Lewis 63 Metabolic Bone Disease
A patient has been taking bisphosphonates for the treatment of osteoporosis and has demonstrated a low tolerance to the drug. What alternative medication does the nurse anticipate will be prescribe? A. Calcitonin B. Corticosteroids C. Cholestyramine D. Divalproex sodium
A. Calcitonin is recommended for patients who are unable to tolerate bisphosphonates. Patients on corticosteroids are put on bisphosphonates because long-term corticosteroid use to osteoporosis and hence it cannot be alternative. Cholestyramine is known for the risks associated with osteomalacia. Divalproex sodium does not contain a bisphosphonate compound.
What is the correlation of bone resorption to bone deposition in osteoporosis? A. Bone resorption exceeds bone deposition. B. Bone deposition exceeds bone resorption. C. Bone deposition is equal to bone deposition. D. Bone resorption is followed by bone replacement.
A. In osteoporosis, bone resorption exceeds bone deposition. Osteomalacia is weakening of the bones due to bone deposition exceeding bone resorption. Normally, there is an equal rate of bone deposition to absorption. Paget's disease is a bone disorder in which excessive bone resorption is followed by the replacement of existing bone with larger, disorganized, and weaker new bone.
The nurse is educating a patient that is prescribed calcitonin. What dietary supplement should the nurse encourage the patient to take while on this medication? A. Protein B. Calcium C. Vitamins D. Amino acids
B. An adequate intake of calcium is necessary for a patient on calcitonin to prevent secondary hyperparathyroidism. Protein drinks, vitamins tablets, and amino acid supplements given to add additional nutritional value to the diet.
Bone remodeling is consistent in reducing fractures unless the patient has which condition? A. Cancer B. Osteoporosis C. Osteomyelitis
B. Bone remodeling is not consistent in patients with osteoporosis, since bone loss exceeds building of bone with osteoclasts. Cancer does not cause bone remodeling to occur, but cancer treatment may alter the rate of osteoclasts. Osteomyelitis is an infection of the bone and does not affect remodeling. Osteochondroma is a common benign bone tumor, an overgrowth of cartilage and bone near the end of the growth plate, and does not affect remodeling.
A patient is being evaluated for the treatment of osteoporotic vertebral fractures. Which invasive procedure does the nurse prepare the patient for? A. Diskectomy B. Kyphoplasty C. Spinal fusion D. Laminectomy
B. Invasive procedures in the treatment of osteoporotic vertebral fractures include kyphoplasty and vertebroplasty. Diskectomy, spinal fusion, and laminectomy focus on the correction of intervertebral disc disease.
Peak bone mass occurs before which age? A. 10 B.20 C.30 D. 40
B. Peak bone mass occurs before age 20. The age of 10 years is too early for peak bone mass, and the ages of 30 and 40 years are past the development of peak bone mass.
A patient is prescribed bisphosphonates for the treatment of Paget's disease. What outcome does the nurse expect from the administration of this medication? A. Reduction in bone resorption B. Relief from pain and discomfort C. Decrease in the risk of breast cancer D. Increase in serum alkaline phosphatase levels
A. The primary goal of bisphosphonates is to reduce bone resorption by inhibiting osteoclast activity in order to increase total bone mass and bone density. Nonsteroidal antiinflammatory drugs (NSAIDs) are used to manage pain and discomfort. Medications that can mimic the positive effects of estrogen are effective in decreasing the risk of breast cancer. Bisphosphonate is an osteoclast inhibitor and decreases the already elevated serum alkaline phosphate levels.
A patient is diagnosed with osteomalacia. Which clinical manifestation does the nurse determine correlates with this diagnosis? A. Dementia B Headaches C. Loss of hearing D. Weakness in the pelvic girdle
D. Muscular weakness in the pelvic girdle is a clinical manifestation of osteomalacia. This makes simple tasks such as getting up from a chair difficult. Patients with Paget's disease report dementia, headaches, and loss of hearing.
An older adult patient is admitted with a vertebral compression fracture. For which procedure does the nurse anticipate preparing the patient? A. Kyphoplasty B. Spinal fusion C. Vertebroplasty D. Bone mineral density (BMD)
A. Kyphoplasty is the preferred treatment for vertebral compression fractures and uses a balloon inflation to insert bone cement. Vertebroplasty provides bone cement to stabilize the area and reduce pain. BMD is a test to determine peak bone mass. Spinal fusion uses bone to make a bridge between vertebrae next to one another.
A patient is demonstrating signs of Paget's disease. When obtaining a health history from the patient, which initial manifestation reported does the nurse recognize correlates with this diagnosis? A. Bone pain B. Weight loss C. Thinning of the skull
A. Most people who have Paget's disease do not experience any symptoms. However, when symptoms do occur, the most common symptom is bone pain, which later progresses into severe, intractable plain. Patients with osteomalacia report weight loss. Paget's disease results in the enlargement and thickening of the skull. Spontaneous fractures are associated with osteoporosis.
A patient is diagnosed with Paget's disease and asks the nurse to explain what the disease does to the bones. What is the best response by the nurse to describe the disease? A. Excessive bone resorption followed by bone regeneration B. Benign tumor, which is an overgrowth of cartilage and bone C. Structural deterioration of bone tissue leading to bone fragility D. Decalcification and softening of bones due to vitamin D deficiency
A. Paget's disease is a skeletal bone disorder in which an existing broken bone is replaced quickly with a new bone. The new bone that is formed is bigger but disorganized, as well as weaker than the normal bone. Osteochondroma is a benign bone tumor that is characterized by an overgrowth of cartilage and bone near the end of the bone at the growth plate. Osteoporosis is characterized by low bone mass and structural deterioration of bone tissue leading to bone fragility. Osteomalacia is caused by a vitamin D deficiency, resulting in decalcification and softening of bones.
A patient is determined to have a vitamin D deficiency when the laboratory work is reviewed and supplementation is discussed. What should the nurse inform the patient might occur if the deficiency is uncorrected? A. Bone softening B. Low bone mass C. Bone replacement D. Infection of the bone
A. Vitamin D deficiency intervenes with normal mineralization, leading to loss of calcium from the bones and softening of the bones. Low bone mass is a result of bone deterioration caused by low calcium intake and estrogen deficiency, especially in women. Bone replacement is a characteristic of Paget's disease, in which the bone cells regenerate and old bone is replaced by new bone. Microorganisms cause infection of the bone, bone marrow, and the soft tissues surrounding it.
A patient is suspected of having Paget's disease. What diagnostic test will the nurse prepare the patient for that will confirm the diagnosis? <p>A patient is suspected of having Paget’s disease. What diagnostic test will the nurse prepare the patient for that will confirm the diagnosis?</p> A. X-rays B. Bone scan C. Blood serum tests D. Dual-energy x-ray absorptiometry (DXA)
B. Bone scans are the most preferred test to confirm Paget's disease. Bone scans using radiolabeled bisphosphonate demonstrate increased uptake in the affected skeletal areas. X-rays may demonstrate that the normal contour of the affected bone is curved and the bone cortex is thickened and irregular. A serum alkaline phosphatase test is effective during advanced stages of the disease. DXA is used as an alternative to x-rays. It reveals the bone mineral density in patients with bone disorder
When discussing the prevention of osteomalacia with an older adult patient, what should the nurse be sure to include? A. Preventing bone fragility B. Control of weight to prevent obesity C. Controlling the symptoms of bowel disease D. Taking estrogen supplements to prevent low estrogen levels
B. People with morbid growth of body fat are at an increased risk of osteomalacia. Spending most time indoors reduces the exposure to ultraviolet rays from sunlight needed for vitamin D synthesis, which leads to bone fragility. Low levels of estrogen in postmenopausal women increase the risk for osteoporosis. Inflammatory bowel disease is a disease associated with osteoporosis, not osteomalacia.
Which factor makes women more prone to osteoporosis compared to men? A. Large-boned frame B. Estrogen deficiency C. High-impact aerobics D. Bisphosphonates intake
B. Postmenopausal women are at a greater risk for osteoporosis due to decreased estrogen. Women with larger boned frames with more bone mass are less prone to osteoporosis. High-impact aerobics can result in stress fractures due to extra pressure on the bones. Postmenopausal women are prescribed bisphosphonates to treat estrogen deficiency.
A woman is considering estrogen therapy. About which priority risk factor does the nurse teach her? A. Estrogen causes loss of bone. B. Estrogen can cause a heart attack. C. Estrogen raises the risk of breast cancer. D. Estrogen increases menopausal symptoms.
B. The greatest risk of taking estrogen therapy is the risk of heart attacks. Estrogen prevents loss of bone, reduces menopausal symptoms, and reduces the risk of breast cancer. However, these benefits are secondary to the risk of heart disease, and estrogen is no longer routinely prescribed.
A patient with morbid obesity is scheduled for bariatric surgery. Which condition needs to be assessed by the nurse who is providing preoperative care to the patient? A. Osteopenia B. Osteoporosis C. Osteomalacia D. Osteoarthritis
C. Morbidly obese people who choose bariatric surgery to treat obesity should be assessed for osteomalacia due to the risk of metabolic bone diseases caused by vitamin deficiency, low bone-calcium, and sedentary lifestyle. Osteopenia and osteoporosis are characterized by low bone mass and cannot be detected with diagnostic tests; therefore they cannot be assessed during preoperative evaluation. Osteoarthritis is a joint disease of unknown origin and is difficult to assess.
The nurse is educating an older adult patient with osteoporosis that has a sedentary lifestyle. What should the nurse include when discussing this with the patient? "A.Avoid exposure to sunlight." "B. Reduce intake of meat and fish." "C. Quit smoking and reduce alcohol intake." "D. Refrain from any weight-bearing exercise."
C. The nurse should instruct the patient to quit smoking and reduce intake of alcohol, because both can increase the risk of bone loss. The patient should be advised to be more active and spend at least 20 minutes a day in the sun. A daily intake of food should include eggs, meat, fish, and cereals fortified with calcium and vitamin D. The patient should gradually begin weight-bearing exercises to promote bone growth.
The patient is prescribed calcium supplements. What does the nurse recommend to help increase calcium absorption into the bone? A. Aspirin B. Steroids C. Vitamin D D. Calcium citrate
C. Vitamin D increases calcium absorption into the bone. Calcium citrate is poorly absorbed. Steroids reduce bone metabolism. Aspirin does not have an effect on calcium.
A patient is at risk for bone fracture related to osteoporosis. Which weight-bearing activity does the nurse instruct the patient to use to reduce risk of bone fracture? A. Do chair aerobics. B. Swim laps in the pool. C. Walk 30 minutes daily. D. Do isometric excersices
C. Weight-bearing exercises involve activities while standing or moving on the feet. Walking is a weight-bearing activity using the weight of the body. Swimming, isometric exercise, and chair aerobics do not use the weight of the body, making them less effective in preventing bone fractures.
The nurse is reviewing the diagnostic test results for a patient with Paget's disease. What findings on the x-ray report does the nurse anticipate reviewing? A. Ribbons of decalcification B. Overgrowth of cartilage and bone C. Curved shape of the affected bone D. More than 25 percent to 40 percent of bone loss
C. X-ray reports for a patient with Paget's disease reveal a curved shape of the structurally weak bone. X-rays of patients with osteomalacia are characterized by ribbons of decalcification. X-ray reports that reveal overgrowth of cartilage and bone confirm osteochondroma in the patient. X-rays detect osteoporosis only after more than 25 percent to 40 percent of bone is lost.
The health care provider determines that a patient with Paget's disease needs help slowing down bone reabsorption. What medication does the nurse anticipate educating the patient regarding? A. Calcium B. Vitamin D C. Denosumab D. Alendronate
D. Alendronate is a bisphosphonate drug that inhibits bone reabsorption and increases total bone mass. Both calcium and vitamin D are supplements that usually are given to decrease hypocalcemia as a result of the patient taking a bisphosphonate drug. Denosumab is given to postmenopausal females experiencing osteoporosis.
The nurse knows the risk of bone fractures increases for women as they age. Bone density tests are recommended for all women over which age? A. 45 B. 50 C. 55 D. 65
D. Bone density tests are recommended for all women over age 65. Women under 65 are recommended to have bone density tests only if they have risk factors like low body weight, smoking, and a history of fracture.
A patient that is postmenopausal asks the nurse why she would not be taking estrogen therapy for the primary treatment to prevent osteoporosis. What is the best response by the nurse? "A. Estrogen therapy can cause weight loss and gastritis." "B. Estrogen therapy causes leg cramps and hot flushes." "C. Estrogen therapy will cause nasal dryness and irritation." "D. Estrogen therapy places women at risk for breast and uterine cancer."
D. Estrogen therapy for women after menopause is not considered a primary treatment to prevent osteoporosis due to the increased risk of breast and uterine cancer. Common side effects of bisphosphonates include weight loss and gastritis, especially if not administered properly. Raloxifene mimics the effects of estrogen in a positive way, but adverse effects include leg cramps and hot flushes. Calcitonin, if administered as a nasal spray, can cause nasal dryness and irritation.
A patient is being treated for a spinal vertebral fracture due to osteoporosis. Which condition poses a risk to the patient? A. Loss of hearing B. Enlarged and thickened skull C. Second vertebral fracture within 18 months D. Wedging and fractures of the vertebrae over time
D. Wedging and fractures gradually reduce the height of patients with osteoporosis, resulting in a hunched-back look. Patients with Paget's disease have a risk of loss of hearing due to an enlarged and thickened skull. A patient with osteoporosis who has a spinal vertebral fracture is at a risk of another fracture in a year's time.
