# A nurse teaches a client newly prescribed cinacalcet for secondary hyperparathyroidism in CKD. Which monitoring instruction is essential?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391830&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse teaches a client newly prescribed cinacalcet for secondary hyperparathyroidism in CKD. Which monitoring instruction is essential?

## Option

1. Check serum phosphate levels regularly — hyperphosphatemia is a frequent effect of cinacalcet; symptoms include itching, bone pain, and calciphylaxis.
2. Serum calcium routinely — hypocalcemia is a common adverse effect of cinacalcet; symptoms include perioral tingling, muscle cramps, and seizures **✔ Correct answer**
3. Monitor for elevated calcium signs each visit — hypercalcemia is a potential adverse effect of cinacalcet; symptoms include nausea, vomiting, and confusion.
4. Record daily body weight each morning — fluid retention is a known effect of cinacalcet; signs include edema, shortness of breath, and fatigue.

**Correct answer: 2**

## Explanation

Correct (2): Cinacalcet activates the calcium-sensing receptor of the parathyroid gland → lowers PTH AND lowers serum calcium. Routine Ca monitoring; hold if Ca

## In-depth explanation

Memory Tip Cinacalcet = "Calcimimetic mimics Ca to suppress PTH; serum Ca DROPS." Lab monitoring is Ca, P, PTH every 1-3 months.

## Clinical scenario

Scenario 60-year-old male CKD on dialysis starting cinacalcet 30 mg PO daily for elevated PTH.

## Key concepts

- **Cinacalcet** — Calcimimetic for secondary hyperparathyroidism; etelcalcetide IV alternative.
- **Hypocalcemia from cinacalcet** — Common adverse effect; monitor Ca and educate symptoms.
- **CKD-MBD therapies** — Vit D analog (calcitriol), calcimimetic (cinacalcet), phosphate binders, parathyroidectomy.

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