# A dialysis client with CKD-mineral and bone disorder is scheduled for denosumab and reports new perioral tingling and muscle spasms. Which action is best?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522078&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A dialysis client with CKD-mineral and bone disorder is scheduled for denosumab and reports new perioral tingling and muscle spasms. Which action is best?

## Option

1. Administer denosumab now and schedule the next calcium test at the routine annual visit.
2. Proceed because regular dialysis prevents clinically important treatment-related hypocalcemia.
3. Hold denosumab and urgently assess calcium and the CKD-mineral bone plan with the authorized team. **✔ Correct answer**
4. Ask the client to take an additional denosumab dose independently after dialysis.

**Correct answer: 3**

## Explanation

Advanced CKD and CKD-mineral bone disorder increase the risk of severe denosumab-associated hypocalcemia; symptoms require urgent evaluation before dosing.

## In-depth explanation

Quick answer
Treat symptoms as possible severe hypocalcemia in advanced CKD.

Why this is correct
FDA added a boxed warning because denosumab can cause severe, sometimes life-threatening hypocalcemia in advanced CKD, especially with CKD-mineral bone disorder.

Easy analogy or mental picture
Think of medication safety as a control panel: identify the dangerous signal, change the correct control, and verify the response.

Memory hook
Cue, action, response, reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving the continuing indication.

Why the other choices are wrong
Options that delay escalation, ignore a contraindication, or change therapy without authorization do not close the safety loop.References
1FDA Drug Safety Communication: Prolia and Advanced CKDBoxed warning for severe hypocalcemia, CKD-mineral bone disorder assessment, supplementation, and monitoring

## Clinical scenario

Medication safety review
Verify the indication, current assessment, laboratory trend, timing, interactions, authorized action, and measurable follow-up.

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