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Endocrine System

Parathyroid Disorders and Calcium Balance Practice Questions

19 free Parathyroid Disorders and Calcium Balance practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 19 Medium

What is the primary role of the Parathyroid hormone (PTH)?

  1. A Lower serum calcium and raise serum phosphate
  2. B Raise calcium, lower phosphate, activate vitamin D
  3. C Raise serum phosphate while lowering calcium
  4. D Inhibit bone resorption and renal calcium reabsorption

Correct answer: Raise calcium, lower phosphate, activate vitamin D

PTH acts to increase serum calcium by stimulating bone resorption, increasing renal calcium re-absorption and promoting activation of vitamin D to increase intestinal calcium absorption.

Question 2 of 19 Medium

In primary hyperparathyroidism, which laboratory pattern would be expected?

  1. A Low PTH, low calcium, high phosphate
  2. B High PTH, high calcium, low phosphate
  3. C High PTH, low calcium, high phosphate
  4. D Low PTH, high calcium, low phosphate

Correct answer: High PTH, high calcium, low phosphate

In primary hyperparathyroidism, excess PTH secretion leads to hypercalcemia and hypophosphatemia.

Question 3 of 19 Medium

What is a common skeletal complication of untreated hyperparathyroidism?

  1. A Osteosclerosis with bone hardening
  2. B Osteitis fibrosa cystica from bone resorption
  3. C Osteopetrosis with dense brittle bone
  4. D Rickets from defective mineralization

Correct answer: Osteitis fibrosa cystica from bone resorption

Excess PTH causes increased bone resorption leading to bone weakening, characteristic of osteitis fibrosa cystica in advanced primary hyperparathyroidism.

Question 4 of 19 Medium

Which physical sign may be expected in a patient with mild hypercalcemia from primary hyperparathyroidism?

  1. A Carpopedal spasm with positive Trousseau's sign
  2. B Muscle twitching, cramps, and a positive Chvostek's sign
  3. C Bone pain, kidney stones, GI upset, and psychiatric symptoms
  4. D Marked hypotension and bradycardia without other symptoms

Correct answer: Bone pain, kidney stones, GI upset, and psychiatric symptoms

Classic features of hypercalcemia from hyperparathyroidism include bone pain, kidney stones, GI symptoms (groans) and psychiatric manifestations (moans).

Question 5 of 19 Medium

Which medication class might be used in a patient with hyperparathyroidism who cannot tolerate surgery?

  1. A Calcimimetics (e.g., cinacalcet)
  2. B Thiazide diuretics such as hydrochlorothiazide
  3. C Beta-blockers such as metoprolol
  4. D Proton-pump inhibitors such as omeprazole

Correct answer: Calcimimetics (e.g., cinacalcet)

Calcimimetics like cinacalcet act on calcium-sensing receptors to reduce PTH secretion and are used medically when surgery is not feasible.

Question 6 of 19 Medium

In hypoparathyroidism, what is the expected phosphate level?

  1. A Low phosphate due to renal wasting
  2. B High phosphate (hyperphosphatemia)
  3. C Normal phosphate with normal calcium
  4. D Phosphate that varies independently of PTH

Correct answer: High phosphate (hyperphosphatemia)

Low PTH leads to reduced renal excretion of phosphate, causing hyperphosphatemia in hypoparathyroidism.

Question 7 of 19 Medium

Which condition may predispose to tertiary hyperparathyroidism?

  1. A Acute pancreatitis with calcium sequestration
  2. B Long-standing secondary hyperparathyroidism causing autonomous PTH secretion
  3. C Recent thyroidectomy with gland injury
  4. D Excessive vitamin D intake raising calcium

Correct answer: Long-standing secondary hyperparathyroidism causing autonomous PTH secretion

Tertiary hyperparathyroidism occurs when parathyroid glands become hyperplastic and autonomous after long-term secondary hyperparathyroidism, such as with CKD.

Question 8 of 19 Medium

For a patient with hyperparathyroidism who is asymptomatic but meets surgical criteria, what is the nurse's recommended action?

  1. A Continue to wait and monitor only, taking no further action
  2. B Recommend parathyroidectomy as the definitive treatment
  3. C Treat solely with high-dose vitamin D supplementation
  4. D Reassure that dietary changes alone will correct the abnormality

Correct answer: Recommend parathyroidectomy as the definitive treatment

Surgery (parathyroidectomy) is the definitive treatment for primary hyperparathyroidism when symptomatic or when surgical criteria are met.

Question 9 of 19 Medium

In primary hyperparathyroidism, one would expect which of the following laboratory patterns?

  1. A Low PTH, low calcium, high phosphate
  2. B High PTH, high calcium, low phosphate
  3. C High PTH, low calcium, high phosphate
  4. D Low PTH, high calcium, low phosphate

Correct answer: High PTH, high calcium, low phosphate

In primary hyperparathyroidism, the parathyroid glands secrete excess PTH, causing hypercalcemia and hypophosphatemia.

Question 10 of 19 Medium

A patient with hypocalcemia, tetany, tingling around lips and fingers, and a history of thyroid surgery likely has:

  1. A Primary hyperparathyroidism
  2. B Secondary hyperparathyroidism
  3. C Hypoparathyroidism
  4. D Tertiary hyperparathyroidism

Correct answer: Hypoparathyroidism

Hypoparathyroidism leads to low PTH, low calcium, and neuromuscular irritability from hypocalcemia.

Question 11 of 19 Medium

Which of the following is a common skeletal complication of untreated hyperparathyroidism?

  1. A Osteosclerosis with increased bone density
  2. B Osteitis fibrosa cystica
  3. C Osteopetrosis with marble-bone changes
  4. D Rickets from vitamin D deficiency

Correct answer: Osteitis fibrosa cystica

Excess PTH causes increased bone resorption leading to bone weakening, characteristic of osteitis fibrosa cystica in advanced primary hyperparathyroidism.

Question 12 of 19 Medium

A nurse monitors a patient post-parathyroidectomy for “hungry bone syndrome”. Which finding would support this condition?

  1. A Rapid rise in serum calcium soon after surgery
  2. B Prolonged hypocalcemia after surgery
  3. C Persistently high PTH levels after surgery
  4. D Isolated hyperphosphatemia after surgery

Correct answer: Prolonged hypocalcemia after surgery

After removal of hyper-secreting glands, bone may rapidly uptake calcium leading to sustained low serum calcium (hungry bone syndrome).

Question 13 of 19 Medium

In Secondary hyperparathyroidism, which of the following is often the underlying cause?

  1. A Hypercalcemia caused by a parathyroid adenoma
  2. B Chronic kidney disease with low vitamin D and hypocalcemia
  3. C Excessive vitamin D intake raising serum calcium
  4. D A primary parathyroid carcinoma secreting PTH

Correct answer: Chronic kidney disease with low vitamin D and hypocalcemia

Secondary hyperparathyroidism is a reactive over-secretion of PTH due to low serum calcium, often from chronic kidney disease and/or vitamin D deficiency.

Question 14 of 19 Medium

Which of the following patients is most at risk for developing hypoparathyroidism?

  1. A A 70-year-old male with prostate cancer
  2. B A young woman after total thyroidectomy
  3. C A child with juvenile arthritis
  4. D A patient with newly diagnosed hyperthyroidism

Correct answer: A young woman after total thyroidectomy

Thyroid surgery may inadvertently remove or damage parathyroid glands, making postsurgical hypoparathyroidism a recognized complication.

Question 15 of 19 Medium

A patient with hypoparathyroidism is started on calcium and active vitamin D. The nurse’s teaching should include:

  1. A High-phosphorus foods help compensate
  2. B Monitor for signs of hypercalcemia and maintain normal magnesium
  3. C Avoid all milk products permanently
  4. D No laboratory follow-up is required once symptoms improve

Correct answer: Monitor for signs of hypercalcemia and maintain normal magnesium

In hypoparathyroidism care involves calcium and active vitamin D supplementation, and monitoring calcium, phosphorus, and magnesium because these interact and calcium overload is possible.

Question 16 of 19 Medium

Which electrolyte abnormality should a nurse anticipate in a patient with hyperparathyroidism?

  1. A Hypokalemia
  2. B Hypocalcemia
  3. C Hypercalcemia
  4. D Hypermagnesemia

Correct answer: Hypercalcemia

Excess PTH increases serum calcium via bone resorption and increased renal reabsorption, so hypercalcemia is expected.

Question 17 of 19 Medium

What is the expected phosphate level in hypoparathyroidism?

  1. A Low phosphate
  2. B High phosphate (hyperphosphatemia)
  3. C Normal phosphate only
  4. D Variable phosphate unrelated to PTH level

Correct answer: High phosphate (hyperphosphatemia)

Low PTH leads to reduced renal excretion of phosphate, causing hyperphosphatemia in hypoparathyroidism.

Question 18 of 19 Medium

A patient with hyperparathyroidism is found to have bone demineralization. Which bone density site is particularly vulnerable?

  1. A The lumbar spine, which is mostly trabecular bone
  2. B The distal forearm, a cortical bone site
  3. C The skull, sparing other bony sites
  4. D The metacarpals, sparing other bony sites

Correct answer: The distal forearm, a cortical bone site

PTH excess preferentially affects cortical bone, such as the distal forearm, leading to greater bone loss in those sites in primary hyperparathyroidism.

Question 19 of 19 Medium

For a patient with hyperparathyroidism who is asymptomatic but meets surgical criteria, the nurse emphasizes:

  1. A Continue to wait and monitor only, taking no further action
  2. B Recommend parathyroidectomy as the definitive treatment
  3. C Treat solely with high-dose vitamin D supplementation
  4. D Reassure that dietary changes alone will correct the abnormality

Correct answer: Recommend parathyroidectomy as the definitive treatment

Surgery (parathyroidectomy) is the definitive treatment for primary hyperparathyroidism when symptomatic or when surgical criteria are met.

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