Use Davis Advantage / Edge - Osteoporosis

Loss of height Previous fractures History of falls

The nurse is assessing a client with a diagnosis of osteoporosis. What clinical manifestations would the nurse expect to observe? Select all that apply. Loss of height Pain relieved with activity and increased with rest Lordosis of the dorsal spine Previous fractures History of falls

A decrease in calcitonin levels An increase in the parathyroid hormone levels

The nurse is aware that a client's bone mineral density can be impacted by which factors related to aging? Select all that apply. An increase in progesterone levels A decrease in calcitonin levels An increase in estrogen levels An increase in the parathyroid hormone levels A decrease in prolactin levels

"Its replacement life span is 5 to 6 years." Rationale: The replacement life span of TJR is 10 to 15 years. Test Taking Tips: Find the incorrect response.

A nurse is teaching a about total joint replacement (TJR). Which statement indicates a need for further teaching? "It is also referred to as arthroplasty." "Its replacement life span is 5 to 6 years." "It is most commonly associated with the joints of the hip and the knee." "It is the surgical procedure designed to repair an articulating surface with a synovial joint."

Plantar Fascitis Rationale: The symptoms of plantar fasciitis include stabbing heel pain that is typically worsened with the first steps in the morning. Test Taking Tips: Inflammation causes pain.

A patient reports a stabbing heel pain that worsens when walking in the morning. What condition should the nurse consider? Bunion Pes planus Plantar fasciitis Morton's neuroma

"Your pain may increase, but you should strive for an active lifestyle." CORRECT. The client may find that when she increases her activity, her pain level increases. Exercises should include abdominal and back muscle strengthening and low-intensity, weight-bearing exercise such as walking. Regular exercise will improve posture and balance and strengthen muscle tone.

Min is concerned that her pain level will worsen as she becomes more active. What would be an appropriate nurse response? "Your pain may increase, but you should strive for an active lifestyle." "Your pain should not increase when you add more activity in your life." "You cannot add pain medication to the medications that you take for osteoporosis." "You will find that your pain will decrease when you become more active."

"Preventive lifestyle and medications can slow the progression of the disease." CORRECT. Prevention is the key modifying factor to incorporate into medical care for those at risk for osteoporosis. Weight loss and muscle-strengthening exercises to reduce the incidence of falls and fractures are highly recommended. A healthy lifestyle and avoidance of smoking and excessive alcohol intake are endorsed by the surgeon general for prevention of osteoporosis.

Min is upset by the new diagnosis and fearful of complications. What can the nurse tell her to provide some comfort? "Osteoporosis is genetic and you had no control over getting the disease." "Osteoporosis is curable and with proper treatment, you won't have residual effects." "Preventive lifestyle and medications can slow the progression of the disease." "Surgery is often a great alternative to living with the debilitating disease."

"My diet should focus on carbohydrates and fat with little protein." CORRECT. A balanced diet with adequate protein is important for bone formation. Proper calcium and vitamin D intake are important when managing osteoporosis, as is a healthy activity level.

Min states she wants to lose weight and lead a healthier lifestyle. Which statement by the client requires additional teaching? "I can drink orange juice with Vitamin D added to help my body with the absorption of calcium." "My diet should focus on carbohydrates and fat with little protein." "I need to find an exercise activity to add to my life, along with a healthy diet to help manage my osteoporosis." "Along with a healthy diet, I should plan to take a multivitamin daily."

The DEXA scan is noninvasive and requires no preparation.

The nurse is providing client teaching to a client suspected to have osteoporosis who is scheduled for a dual-energy x-ray absorptiometry (DEXA) scan. What would be included in the nurse's client teaching? The DEXA scan requires a barium swallow. The client should have a family member or friend present to drive the client home at the end of the scan. The DEXA scan will require an overnight hospital stay the night before the procedure. The DEXA scan is noninvasive and requires no preparation.

Constipation Respiratory depression Drowsiness

The nurse is reviewing the risks and benefits of opioid analgesic medication with the client with osteoporosis. Which of the following would the nurse include as side effects of opioids? Select all that apply. Constipation Respiratory depression Decreased uptake of calcium and vitamin D Drowsiness Esophagitis

Diet Weight Lifestyle

The nurse is talking with a client who is confused about modifiable and non-modifiable risk factors for osteoporosis. Which of these are examples of modifiable risk factors? Select all that apply. Diet Weight Gender Lifestyle Ethnicity

Sitting in the sun 15 minutes each day. CORRECT. Sunlight for 15 minutes per day also helps with vitamin D and calcium absorption.

Min tells the nurse she doesn't like any of the food and asks if there is another way to get vitamin D. What should the nurse suggest? Taking a multivitamin with vitamin D Sitting in the sun 15 minutes each day. Increasing the amount of table salt in her diet. Increasing weight-bearing exercises.

Fish Milk Cereals Liver CORRECT. The recommended intake for vitamin D is 800 to 1,000 international units (IU), which can be ingested from dietary sources such as vitamin D-fortified milk, cereals, egg yolks, saltwater fish, and liver.

The nurse also suggests that Min increase the amount of vitamin D that she consumes to improve absorption. What foods should the nurse suggest? Select all that apply. Fish Milk Cereals Liver Egg whites

Hypotension Rationale: Hypotension is one of the complications of postoperative complications in total joint replacement. Hypovolemic shock Rationale: Hypovolemic shock is one of the complications of postoperative complications in total joint replacement. Deep vein thrombosis Rationale: Deep vein thrombosis is one of the complications of postoperative complications in total joint replacement. Test Taking Tips: Understand complications that can arise.

A patient has undergone joint replacement. Which complications should the nurse monitor for? Select all that apply. Myeloma Hypotension Spinal deformity Hypovolemic shock Deep vein thrombosis

Osteomyelitis Rationale: The clinical manifestations of osteomyelitis are fever, swelling of the bone, and warmth at the site of swelling. Test Taking Tips: Recognize signs of inflammation.

A patient reports fever, swelling, and warmth at the site of swelling. Which musculoskeletal disorder should the nurse be concerned about? Osteoporosis Osteomyelitis Paget's disease Muscular dystrophy

Dual-energy x-ray absorptiometry (DEXA) CORRECT. The client would be scheduled for a dual-energy x-ray absorptiometry (DEXA) scan, the established standard diagnostic exam used to diagnose osteoporosis and provide follow-up about the effectiveness of a prescribed treatment plan. The DEXA scan is noninvasive with no prep required prior to the test. The other diagnostic tests would not be used for assessment of osteoporosis; instead, they would be used for diagnostic management of the disease process.

After the healthcare provider completes a fracture risk assessment screening, Min is scheduled for outpatient diagnostic testing to further evaluate her risk for osteoporosis. Which diagnostic test will be used to evaluate her bone density? Dual-energy x-ray absorptiometry (DEXA) Quantitative computerized tomography (qCT) Serum biochemical markers X-ray of the pelvis

-The medication should be taken on an empty stomach first thing in the morning. CORRECT. Most bisphosphonates should be taken first thing in the morning on an empty stomach since laying down can increase the esophagitis and GI upset.

After the results of the DEXA scan, Min is started on a daily bisphosphonate. She states that she takes her daily medications at bedtime but has developed indigestion. What information should the nurse share with the client regarding this class of drug? -Bedtime is an acceptable time to take the medication with a glass of milk. -The medication should be taken at lunch with a large meal. -The medication should be taken on an empty stomach first thing in the morning. -The medication should be taken on an empty stomach 1 hour after a meal.

That dose is appropriate and should be continued. CORRECT. The recommended dose of calcium either via dietary consumption or via supplements varies by age; however, 1,200 mg/day is the recommended daily intake for adults 51 years of age or older.

Min is started on calcium but feels like the dose is too high. The nurse learns she is taking 1,200 mg each day in divided doses. What should the nurse suggest to Min? That dose is appropriate and should be continued. Decrease the dose by half. Clarify the dose with your provider. Increase the dose to 1,500 mg/day.

Gender Postmenopausal age Smoker Overweight CORRECT. Female gender, age older than 50 years, being a smoker, and being overweight are all risk factors for developing osteoporosis. Daily use of a multivitamin that includes both calcium and vitamin D is important in preventing osteoporosis.

Min, a 55-year old postmenopausal Asian female, is visiting her healthcare provider for an annual physical. She is approximately 50 pounds overweight. Min states that she is a pack-a-day smoker and takes a daily multivitamin designed for women older than 50. When questioned by the healthcare provider, the client says she has never had bone mineral density testing.The nurse recognizes that that Min is at risk for osteoporosis because of which identified factors? Select all that apply. Gender Postmenopausal age Smoker Overweight Multivitamin use

None; correct positioning is occurring. Rationale: The nurse needs to reinforce teaching for hip flexion less than 90 degrees for approximately 2 to 3 months. This positioning is correct. Test Taking Tips: Consider safety teaching postoperatively.

The nurse is caring for a patient after a total hip replacement. The nurse observes the patient in this position. What action should the nurse take? None; correct positioning is occurring. Encourage the patient to lean forward when sitting. Stop the patient from sitting and have them lay down. Have the patient stand rather than sit.

"When have you been taking the medication? The best time to take this medication is first thing in the morning, on an empty stomach."

The nurse is seeing a client with osteoporosis who started on a bisphosphonate last month to treat osteoporosis. The client states "Ever since I started taking that medicine, my stomach has really been bothering me." What is the nurse's best response? "Are you taking the medication with food? Sometimes taking the medication when you haven't eaten can cause an upset stomach." "What time of day are you taking the medicine? Most individuals have fewer side effects if the medicine is taken at bedtime." "When have you been taking the medication? The best time to take this medication is first thing in the morning, on an empty stomach." "Are you having any other stomach issues? Gastrointestinal issues are very common with this drug."

Calcium Vitamin D

The nurse is speaking with a female client in her 40s who has a family history of osteoporosis and wants to know what dietary changes can decrease her risk of developing the disorder. What nutrient deficiencies have been correlated with osteoporosis? Select all that apply. Magnesium Calcium Vitamin E Vitamin D Potassium

"Early bone demineralization cannot be detected by an x-ray."

The nurse is talking with a client who asks why a traditional x-ray cannot be used to screen for osteoporosis. The nurse would give which explanation to the client's question? "It can be used with equal results, but with a dual-energy x-ray absorptiometry scan, we don't have to expose you to as much radiation." "Great question. Let me check with your healthcare provider." "Early bone demineralization cannot be detected by an x-ray." "The healthcare provider orders the test that your insurance will cover."

Weight loss Muscle-strengthening exercises Avoiding excessive alcohol intake Smoking cessation

The nurse is talking with a postmenopausal woman about how to prevent osteoporosis. Which of these lifestyle modifications could the nurse include? Select all that apply. Weight loss Muscle-strengthening exercises Avoiding excessive alcohol intake Increasing carbohydrate intake Smoking cessation

"I should encourage the patient to sit with legs crossed." Rationale: The nurse should teach the patient to avoid crossing leg over the midline to prevent hip abduction. Test Taking Tips: Understand safety for this procedure.

The nurse is teaching about home care for patients who have undergone joint replacement. Which statement indicates the need for further teaching? "I should encourage the patient to use slip socks." "I should encourage the patient to use walking devices." "I should encourage the patient to sit with legs crossed." "I should encourage the patient to use a raised toilet seat and a pull bar in the bathroom."

Cushing's disease Rationale: Cushing's disease causes osteoporosis. Steroid use Rationale: Use of steroids increases the risk for osteoporosis. Down's syndrome Rationale: Down's syndrome increases the risk for osteoporosis. Test Taking Tips: Do not confuse primary and secondary risks.

Which are secondary risk factors for a patient with osteoporosis? Select all that apply. Cigarette smoking Cushing's disease Steroid use Gender Down's syndrome

Patient C Generalized pain in lower back and bone, spinal curvature Rationale: The nurse anticipates Paget's disease in patient C. The clinical manifestations of this disorder are generalized pain in lower back and bone and spinal curvature. Test Taking Tips: Consider the impact of musculoskeletal disorders.

Which patient most likely has Paget's disease, based on the symptom provided Patient A calf enlargement with pain and redness, depression Patient B Back pain, constipation with abd cramping Patient C Generalized pain in lower back and bone, spinal curvature Patient D General malaise, lethargy, and fevers

Women of Asian descent Individuals with a family history of osteoporosis Individuals who are overweight Individuals who use tobacco

Which populations have a high risk of osteoporosis? Select all that apply. Women younger than 50 Women of Asian descent Individuals with a family history of osteoporosis Individuals who are overweight Individuals who use tobacco

Becker muscular dystrophy Rationale: Becker muscular dystrophy is common in males and in childhood. Test Taking Tips: Do not confuse different types of muscular dystrophy (MD).

Which type of muscular dystrophy is most common in men and children? Becker muscular dystrophy Myotonic muscular dystrophy Duchenne muscular dystrophy Limb-girdle muscular dystrophy

Scoliosis Rationale: The nurse anticipates that the patient may have scoliosis. The clinical manifestations of this disorder are uneven waist and shoulders. Test Taking Tips: Understand terminology.

While assessing a patient , the nurse observes uneven waist and shoulders. Which musculoskeletal disorder could cause this? Scoliosis Bone cancer Osteomyelitis Muscular dystrophy