EXAM 4: Musculoskeletal
What food can the nurse suggest to the client at risk for osteoporosis? Broccoli Chicken Bananas Carrots
Broccoli
The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? 1- Increase fiber in the diet 2- Walk or perform weight-bearing exercises outdoors 3- Reduce stress 4- Decrease the intake of vitamin A and D
2
Which is not a risk factor for osteoporosis? family history being male being postmenopausal small-framed, thin White or Asian women
Correct response: being male Explanation: Being male is not considered a risk factor. Some of the risk factors for osteoporosis are being a small-framed, thin White or Asian woman; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use.
A nurse provides nutritional health teaching to an adult client who had two fractures in 1 year. Besides recommending supplemental calcium, the nurse suggests a high-calcium diet. What would the nurse recommend that the client increase intake of? Canned mixed fruit. Salmon and sardines. Yogurt and cheese. Almonds and peanuts.
Yogurt and cheese. Explanation: Yogurt and cheese are excellent sources of calcium. The other choices are low-calcium foods.
A provider prescribes a subcutaneous anabolic agent for an older adult client to prevent fractures associated with osteoporosis. What is the most likely prescribed drug? Teriparatide Alendronic acid Calcitonin Raloxifene
Correct response: Teriparatide Explanation: Teriparatide (Forteo) is a subcutaneously administered anabolic agent that is taken once daily. The other drug choices are oral preparations.
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? 1- Deficient knowledge about osteoporosis and the treatment regimen 2- Acute pain related to fracture and muscle spasm 3- Risk for constipation related to immobility 4- Risk for injury related to fractures due to osteoporosis
4
A nurse is caring for an older woman with a hip fracture. What are appropriate risk factors for the nurse to consider related to the client's hip fracture? Select all that apply. Presence of anemia Muscular agility Female gender Osteoporosis History of diverticulitis
Anemia, female gender, and osteoporosis are risk factors for hip fractures. Muscular agility decreases the risk for hip fracture. A history of diverticulitis is not related to hip fractures.
The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement? A) "We need to increase aerobic exercise." B) "We need to consume a low-calcium, high-phosphorus diet." C) "Estrogen deficiency increases bone density." D) "We need an adequate amount of exposure to sunshine."
D) We need an adequate amount of exposure to sunshine. The only accurate statement is related to getting an adequate amount of exposure to sunshine. Aerobic exercise, such as swimming, does not prevent osteoporosis. The exercise needs to be weight bearing. A diet low in calcium and high in phosphorus will increase the risk forosteoporosis. Estrogen deficiency is linked to decreased bone mass.
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Dowager's hump Negative calcium balance Bone fracture Loss of estrogen
Correct response: Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.
A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication? Ensure adequate intake of vitamin D in the diet Assess for the use of corticosteroids Encourage the client to get yearly dental exams Have the client sit upright for at least 30 minutes following administration
Have the client sit upright for at least 30 minutes following administration Explanation: While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis.
the pregnant client who is prescribes supplemental vitamin d during pregnancy asks the nurse why vitamin d is so important.. which responses by the nurse are correct? select all a. almost 50% of pregnant women lack sufficient vitamin d levels during late pregnancy b. a low level of vitamin d is associated with reduced bone mineral accumulation during your child's growing years c. a low level of vitamin d may predispose you to premature rupture of your membranes d. a low level of vitamin d causes a breakdown of cervical collagen prompting early cervical dilation e. vitamin d supplements taken during pregnancy may reduce the risk for osteoporosis related fractures in your child
a, b, e vitamin d is essential for the absorption of calcium; all 3 options relate to bone growth
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?1- Calcitonin (Miacalcin) 2- Raloxifene (Evista) 3- Teriparatide (Forteo) 4- Vitamin D
1
Which client would the nurse identify as having the greatest risk for osteoporosis? 1- A 40-year-old overweight African American woman 2- A 16-year-old male with a history of asthma 3- A small-framed, thin 45-year-old white woman 4- A 20-year-old male athlete with repeated injuries
3
The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis?1- penicillamine (Cuprimine) 2- methotrexate (Rheumatrex) 3- plicamycin (Mithracin) 4- raloxifene (Evista)
4
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Magnesium level Potassium level Alkaline phosphatase Troponin levels
Alkaline phosphatase Explanation: Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.
A nurse practitioner who works with many older adult patients integrates screening for osteoporosis into health promotion activities. What screening tool is most clinically useful when screening for osteoporosis? 1- Hip bone mineral density (BMD) testing 2- Assessment of serum calcium levels 3- Bone biopsy 4- Assessment of 25-hydroxy-vitamin D levels
1
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? 1- "After age 40, height may show a gradual decrease as a result of spinal compression" 2- "After menopause, the body's bone density declines, resulting in a gradual loss of height." 3- "There may be some slight discrepancy between the measuring tools used." 4- "The posture begins to stoop after middle age."
2
Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? Growth hormone Vitamin D Sex hormones Calcitonin
Calcitonin Explanation: Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.
Which nursing instruction is most important to stress when teaching on calcium intake? Eat green, leafy vegetables. Drink calcium- and vitamin D-fortified orange juice. Provide age-related calcium intake recommendations. Maintain diary sources of calcium intake.
Provide age-related calcium intake recommendations. Explanation: Providing accurate and specific age-related daily calcium intake guidelines empowers clients to meet those recommendations in a manner that fits their lifestyle. It is also important to realize that calcium intake guidelines increase to 1200 mg/day for those older than age 50 years. Eating green, leafy vegetables is an important source of calcium as well as drinking fortified orange juice. Dairy sources also provide calcium intake in varying degrees.
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? 1- Alendronate (Fosamax) 2- Calcium gluconate 3- Tamoxifen (Nolvadex) 4- Raloxifene (Evista)
Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen
Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. 1,800 mg; 1,600 IU 1,600 mg; 1,400 IU 1,400 mg; 1,200 IU 1,200 mg; 1,000 IU
The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.
while attending a health fair, the 62 yo female is found to have many risk factors for osteoporosis. the nurse at the booth recommends that she contact her HCP about scheduling a DEXA scan. which risk factors influenced the nurse's recommendation? a. hyperthyroidism b. postmenopausal c. overweight d. african american e. 62 year old female
a, b, e too much thyroid hormone can cause bone loss, estrogen levels decrease at menopause and this decrease is one of the strongest risk factors for osteoporosis, advancing age and being female are both risk factors for osteoporosis a thin body structure rather than being overweight is a risk factor for osteoporosis; being overweight can contribute to the development of OA
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? aspirin furosemide digoxin NPH insulin
aspirin Explanation: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.
the nurse is assessing the 84 year old client during a routine health examination. which finding should the nurse investigate first? a. decreased force of cough b. impaired swallowing c. urine light yellow in color d. height decreased by 1/2 inch
b this increases the client's' risk for aspiration and should be investigated first; although a decrease in height is important to investigate, this is not a priority
the 62 year old client is diagnosed with osteoporosis. which medication if taken by the client should the nurses identify as posing a secondary risk factor for the client's osteoporosis? a. baby aspirin daily for past 4 years b. escitalopram 5mg daily for past 7 months c. multivitamin for many years d. 10 year use of budesonide nostril spray BID
d long term use of corticosteroids such as budesonide (pulmicort) should be identified as a risk factor for osteoporosis
A nurse who oversees care in a long-term care facility is aware that a high percentage of residents have osteoporosis, and that residents who do not have the disease must be assessed and monitored closely for this health problem. Which of the following older adults most clearly exemplifies the risk factors for osteoporosis? 1- A Caucasian woman who has low body mass index 2- An African American woman who is slightly obese 3- An Asian man whose mobility is limited to a wheelchair 4- A Caucasian man who has led a sedentary lifestyle
1
An 80-year-old female patient has been admitted to the hospital and lives with numerous health problems, which include osteoporosis. The patient's medication regimen includes calcitonin nasal spray, vitamin D and calcium supplements, and a bisphosphonate that is administered weekly. When administering the patient's bisphosphonate, the nurse should: A) Administer the drug with food and encourage fluid intake. B) Position the patient in high Fowler's after giving the drug. C) Administer the drug at bedtime with a snack. D) Combine the drug with a dose of calcium and vitamin D.
B) Position the patient in high Fowler's after giving the drug Side effects of bisphosphonates include gastrointestinal symptoms (eg, dyspepsia, nausea, flatulence, diarrhea, constipation), and some patients may develop esophageal ulcers, gastric ulcers, or osteonecrosis of the jaw related to bisphosphonate use. Patients must take these medications on an empty stomach on arising in the morning, with a full glass of water, and must sit upright for 30 to 60 minutes after their administration. They do not need to be given simultaneously with calcium and vitamin D.
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? To prevent fractures, the client should avoid strenuous exercise. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. The recommended daily allowance of calcium may be found in a wide variety of foods.
Correct response: The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.
Which of the following inhibits bone resorption and promotes bone formation? 1- Calcitonin 2- Estrogen 3- Parathyroid hormone 4- Corticosteroids
1
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? Inadequate nutrition Impaired physical mobility Risk for infection Disturbed body image
Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image.
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Stopping estrogen therapy Initiating weight-bearing exercise routines Living a sedentary lifestyle to reduce the incidence of injury Taking a 300-mg calcium supplement to meet dietary guidelines
Correct response: Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.
The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? Increase in calcitonin Decrease in parathyroid hormone Increase of vitamin D Decrease in estrogen
Decrease in estrogen Explanation: Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? 1- Take weekly on the same day and at the same time. 2- Remain in an upright position 30 minutes after taking the supplement. 3- Take the supplement on an empty stomach with a full glass of water. 4- Take the supplement with meals or with orange juice.
Take the supplement with meals or with orange juice. Explanation: Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.
A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored? The plate will be removed to determine if the bone is growing back. Serial x-rays will be taken. An arthroscopy will be performed. The bone will heal on its own without intervention.
serial x-rays will be taken. Explanation: Serial x-rays are used to monitor the progress of bone healing. The plate need not be disturbed. An arthroscopy is used to visualize joints. While the bone will heal without interference, monitoring of bone healing is needed to ensure further adjustments are not necessary.
A client with a musculoskeletal injury is instructed to increase dietary calcium. Which statement by the nurse is appropriate? "You need to increase the amount of red meat in your diet." "You need to increase the amount of non-citrus fruits in your diet." "You need to increase the amount of vitamin D in your diet." "You need to increase the amount of phosphorus in your diet."
"You need to increase the amount of vitamin D in your diet." Explanation: Vitamin D is needed for the absorption of calcium. Although fruits containing vitamin C assist in the absorption of calcium, non-citrus fruits are of little benefit for calcium absorption. Increasing phosphorus in the diet can cause calcium to be lost from the bone, decreasing bone density. Red meat does not facilitate calcium absorption.
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? 1- Yoga 2- Walking 3- Bicycling 4- Swimming
2
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? 1- Bone spurs 2- Diarrhea 3- Increased heel pain 4- Decreased height
4
A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor? A) Excess caffeine intake B) Prolonged corticosteroid use C) Hypothyroidism D) Prolonged immobility
C) Hypothyroidism Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.
A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? Potassium level of 6.3 mEq/L Calcium level of 11.6 mg/dl Sodium level of 110 mEq/L Magnesium level of 0.9 mg/dl
Calcium level of 11.6 mg/dl Explanation: In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
An older adult client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? Maintaining protein levels Maintaining vitamin levels Promoting weight-bearing exercises Promoting range-of-motion (ROM) exercises
Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Supine, with the bed flat and a firm mattress in place Prone, with a pillow under the shoulders High-Fowler's to allow for maximum hip flexion
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? Yoga Walking Bicycling Swimming
Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.
A nurse is caring for a patient who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. the nurse should address the nursing diagnosis of acute pain related to fracture by implementing what intervention? a. maintenance of high fowlers positioning whenever possible b. intermittent application of heat to the patients back c. use of a pressure reducing mattress d. passive range of motion exercises
b intermitted local heat and back rubs promote muscle relaxation following osteoporotic vertebral fractures. high fowlers positioning is likely to exacerbate pain. mattress must be adequately supportive but pressure reduction is not necessarily required. passive rom to the back would cause pain and impair healing
a patient has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis; which of the following nursing diagnoses must be addressed in the plan of care? a. risk for aspiration related to vertebral fracture b. constipated related to vertebral fracture c. impaired swallowing related to vertebral fracture d. decrease CO related to vertebral fracture
b. constipation is a problem related to immobility and medications used to treat fractures; the patient's risk for aspiration, dysphagia and decreased CO are not necessarily heightened
