# Situation: A 58-year-old woman with primary hyperparathyroidism is seen before a planned parathyroidectomy. She has passed two kidney stones in the past year. Her serum calcium is 11.6 mg/dL (8.6–10.2 mg/dL). She has no heart or kidney failure and no fluid restriction. Which instruction should the nurse give her while she waits for surgery?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630409  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 58-year-old woman with primary hyperparathyroidism is seen before a planned parathyroidectomy. She has passed two kidney stones in the past year. Her serum calcium is 11.6 mg/dL (8.6–10.2 mg/dL).

She has no heart or kidney failure and no fluid restriction. Which instruction should the nurse give her while she waits for surgery?

## 보기

1. Stay active and drink 2 to 3 liters of fluid daily **✔ 정답**
2. Rest in bed to lower the risk of a bone fracture
3. Limit fluids to 1 liter a day to protect the kidneys
4. Take a daily calcium tablet to strengthen the bones

**정답: 1**

## 해설

Generous fluids (about 2–3 L/day unless restricted) dilute the urine and reduce stone formation, and staying mobile limits calcium release from bone. Immobility raises serum calcium, and extra calcium supplements are avoided unless prescribed.

## 심화 해설

The correct instruction
While she waits for parathyroidectomy, the aim is to limit the effects of hypercalcemia. She has no heart or kidney failure and no fluid restriction. Generous fluids of about 2–3 L/day dilute the urine and reduce stone formation, and staying mobile limits calcium release from bone. The best instruction is to stay active and drink 2 to 3 liters of fluid daily.

Why fluids and activity help
Excess parathyroid hormone draws calcium out of bone and increases calcium in the urine. Concentrated urine with high calcium content readily forms stones, and she has already passed two in the past year. Drinking more fluid keeps the urine dilute so that calcium salts stay dissolved. Weight-bearing activity provides mechanical stress that encourages bone formation and reduces bone resorption. Immobility does the opposite: it accelerates calcium loss from bone and raises serum calcium further.

| Instruction | Effect | Verdict |
| --- | --- | --- |
| Stay active; 2–3 L fluid daily | Dilutes urine; limits bone calcium loss | Correct |
| Bed rest to prevent fracture | Increases bone resorption; raises calcium | Incorrect |
| Limit fluids to 1 L | Concentrates urine; promotes stones | Incorrect |
| Daily calcium tablet | Adds calcium to an already high level | Incorrect |

Why the other instructions are wrong
Bed rest increases bone resorption and raises serum calcium; fall precautions are used to protect fragile bones instead. Restricting fluids concentrates the urine and promotes more stones. Calcium supplements are avoided unless prescribed because serum calcium is already high.

Additional teaching
The nurse teaches her to report symptoms of worsening hypercalcemia, such as increasing fatigue, confusion, constipation, nausea, or flank pain suggesting another stone. Thiazides and other drugs that raise calcium are reviewed with the provider, and a safe home environment reduces fall risk.

Exam takeaway
Key point For hypercalcemia awaiting treatment: push fluids, keep moving, use fall precautions, and avoid extra calcium and thiazides.

## 임상 시나리오

Hyperparathyroidism Before SurgeryFluids and activity
Excess parathyroid hormone releases calcium from bone and raises urinary calcium, promoting kidney stones. Drinking about 2–3 L a day keeps urine dilute and reduces stone formation.

Weight-bearing activity limits calcium loss from bone, while immobility raises serum calcium. Fall precautions protect fragile bones without bed rest.

CautionAvoid fluid restriction, unprescribed calcium supplements, and thiazide diuretics, all of which can worsen stones or hypercalcemia.

## 핵심 개념

- **Bone resorption** — Breakdown of bone tissue that releases calcium into the blood.
- **Nephrolithiasis** — Formation of stones in the kidney or urinary tract.
- **Parathyroidectomy** — Surgical removal of one or more parathyroid glands.
- **Fall precautions** — Measures that reduce the risk of falls, such as clear walkways, good lighting, and supervised mobility.

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