DSM: Osteoporosis
The nurse is providing care for an older adult female patient who states, "I have been experiencing low back pain, which has been causing me to lose sleep." Which question will best help the nurse determine if the patient's pain is associated with osteoporosis? "Are you experiencing decreased range of motion?" "Do you have pain in your joints?" "Do you have a history of fractures?" "What position do you sleep in?"
"Do you have a history of fractures?" A hx of fractures and low back pain are risk factors for osteoporosis. Decreased ROM, arthritis, & position of sleep are not directly related to osteoporosis.
A patient with osteoporosis has been prescribed calcium citrate supplements.Which topic should the nurse include in the patient's medication teaching? Increased risk for depression Best taken with meals Decreasing overall caloric intake Necessity for additional iron supplementation
Best taken with meals Calcium citrate supplements may cause indigestion and should be taken with meals. Calcium supplements are not associated with depression, weight gain, or anemia.
The nurse is preparing to provide dietary teaching for the pt who is diagnosed c osteoporosis.Which food should the nurse recommend to provide dietary Ca? Wine Organ meats Canned sardines Brown rice
Canned sardines Pts who have osteoporosis or who are at risk for development of disease later on benefit from choosing healthy menu items, particularly those high in Ca & vit D. Foods that are rich in Ca include canned sardines. Organ meats, brown rice & wine are not high in Ca.
The nurse is caring for a patient suspected of having osteoporosis. Which diagnostic test should the nurse anticipate to be ordered to specifically diagnose osteoporosis? Magnetic resonance imaging (MRI) Ultrasound Computerized tomography (CT) scan with contrast Dual-energy x-ray absorptiometry (DEXA)
Dual-energy x-ray absorptiometry (DEXA) DEXA is a bone mineral density test that measures bone density in the lumbar hip or spine. It differentiates osteoporosis from other bone-related disorders and is considered to be highly accurate. An MRI, ultrasound, & CT scan with contrast are not used to dx osteoporosis.
The nurse is providing medication teaching to a patient who has been prescribed alendronate sodium (Fosamax) for the treatment of osteoporosis.Which adverse effect should the nurse include? Sinusitis Dyspepsia Hot flashes Constipation
Dyspepsia Dyspepsia is a common adverse effect that occurs for pts taking alendronate sodium (Fosamax). Sinusitis and hot flashes are expected adverse effects that occur c raloxifene hydrochloride (Evista). Diarrhea, not constipation, is an adverse effect expected c med.
An older adult female pt is diagnosed c osteoporosis. Which risk factor should nurse recognize as contributing to this disease? Lack of vitamin D Low testosterone Diet rich in calcium Aerobic exercise 3 times per week
Lack of vitamin D. Pt c a hx of decreased levels of vit D will be at a risk of developing osteoporosis. This is a modifiable risk factor for osteoporosis. Low testosterone in male pts increases the risk of osteoporosis. A diet rich in Ca & weight-bearing exercise both decrease risk of osteoporosis.
The nurse is teaching a postmenopausal woman how to reduce the risk factors associated with osteoporosis. Based on the patient's history, which activity should the patient be advised? Maintaining a vitamin D intake of 400 IU per day Maintaining calcium intake of 1000-1500 mg per day Maintaining a calcium intake of 1500-2000 mg per day Maintaining a vitamin D intake of 1500 IU per day
Maintaining Ca intake of 1000-1500 mg per day. The postmenopausal pt should be encouraged to maintain a Ca intake of 1000-1500 mg daily, through either diet or a Ca supp. The National Institutes of Health recommends a daily vit D intake of 800-1000 IU for those aged 50 and older.
The nurse who is caring for an older adult at risk for osteoporosis discusses the importance of weight-bearing activity. Which statement made by the patient requires further teaching? "I enjoy swimming, so I will try and swim at least 3 times a week." "I will attend a tai chi class at least 4 times a week." "I will join a gym and begin a weight-lifting program." "I used to be an avid golfer, and I will get back out on the course at least 4 times a week."
"I enjoy swimming, so I will try and swim at least 3 times a week." Swimming is not a weight-bearing exercise. Weight-bearing exercises like tai chi, weight lifting & walking on a golf course, influence bone metabolism in several ways. stress of this type of exercise causes an increase in blood flow to bones, which brings growth-producing nutrients to the cells, resulting in increased osteoblast growth & activity.
The nurse is obtaining a health hx on a pt diagnosed with osteoporosis. Which pt statement has the strongest association c osteoporosis? "I try to walk twice a week." "I am lactose intolerant and do not eat any dairy products." "I do not smoke and occasionally drink alcohol." "I follow a strict vegan diet."
"I try to walk twice a week." Walking is a weight-bearing exercise, but it is recommended that pt will participate in weight-bearing exercises for approx 30 mins a day at least 4 days a wk. statements regarding lactose intolerance, abstinence from smoking, occasional alcohol use, and consuming a vegan diet are not risk factors for osteoporosis.
The nurse has completed the med teaching for the pt prescribed a bisphosphonate for osteoporosis. Which pt statement indicates that further teaching is required? "I will keep a dietary log to track my intake of foods high in calcium, vitamin D, and phosphate." "I will make sure that I walk 30-40 minutes a day four times a week." "I will take my medication with my breakfast, so I do not get nauseated." "After I take my medication, I will wait for 1 hour before I take my calcium and vitamin D supplements."
"I will take my med with my breakfast, so I do not get nauseated." Bisphosphonates should be taken on an empty stomach c water 1st thing in morning. Pt should remain upright for 30 mins & should not eat or drink anything else for 30 mins to avoid esophagitis. A dietary log is helpful to hcp & pt to ensure that adequate dietary Ca, vit D, & phosphate are consumed. Walking is a weight-bearing exercise that is important in prevention of further complications of osteoporosis. Ca & vit D supss should be held 60 min or longer after taking bisphosphonate.
The nurse is providing nutritional teaching for a newly diagnosed pregnant patient.Which dietary intervention should the nurse suggest in order for the growing fetus to obtain enough maternal dietary calcium without having to pull calcium from the maternal bones? "Increase your dietary intake of chicken." "Increase your dietary intake of beans." "Increase your dietary intake of beef." "Increase your dietary intake of wheat."
"Increase your dietary intake of beans."The newly diagnosed pt should be encouraged to increase their intake of beans. Beans not only contain fiber that will help c constipation that occurs during pregnancy, but more important, contain high levels of Ca necessary for growing fetal skeleton. Other Ca-rich foods include dairy and vegetables. Beef, chicken, and wheat do not contain high amounts of calcium.
A pregnant woman asks, "Can you tell me about breastfeeding and bone loss? I read an article stating that I am at risk for bone loss if I breastfeed."Which response by the nurse demonstrates an understanding of breastfeeding and its effects on loss of maternal bone mass? "Loss of maternal bone mass does occur with breastfeeding but is restored after weaning." "Loss of maternal bone mass does not occur; the infant obtains calcium from your dietary intake." "Loss of maternal bone mass will not occur if you continue to take your prenatal vitamins while breastfeeding." "You will be supplemented with extra calcium and vitamin D while breastfeeding to prevent loss of maternal bone mass."
"Loss of maternal bone mass does occur with breastfeeding but is restored after weaning." Several studies indicate that breastfeeding affects maternal bones. Evidence suggests that some women may lose up to 5% of their bone mass while breastfeeding. Restoration occurs in several months once infant is weaned. Taking prenatal vits, Ca, & vit D will not prevent bone loss but may decrease amount of bone loss.
The nurse is providing care to a patient diagnosed with osteoporosis. Dual-energy x-ray absorptiometry (DEXA) has been ordered for the patient. Which explanation of this diagnostic procedure is appropriate for the nurse to give the patient? "The test detects osteopenia and identifies fractures." "The test is administered to the heel of the foot to measure bone density." "The test measures bone density in the lumbar spine or hip." "The test is used to evaluate bone mineral density and the degree of osteoporosis."
"The test measures bone density in the lumbar spine or hip." The DEXA measures bone density in the lumbar spine or hip. An ultrasound is administered to the heel of the foot to measure bone density. X-rays detect osteopenia & ID fractures. A quantitative ultrasound (QUS) is used to evaluate bone mineral density & degree of osteoporosis.
A pt diagnosed c osteoporosis asks, "How can I prevent this disease from progressing?" Which response by nurse provides pt c important dietary info to prevent osteoporosis from progressing? "To help prevent further progression of the disease, it is important for you to increase your calcium intake." "An increase in dietary intake of foods rich in vitamins A and E will help slow down the disease progression." "Increasing your dietary intake of animal protein will help slow the progression of your osteoporosis." "Foods high in dietary zinc and iron are a key factor in the prevention of disease progression."
"To help prevent further progression of the disease, it is important for you to increase your calcium intake." Ca is an essential mineral in process of bone formation & other significant body functions. When intake of Ca through diet is insufficient, body compensates by removing Ca from skeleton, weakening bone tissue. The nurse should also remind pt that vit D helps with Ca absorption. Foods high in vit A, iron, animal protein, & zinc not effective in prevention of progression of osteoporosis.
A 65-year-old female patient has been recently diagnosed with osteoporosis. Which information should the nurse include in the teaching related to the patient's diagnosis? "Consume foods low in iron." "Increase dietary protein." "Walk 30-40 minutes per day." "Abstain from any caffeine intake."
"Walk 30-40 minutes per day." Walking is a weight-bearing exercise. The pt should be encouraged to walk 30-40 min per day, at least four times a week, to promote bone growth. It is not necessary to decrease dietary iron intake, increase dietary protein, or completely abstain from caffeine.
A pt is prescribed estrogen replacement therapy for tx of osteoporosis. Pt states "I heard that estrogen is associated c an increased risk of uterine cancer." Which response made by the nurse provides the patient with accurate information? "Your provider will prescribe bisphosphonates to decrease risk of cancer." "You will be prescribed progesterone with the estrogen to protect you from uterine cancer." "The dose of estrogen is too low to increase your risk of cancer." "The new research does not link estrogen replacement therapy to increased risk of cancer."
"You will be prescribed progesterone with the estrogen to protect you from uterine cancer." Estrogen therapy alone is associated c an increased risk of endometrial cancer, so it usually is prescribed in combo c progesterone; this is referred to as hormone replacement therapy. Bisphosphonates are not used to decrease risk of cancer, they are used to inhibit bone reabsorption. There is no new research that disputes the risk factor of endometrial cancer associated c estrogen replacement therapy.
The nurse is performing a yearly health screening on a patient at risk for osteoporosis. Which clinical assessment finding should the nurse associate with osteoporosis? An increase in weight over time Chronic episodes of vertebral pain A decrease in height over time Vertebral pain with substantial movement
A decrease in height over time A clinical assessment finding associated with osteoporosis is a decrease in height over time. An increase in weight is not associated c osteoporosis. Chronic episodes of vertebral pain or vertebral pain occurring with substantial movement are not associated with osteoporosis. Osteoporosis is characterized by acute, not chronic, episodes of vertebral pain.
A pt diagnosed with osteoporosis states to the nurse, "I don't understand how my bones can be so brittle and break easily." Before responding to the pt, the nurse should understand that which process is involved in the pathophysiology of osteoporosis? Osteoclasts are unable to produce new bone. Osteoblasts are not able to reabsorb bone. Excessive bone reabsorption has occurred. An imbalance between osteoblasts and osteoclasts has occurred.
An imbalance between osteoblasts and osteoclasts has occurred. Osteoporosis is a metabolic bone disorder characterized by loss of bone mass, increased bone fragility & increased risk of fxs. Although exact pathophysiology of osteoporosis is unclear, it is known to involve an imbalance in activity of osteoblasts that form new bone & osteoclasts that reabsorb bone. Osteoclasts are responsible for reabsorption of bone and osteoblasts the formation of new bone.
The nurse caring for a pt with osteoporosis notes that the patient's height has significantly decreased each year over the past few years. Which further additional assessment finding should the nurse anticipate? Recumbent lordosis Dorsal kyphosis Cervical kyphosis Thoracic lordosis
Dorsal kyphosis Along with loss of height, characteristic dorsal kyphosis & cervical lordosis develop, accounting for buffalo hump (sometimes referred to as a "dowager's hump") frequently associated with aging. Recumbent is a position, & cervical kyphosis and thoracic lordosis do not occur with osteoporosis.
The nurse is providing teaching to a patient diagnosed with osteoporosis about how to slow the disease process. Which information is the most appropriate to provide? Decreasing fluid intake Encouraging use of prescribed pain medications Encouraging smoking cessation Discouraging further physical activity
Encouraging smoking cessation Smoking decreases the blood supply to bones, & nicotine slows the production of osteoblasts and impairs absorption of Ca, contributing to decreased bone density.
A 62 YO female pt presents c a possible wrist fx & reports no other health problems. This is third such injury that the pt has had in the past year, nurse suspects osteoporosis. Which assessment finding in the pt's health hx supports the dx of osteoporosis? History of alcoholism Increased BMI Active lifestyle Daily vitamin D intake
History of alcoholism A hx of alcoholism places this pt at risk for osteoporosis. An inactive lifestyle, not an active lifestyle, would place this pt at risk. Being underweight, not overweight, is a risk factor. A lack of vit D intake, not daily intake, is another risk factor for osteoporosis.
A 65 YOman with a low testosterone & lifetime Ca level has had two bone fractures in the past 2 yrs.Which intervention should nurse suggest to prevent or slow development of osteoporosis? Implementing corticosteroid use Increasing calcium intake Implementing estrogen therapy Exercising less to avoid injury
Increasing calcium intake nurse will recommend that PT increase Ca intake as a way to slow the development of osteoporosis. The use of corticosteroids increases the risk factor for osteoporosis. Low estrogen levels are a cause of osteoporosis in women but not in men, so estrogen suppls would not be indicated for older man. pt should be advised to increase activity, not to decrease it.
The nurse is providing dietary teaching for pt newly diagnosed with osteoporosis. Included in teaching is importance of dietary intake of Ca & vit D. What foods are high in vit D should nurse recommend? Milk Beef Orange juice Beans
Milk. Vit D is necessary for body to absorb Ca. The food the nurse will recommend that is high in vit D is milk. Milk is also high in Ca, which is recommended in the prevention of further complications of osteoporosis. Beef does not contain high amounts of vit D. Orange juice & beans contain high amounts of calcium.
The nurse is caring for a pt diagnosed with osteoporosis. When planning the pt's care, which nursing diagnosis is most appropriate? Hypothermia Hyperthermia Mobility: Physical, Impaired Neurovascular Dysfunction: Peripheral, Risk for
Mobility: Physical, Impaired A nursing diagnosis that is most appropriate for a patient with osteoporosis is Mobility: Physical, Impaired. The patient may experience impaired mobility due to fractures and acute pain. The other diagnoses are not appropriate for a patient with osteoporosis.
The nurse is caring for an older adult at risk for osteoporosis who frequently experiences a loss of balance.Which activity should the nurse encourage the patient to do to prevent osteoporosis? Tai chi Increasing calcium supplementation Walking when they feel stable Obtaining an assistive device, so the patient can walk
Tai chi is beneficial to the pt who has probs with balance. Increasing ca supps will not provide the weight-bearing exercise necessary to increase osteoblast growth & activity necessary to maintain strong bones. Having pt walk when they "feel" stable may not provide consistent exercise that is necessary to maintain health of bones. An assistive device should be secured for the safety of a patient who is unstable.
nurse working in a clinic is screening female adolescent pts for risk factors of osteoporosis. Which pt has greatest risk for osteoporosis? The female adolescent that is on the golf team The female adolescent that is sedentary The female adolescent on a cross-country running team The female adolescent that is on a chess team
The female adolescent on a cross-country running team Adolescent athletes who participate in sports that emphasize leanness, such as gymnastics or cross-country running, are at risk for osteoporosis. Golf does not pose a great risk factor. A sedentary lifestyle over a long period of time or sedentary activity such as chess increases the risk for osteoporosis in adults.
The nurse is providing care for a patient diagnosed with osteoporosis who is recovering from a wrist fracture. Which outcome should the nurse expect the patient to meet? The patient achieves adequate calcium and vitamin D intake. The patient incorporates weight-bearing exercises. The patient identifies and eliminates safety hazards. The patient maintains a healthy weight.
The patient identifies and eliminates safety hazards. A pt with a wrist fx should be able to identify & eliminate safety hazards to prevent further injury. Achieving adequate Ca & vit D intake, incorporating weight-bearing exercises, and maintaining a healthy weight are not expected outcomes at this time.
During a home visit, the nurse is concerned that a pt recovering from an osteoporosis-related fx is at risk for future fxs. Which assessment finding supports nurse's conclusion? The patient is using a treadmill every day. The patient drinks an occasional glass of wine. The patient is consuming fresh fruits and vegetables every day. The patient is smoking cigarettes.
The patient is smoking cigarettes.For osteoporosis, nurse can help pt id risk factors & encourage actions like increasing activity, smoking cessation, healthy eating, taking recommended amount of Ca & vit D daily. Smoking cigs increases pt's risk for future osteoporosis-related fx. Smoking decreases blood supply to bones & nicotine slows production of osteoblasts & impairs absorption of Ca, contributing to decreased bone density. Although pt should be discouraged from using alcohol, drinking occasional glass of wine does not support pt is at an increased risk for future fxs. Using a treadmill for exercise & consuming fresh produce help reduce risk of fx osteoporosis-related fractures.
The nurse is caring for an older adult c advanced dementia, osteoporosis & frequently gets out of bed throughout the night. Which nursing intervention is most appropriate for the nurse to include in the plan of care? Medicating the patient Providing the patient with an assistive device Obtaining an order for restraints Placing the bed in the lowest position
The safest nursing intervention to prevent injury to the pt c advanced dementia who frequently gets out of bed at night is to place bed in lowest position. Medicating pt is a chemical restraint. Providing pt c an assistive device is necessary if one is needed & pt can use it safely. Restraints should be avoided, because they may actually increase pt's risk for falling and the risk of injury associated with fall.
The nurse is caring for a postmenopausal pt who reports difficulty sleeping & low back pain. Which test procedure should the nurse anticipate being ordered to screen for osteoporosis? Ultrasound Alkaline phosphatase Gla protein Dual-energy x-ray absorptiometry (DEXA)
Ultrasound An ultrasound transmits painless sound waves through the heel of foot to measure bone density & is accurate for screening purposes only. Alkaline phosphatase is elevated following a fx. A dual-energy x-ray absorptiometry (DEXA) is used for diagnostic purposes & is not a screening tool for osteoporosis. Gla protein is used as a marker for osteoclastic activity and is an indicator of bone turnover. This test is most useful to evaluate effects of tx, rather than to indicate severity
