A nurse is reinforcing teaching about a tonometry examination with a client who has manifestations of glaucoma. Which of the following statements should the nurse include in the teaching?

Choice A Reason:

Primary hyperparathyroidism is characterized by elevated PTH levels, which lead to increased serum calcium levels and decreased serum phosphate levels. The patient’s lab results show low PTH and low serum calcium, which are not consistent with primary hyperparathyroidism.

Choice B Reason:

Chronic kidney disease (CKD) can cause disturbances in calcium and phosphate metabolism, but it typically presents with elevated PTH levels due to secondary hyperparathyroidism. The patient’s low PTH levels make CKD an unlikely diagnosis in this context.

Choice C Reason:

Vitamin D deficiency can lead to low serum calcium levels, but it usually results in elevated PTH levels as the body attempts to compensate for the low calcium. The patient’s low PTH levels do not align with a diagnosis of vitamin D deficiency.

Choice D Reason:

Hypoparathyroidism is characterized by low serum calcium, low PTH levels, and elevated serum phosphate levels. This condition occurs when the parathyroid glands do not produce enough PTH, leading to the observed lab results and symptoms such as tingling, muscle cramps, and fatigue. The patient’s lab results are consistent with hypoparathyroidism.

Choice A Reason:

Allowing the client to keep her hearing aids in is crucial for effective communication between the nurse and the client. Hearing aids help the client understand instructions and respond appropriately, which is essential for ensuring the client’s safety and comfort before surgery. According to preoperative guidelines, patients with hearing impairments should be allowed to use their hearing aids until they are taken to the operating room. This practice helps reduce anxiety and ensures that the client can hear and understand all preoperative instructions and consent information.

Choice B Reason:

Allowing the client to consume clear liquids up to the time of surgery is generally not recommended. Preoperative fasting guidelines typically require patients to stop consuming clear liquids at least two hours before surgery to reduce the risk of aspiration during anesthesia. Therefore, this option is not appropriate for ensuring the client’s safety.

Choice C Reason:

Allowing the client to take her morning vitamins is not advisable without specific instructions from the surgical team. Some vitamins and supplements can interact with anesthesia or increase the risk of bleeding during surgery. It is essential to follow the surgical team’s guidelines regarding medication and supplement intake before surgery.

Choice D Reason:

Allowing the client to keep her tongue stud in is not recommended. All jewelry and body piercings should be removed before surgery to prevent complications such as electrical burns during the use of electrocautery devices or interference with airway management. Removing the tongue stud is necessary to ensure the client’s safety during the procedure.