Osteoporosis

What is the primary cause of loss of height in individuals with osteoporosis? A) Collapse of vertebral bodies B) Decrease in length of long bodies C) Flexion of the knees and hips D) Cervical lordosis

A) Collapse of vertebral bodies Rationale: The loss of height in individuals with osteoporosis occurs primarily as a result of vertebral body collapse. Osteoporosis also contributes to cervical lordosis, and the knees and hips flex to help maintain the center of gravity; however, these do not contribute to overall loss of height. Osteoporosis does not cause a decrease in the length of long bones.

The lack of weight bearing leads to what effects on the skeletal system? A) Demineralization, calcium loss B) Thickened bones C) Increased ROM D) Increased calcium deposition in the bones

A) Demineralization, calcium loss Rationale: Weight bearing helps to strengthen the bone. Lack of weight bearing means that the bone is losing minerals and calcium that strengthen it. Thickened bones will not occur with the lack of weight bearing. Range of motion may be decreased with a lack of weight bearing movements.

The nurse is planning a presentation on osteoporosis to clients in an assisted-living center. Which group would be appropriate for the nurse to exclude from the presentations being at risk of developing this disease process? A) Men with high testosterone levels B) Postmenopausal women C) Smokers D) Asian American women

A) Men with high testosterone levels Rationale: Men with high testosterone levels are not at risk of developing​ osteoporosis; therefore, this should not be included in the presentation.​ Women, especially those who are postmenopausal and of Asian​ descent, are much more likely to develop osteoporosis. Smoking increases the​ client's risk of osteoporosis.

The nurse is caring for a client with osteoporosis. Which medication taken by the client may have contributed to this diagnosis? A) Prednisone B) Acetaminophen C) Vitamin D supplements D) Calcium supplements

A) Prednisone Rationale: Glucocorticoids such as prednisone may have contributed to the development of osteoporosis. Calcium supplements and vitamin D supplements are both used to treat osteoporosis. Acetaminophen is a pain​ reliever; it is not associated with the development of osteoporosis.

*Possible Exam Question* The nurse is caring for an older adult client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this medication? SATA A) "The most common adverse effect is hypercalcemia caused by taking too much of the supplement." B) "Oral calcium supplements are best taken on an empty stomach." C) "Adults 50 years of age and over should obtain at least 500-750mg/day of elemental calcium." D) "If you have a condition called ventricular fibrillation, this medication might help." E) "Report symptoms of weakness, increased urination, and thirst."

A, E Rationale: Calcium gluconate and other calcium compounds are used to treat and prevent osteoporosis. Oral calcium supplements are best taken with meals or within 1 hour following meals. It is recommended that adults 50 years of age and over obtain at least 1000 to 1200 mg per day of elemental calcium. The most common adverse effect is hypercalcemia caused by taking too much of the supplement. Symptoms include lethargy, drowsiness, weakness, headache, anorexia, nausea and vomiting, increased urination, and thirst. Calcium supplementation is contraindicated in clients with ventricular fibrillation.

The nurse is assessing a postmenopausal client. Which question should the nurse ask to assess for signs of osteoporosis? A) "Have you experienced any palpitations?" B) "Are you having any low back pain?" C) "Are you having problems with swelling in your feet?" D) "Is constipation a problem for you?"

B) "Are you having any low back pain?" Rationale: A client with osteoporosis will often present with low back pain as well as a decrease in height. Palpitations, constipation, and swelling are not early signs of osteoporosis.

A client diagnosed with osteoporosis indicates reluctance to taking medication on a daily basis. Which class of medication should the nurse anticipate will be prescribed? A) Oral calcium supplement B) Bisphosphonate C) Tetracycline D) Calcium channel blocker

B) Bisphosphonate Rationale: Recent studies suggest that​ once-weekly dosing with bisphosphonates may give the same bone density benefits as daily dosing because of the extended duration of drug action. Tetracyclines and calcium channel blockers are not used to treat osteoporosis. Oral calcium supplements are typically taken on a daily basis.

An adult client who resides in a long-term care facility s diagnosed with osteoporosis. The client has a history of falls and dementia. Which nursing intervention will best aid in meeting an outcome goal of injury prevention for this client? A) Using furniture as obstacles to keep the client in bed B) Keeping the bed in the lowest position C) Keeping a nightlight on in the hallway D) The use of wrist restraints

B) Keeping the bed in the lowest position Rationale: Keeping the bed in the lowest position will reduce the incidence of injury should the client attempt to get up. The use of restraints could increase the incidence of injury. Using the furniture as an obstacle could cause injury if the client is able to get up. In a long-term care facility, a nightlight should be provided in the room so the client can see to use the restroom.

The nurse is caring for an older adult who is visually impaired and at risk for osteoporosis. Which activity is most appropriate to implement for the prevention of osteoporosis? A) Swimming B) Strength and balance training C) Aerobics D) Walking on a treadmill

B) Strength and balance training Rationale: Strength and balance training is the​ safest, most appropriate plan for exercise for the visually impaired client at risk for osteoporosis. Aerobics and walking on a treadmill are not the safest choices for a visually impaired client. The client may lose balance as well as not be able to adjust or stop a treadmill if needed. Swimming is not a​ weight-bearing exercise.​ Weight-bearing exercises influence the bone metabolism necessary to prevent osteoporosis.

The nurse is teaching a client with osteoporosis who has been prescribed calcium citrate supplements. Which information should the nurse include in the teaching? A) Take the calcium on an empty stomach B) Take the calcium with meals C) Take the calcium within 2 hours after meals D) Take the calcium in the morning

B) Take the calcium with meals Rationale: The client prescribed calcium citrate supplementation should be instructed to take the calcium with meals. It does not matter what time of day the client takes the calcium.

The nurse is reviewing the chart of an older adult client with a BMI of 19. Which implication does this clinical finding have on the risk for osteoporosis? A) The client's gender needs to be taken into consideration B) The client is at risk for osteoporosis C) The client is not at risk for osteoporosis D) The client's age in relation to the BMI should be factored in

B) The client is at risk for osteoporosis Rationale: Any individual with a BMI less than 20 ​kg/m2​, regardless of​ age, sex, or weight​ loss, is at a greater risk for both bone loss and subsequent risk for fracture.

The nurse is screening clients in the clinic for osteoporosis. Which client has the greatest risk factor osteoporosis? A) The client with a BMI greater than 25 B) The client taking SSRIs C) The client who walks at the park for 30 minutes each day D) The client who occasionally drinks a diet soda

B) The client taking SSRIs Rationale: Prolonged use of certain medications such as SSRIs increases the risk of developing osteoporosis. Underweight individuals have a​ two-fold increased risk for fracture when compared to people with a BMI greater than 25 ​kg/m2. A high intake of diet​ soda, not occasional​ consumption, can contribute to the development of osteoporosis. An individual who walks for 30 minutes in the park every day most likely gets sufficient vitamin​ D, which also helps prevent osteoporosis.

The nurse is caring for several clients on the unit. Which client is at the greatest risk for osteoporosis? A) The client treated for an eating disorder B) The client treated for withdrawal delirium tremens C) The client with early onset Alzheimer disease D) The client with impaired vision

B) The client treated for withdrawal delirium tremens Rationale: The client being treated for withdrawal delirium tremens is at the greatest risk for osteoporosis. Delirium tremens occurs as a result of alcohol withdrawal. The client who is an alcoholic is at risk for osteoporosis. Impaired vision does not place the client at risk for osteoporosis. The client with an eating disorder will require counseling and a nutritional consultation. The client with early onset Alzheimer disease is mobile and can walk.

A nurse is conducting a health history on an older adult client. Which assessment finding indicates the client is at risk for osteoporosis? A) Having a BMI that indicates obesity B) Using glucocorticoids for 10 years because of a chronic lung disorder C) Eating three to five servings of shrimp and liver per week D) Drinking three glasses of skim milk daily

B) Using glucocorticoids for 10 years b/c of a chronic lung disorder Rationale: Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis. Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis. A diet rich in shellfish and organ meats is high in purine, which may predispose the client to gout.

The nurse is providing teaching on the prevention of osteoporosis. Which modifiable risk factor can increase a client's risk of developing osteoporosis? SATA A) Consumption of milk products B) Sedentary lifestyle C) Excessive alcohol consumption D) Moderate exercise E) Smoking

B, C, E Rationale: Individuals who spend a lot of time sitting have a higher risk of osteoporosis than do their more active counterparts. Excessive alcohol consumption can interfere with the​ body's ability to absorb calcium. Tobacco use contributes to weak bones. The consumption of milk products and moderate exercise are both lifestyle choices that decrease the risk of​ osteoporosis, not contribute to the development of osteoporosis.

An older patient is talking with the nurse about hip fractures. The patient would like to know the best approach to strengthen the bones. What is the nurse's best response? A) "Walk at least 5 miles every day for exercise." B) "Wear proper-fitting shoes to prevent tripping." C) "Talk with your physician about a calcium supplement." D) "Stand up slowly so you don't feel faint."

C) "Talk with your physician about a calcium supplement." Rationale: Calcium strengthens the bones. A calcium supplement will help strengthen bones as they may be affected by aging, illness, or trauma. Walking several miles will help strengthen the bones, but the patient should consult with the healthcare provider before any exercise regimen is implemented for the older adult. Wearing proper shoes and standing slowly to prevent dizziness is important but they will not prevent fractures.

A postmenopausal adult client is concerned about the development of osteoporosis and wants to begin preventative activities. Which statement by the nurse is appropriate? A) "You should first determine if you are at risk for the development of osteoporosis." B) "After menopause, the decline is too rapid to begin preventative interventions." C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." D) "Hormone replacement therapy should be initiated as soon as possible."

C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." Rationale: Osteoporosis risk factors increase after menopause. Preventative activities include implementing weight-bearing exercise and beginning calcium supplements. It is not too late to begin prevention activities. Without additional information, it is not possible to determine if the client is a candidate for hormone replacement therapy. The client in the scenario has two risk factors presented. Although a full analysis would be beneficial, it does not answer the client's request for information.

The nurse is teaching a client about food in the diet that could minimize the risk of osteoporosis. The nurse should encourage the client to increase the intake of which food? A) Fish B) Turkey C) Cheese D) Sweet potatoes

C) Cheese Rationale: The major dietary source of calcium is from dairy foods, including milk yogurt, and a variety of cheeses. Calcium also may be added to certain products such as orange juice, which are then advertised as being "fortified" with calcium. Calcium supplements are available and recommended for those with typically low calcium intake.

The nurse is reviewing the chart of a pediatric client at risk for osteoporosis. Which factor in the client's history should the nurse identify as placing the client at risk for osteoporosis? A) Cystic fibrosis B) Congenital cardiac disease C) Diabetes D) Systemic lupus erythematosus

C) Diabetes Rationale: Diabetes is associated with a lower bone​ mass, placing the client at risk for osteoporosis. Cystic​ fibrosis, congenital cardiac​ disease, and systemic lupus erythematosus do not place the client at risk for osteoporosis. If the client has periods of​ immobility, the nurse can collaborate with physical therapy to provide the client with preventative exercises

A client who is at risk for developing osteoporosis asks what can be done to decrease the risk of actually developing the disease. Which intervention would be the most beneficial for this client? A) Decreasing the amount of calcium in the client's diet B) Providing the client with assisted ROM exercises twice daily C) Increasing regular weight-bearing activities D) Protecting the client's bones with strict bedrest

C) Increasing regular weight-bearing activities Rationale: A standard intervention for those attempting to prevent osteoporosis is beginning an exercise plan that includes weight-bearing activities. Strict bedrest, decreasing calcium intake, and assisted range of motion exercises may make the osteoporosis worse.

The nurse is caring for a client with osteoporosis with a primary focus on preventing injury at night. Which is the best nursing intervention for the nurse to implement to maintain the safety of the client A) Keeping he side rails up on the bed at all times B) Increasing the client's use of assistive devices C) Providing lighting in toilet facilities D) Restricting fluids at night to decrease nocturia

C) Providing lighting in toilet areas Rationale: The nursing intervention that will maintain the safety of the client with osteoporosis is to provide lighting in the toilet facilities. Increasing the use of assistive devices would be dependent on the​ client's overall health. The client should only use the assistive devices that are necessary on which she has been properly fitted and trained. Restricting fluids to decrease nocturia is inappropriate and places the client at risk for dehydration and hypovolemia. It is not necessary to keep the side rails up on the bed at all times. The side rails should be kept up if indicated to prevent the client from getting out of bed alone.

The nurse is caring for a client with advanced osteoporosis who implemented the use of a heating pad in the treatment of pain. Which action by the nurse demonstrates appropriate use of the heating pad? A) Encouraging the use of the heat before the client ambulates B) Utilizing the heat if the prescribed pain medication does not work C) Removing the heat every 20 to 30 minutes D) Alternating the heat with an ice pack every 30 minutes

C) Removing the heat every 20 to 30 minutes Rationale: The heat should be removed every 20 to 30 minutes to avoid a rebound effect from too much heat. Ice is not used in the treatment of pain for the client with osteoporosis. The heat should be utilized when the client experiences discomfort and can be used with or without the use of pain medication.

*Possible Exam Question* The nurse is reviewing the orders for a client with osteoporosis who has been prescribed a bisphosphonate. Which test should the nurse anticipate will be ordered while the client is on the medication? A) Ultrasound B) Dual-energy x-ray absorptiometry (DEXA) C) Serum bone Gla protein (osteocalcin) D) Alkaline phosphatase

C) Serum bone Gla protein (osteocalcin) Rationale: Serum bone Gla protein​ (osteocalcin) is most useful for evaluating the effects of treatment rather than to indicate the severity of the disease.​ Dual-energy x-ray absorptiometry​ (DEXA) and ultrasound both measure bone​ density, not efficacy of treatment. Alkaline phosphatase also does not indicate efficacy of treatment.

The nurse is reviewing the chart of a client with osteoporosis. Which physical assessment finding should the nurse anticipate? A) Generalized pain B) Unsteady gait C) Spinal curvature D) Poor posture

C) Spinal curvature Rationale: The assessment findings associated with osteoporosis include spinal curvature. An unsteady​ gait, poor​ posture, and generalized pain are not findings associated with the physical assessment findings of osteoporosis.

The nurse is providing teaching to a young adult who is at risk for early-onset osteoporosis. Which intervention should the nurse suggest? A) The client should stop all physical activity B) The client should reduce the intake of dairy in the diet C) The client should increase intake of calcium and vitamin D D) The client should start estrogen replacement therapy

C) The client should increase intake of calcium and vitamin D Rationale: An appropriate goal for this client is a diet rich in calcium and vitamin D. Walking and weight-bearing exercise help prevent osteoporosis, so the client should not stop all physical activity. Dairy is rich in calcium, so reducing intake of dairy is not recommended. Due to the client's age, it is not likely that the client needs estrogen replacement therapy at this time

The nurse is preparing medication teaching on a bisphosphonate for a client newly diagnosed with osteoporosis. The nurse should teach the client to monitor for which adverse effect? A) Anorexia B) Headaches C) Vomiting D) Tinnitus

C) Vomiting Rationale: Adverse effects that may occur in a client taking a bisphosphonate include gastrointestinal problems such as​ nausea, vomiting, abdominal​ pain, and esophageal irritation.​ Tinnitus, anorexia, and headaches are not adverse effects of taking bisphosphonates.

A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and cigarettes? SATA A) "Smoking decreases nerve supply to the bones." B) "Nicotine increases calcium absorption leading to decreased bone density." C) "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral content." D) "Alcohol has a direct toxic effect on osteoclast activity, suppressing bone formation." E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis."

C, E Rationale: Both cigarette smoking and excess alcohol intake are risk factors for osteoporosis. Smoking decreases the blood supply to bones, and nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density. Alcohol has a direct toxic effect on osteoblast activity, suppressing bone formation during periods of alcohol intoxication. In addition, heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis. Interestingly, moderate alcohol consumption in postmenopausal women actually may increase bone mineral content, possibly by increasing levels of estrogen and calcitonin.

The nurse is planning care for a female adult client who is high-risk for developing osteoporosis. Which interventions will decrease the client's risk of developing this health problem? SATA A) Increasing the intake of alcoholic beverages B) Isometric exercise for at least 30 minutes 3x/week C) Weight-bearing exercises such as walking D) Having a yearly DEXA test E) A diet with adequate amounts of calcium and vitamin D

C, E Rationale: Interventions that may decrease this client's risk of developing osteoporosis include regular weight-bearing exercise, such as walking, as this activity slows bone loss. Other intervention include encouraging clients to consume adequate amounts of calcium and vitamin D in their diets to prevent osteoporotic fracture. A DEXA test measures bone density, but it does not decrease the client's risk for developing osteoporosis. Measures to prevent or treat osteoporosis include limiting the intake of beverages containing alcohol, caffeine, and phosphorus. Isometric exercises are not effective against osteoporosis.

The nurse identifies the nursing diagnosis: Imbalanced Nutrition: less than body requirements as appropriate for a client with osteoporosis. Which client statement indicated to the nurse that this nursing diagnosis was appropriate? A) "I like to remove all the fat from the meat I eat." B) "I am trying to eat a low-carb diet." C) "I plan to start eating out less." D) "I am allergic to dairy products."

D) "I am allergic to dairy products." Rationale: The client who is allergic to dairy products may not take in much calcium, which increases the risk of osteoporosis, so focusing on diet would be a priority for this client. The statements about removing fat, eating a low-carb diet, and eating out less are healthy changes for many individuals that help reduce calorie intake, but they would not address one of the root causes of osteoporosis, deficient calcium intake.

The nurse is caring for a postmenopausal client prescribed estrogen therapy to reduce the risk of osteoporosis. Which client statement indicates the need for further teaching? A) "I have completed my smoking cessation program." B) "I understand that I may experience hot flashes." C) "I will be sure to maintain all follow-up appointments for evaluation." D) "I am glad I am not at risk for osteoporosis anymore."

D) "I am glad I am not at risk for osteoporosis anymore." Rationale: The client prescribed a selective estrogen receptor modulator to reduce the risk of osteoporosis should address other modifiable risk factors attributed to osteoporosis. Medication alone will not prevent osteoporosis. Hot flashes are a side effect of the medication. Smoking is a risk factor for osteoporosis. The client should maintain all​ follow-up appointments.

Which statement by the nurse indicates an understanding of the effects of Vitamin D and calcium on osteoporosis? A) "Acidosis causes calcium to be deposited into bone." B) "A high intake of high-phosphate foods can help increase serum calcium." C) "Vitamin D is needed for renal absorption of phosphorus and calcium." D) "Impaired vitamin D activation reduces the serum calcium level."

D) "Impaired vitamin D activation reduces the serum calcium level." Rationale: The statement made by the​ nurse, "Impaired vitamin D activation reduces the serum calcium​ level," demonstrates an understanding of the effects of vitamin D and calcium and their association with osteoporosis. Vitamin D is essential because it facilitates calcium absorption from the intestines into the blood. Acidosis does not cause calcium to be deposited in the bone. Vitamin D increases renal absorption of calcium in the distal​ tubule, but the phosphate level is not affected by vitamin D. Foods high in phosphate decrease serum calcium.

The nurse is caring for a client newly diagnosed with osteoporosis who states, "I know I need the extra calcium, but I don't eat any dairy products." Which statement by the nurse provides the client with information for obtaining additional dietary calcium? A) "Seafood is an excellent source of calcium." B) "Many types of pasta are an excellent source of calcium." C) "You can increase your consumption of meat." D) "Increase your consumption of vegetables."

D) "Increase your consumption of vegetables." Rationale: The​ statement, "Increase your consumption of​ vegetables," provides information on an excellent source of calcium.​ Seafood, meat, and pasta are not excellent sources of calcium. Seafood should be consumed cautiously during​ pregnancy, as it contains high levels of mercury.

The nurse is caring for an older adult with a history of fractures as a result of osteoporosis. The client currently has a right radial fracture. Which is the priority nursing diagnosis for the client? A) Pain, Chronic B) Nutrition, Imbalanced: Less than Body Requirements C) Mobility: Physical, Impaired D) Activity Intolerance

D) Activity Intolerance Rationale: The priority nursing diagnosis for the client with right radial fracture is Activity Intolerance. The pain the client will experience with a new fracture is acute. The​ client's mobility should not be impaired with a right radial fracture. The nutritional status of the client can be assessed after the activity intolerance is addressed.​ (NANDA-I ©​ 2014)

* Shit question alert* The nurse is teaching health promotion behaviors to a client diagnosed with osteoporosis. Which behavior should the nurse include? A) Avoiding foods high in purine B) Exercising four times a week C) Decreasing smoking D) Limiting alcohol intake

D) Limiting alcohol intake Rationale: The client should be instructed to limit alcohol intake. Alcohol has a direct toxic effect on osteoblast​ activity, suppressing bone formation during periods of alcohol intoxication. The client should be instructed to stop smoking​ altogether, not just decrease smoking. Smoking decreases the blood supply to​ bones, and nicotine slows the production of osteoblasts and impairs the absorption of​ calcium, contributing to decreased bone density. The instruction on exercising needs to be specified. Foods high in purine are associated with gout.​ Weight-bearing exercises are recommended for approximately 30 minutes four times a week.

*Possible Exam Question* Which change in bone structure contributes to osteoporosis? A) The diaphysis of the bone becomes longer B) Trabeculae are increased in cancellous bone C) The outer cortex of the bone becomes thicker D) The diameter of the bone increases

D) The diameter of the bone increases Rationale: In osteoporosis, the diameter of the bone increases, thinning the outer supporting cortex. Trabeculae are lost from cancellous bone. Osteoporosis does not affect the length of the bone.