. B. Adequate hydration is a primary preventive measure in hyperparathyroidism. High calcium levels increase renal calcium excretion but can also promote calcium stone formation if fluid intake is insufficient. Drinking 2–3 liters of water daily, unless contraindicated, helps dilute urinary calcium and reduce the risk of kidney stones. Hydration also helps prevent the dehydration that often accompanies hypercalcemia due to polyuria. C. Hypercalcemia can cause polyuria, nausea, vomiting, and weakness, all of which increase the risk of dehydration. The nurse should assess skin turgor, mucous membranes, blood pressure, heart rate, and daily weight to detect fluid loss early. Timely detection allows for prompt interventions such as oral or IV fluid replacement, reducing complications such as hypotension or acute kidney injury. D. Laboratory monitoring is essential for tracking disease progression and evaluating treatment effectiveness. Key labs include serum calcium, phosphate, PTH, creatinine, and 25-hydroxy vitamin D levels. Frequent monitoring allows clinicians to adjust interventions, such as recommending surgery or pharmacologic treatment (e.g., bisphosphonates or calcimimetics), before severe complications occur. E. These foods are high in calcium, which can exacerbate hypercalcemia in patients with hyperparathyroidism. Dietary calcium restriction is often advised to prevent further elevation of serum calcium levels, although strict restriction is usually balanced with maintaining adequate calcium for bone health. F. Calcium supplements are generally avoided in hyperparathyroidism unless the patient has undergone parathyroidectomy and is at risk for hypocalcemia. Unmonitored supplementation can worsen hypercalcemia and increase the risk of kidney stones and cardiovascular complications. G. In primary hyperparathyroidism, PTH increases calcium reabsorption and phosphate excretion, leading to hypophosphatemia. Encouraging foods higher in phosphorus (e.g., meat, poultry, fish, eggs, and some whole grains) can help balance calcium-phosphate levels, reduce hypercalcemia complications, and support bone health. H. While high-impact activity or excessive strain should be avoided due to bone fragility, complete inactivity is not recommended. Moderate weight-bearing exercise helps maintain bone density, prevent muscle loss, and support overall cardiovascular health. Limiting all activity could worsen osteopenia, muscle weakness, and functional decline.