A terminally ill cancer patient with metastasis to the bone has ...

[Engineer]

A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer
 
  (Select all that apply.)
  A)
  pamidronate, a bisphosphonate.
  B)
  intravenous drip of insulin.
  C)
  furosemide, a loop diuretic.
  D)
  gallium nitrate, a gallium salt of nitric acid.
  E)
  prednisone, a corticosteroid.

Question 2

A patient has just been diagnosed with pernicious anemia. The patient asks the nurse why his body is not able to absorb vitamin B12. The nurse responds,
 
  A)
  You have too many ulcers in your stomach.
  B)
  More than likely, you were born with deficient vitamin B12 stores.
  C)
  Your stomach is not secreting a substance known as intrinsic factor, which is needed to absorb vitamin B12.
  D)
  Your daily intake of high saturated fats is interfering with the stomach's ability to absorb the nutrients that it needs, especially vitamin B12.

[fur]

Answer to Question 1

Ans:
A, D, E

Feedback:

The bisphosphonates (e.g.,pamidronate, zoledronate), which act mainly by inhibiting osteoclastic activity, provide a significant reduction in calcium levels with relatively few side effects. Calcitonin also inhibits osteoclastic activity. Gallium nitrate is highly effective in the treatment of severe hypercalcemia associated with malignancy. Prednisone, a corticosteroid, inhibits bone resorption.

Answer to Question 2

Ans:
C

Feedback:

Vitamin B12 is not absorbed in the absence of intrinsic factor, which is secreted by the parietal cells of the stomach. Ulcers in the stomach do not cause pernicious anemia. This is not a congenital problem, nor does the intake of fats interfere with the secretion of intrinsic factor.