CHP 42 PHARM

Question 1: (see full question) A female client presents to the physician's office for a routine physical examination. The nurse assesses her current over-the-counter drug history and discovers that she takes vitamin D 600 international units daily. The nurse recognizes that the client is at risk for what condition? You selected: Hypocalcemia Incorrect Correct response: Hypercalcemia Explanation: Clients diagnosed with osteoporosis require adequate calcium and vitamin D (at least the recommended dietary allowance), whether obtained from the diet or from supplements. C ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784-785. Question 2: (see full question) Teriparatide (Forteo) is prescribed for a patient with osteoporosis. The nurse knows that which of these statements regarding teriparatide is correct? Select all that apply. You selected: • Teriparatide stimulates the synthesis of osteoblasts. • Adverse effects of teriparatide include leg cramps. Incorrect Correct response: • Teriparatide stimulates the synthesis of osteoblasts. • Teriparatide decreases the risk of vertebral fractures. • Adverse effects of teriparatide include leg cramps. Explanation: Teriparatide promotes formation of osteoblasts, cells that stimulate bone formation. Teriparatide decreases risk for vertebral fractures. Adverse effects of teriparatide include ba ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 3: (see full question) A patient will be treated for postmenopausal osteoporosis. The nurse knows that which drug for osteoporosis is an estrogen-receptor modulator? You selected: Raloxifene (Evista) Correct Explanation: Raloxifene interacts with specific estrogen receptors. In bone it has agonist activity, which inhibits bone resorption. In the breasts and uterus, it is an estrogen-receptor blocke ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, pp. 788, 790, 791. Question 4: (see full question) A female client presents to the emergency department with symptoms and laboratory values indicative of hypercalcemia. What IV solutions would the physician order to treat the hypercalcemia? You selected: Sodium chloride (0.9%) Correct Explanation: Sodium chloride (0.9%) injection (normal saline) is an IV solution that contains water, sodium, and chloride. It is included here because it is the treatment of choice for hy ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 782. Question 5: (see full question) Alendronate (Fosamax) is prescribed for a patient. Which statement made by the patient will indicate to the nurse that further instruction is needed? You selected: "I must wait at least 30 minutes after taking this drug before eating or drinking anything." Incorrect Correct response: "I can go back to bed as soon as I take this drug." Explanation: The patient must remain upright (sitting or standing) for at least 30 minutes after taking alendronate with a full glass of water. Nothing should be taken by mouth for at least 30 ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 790. Question 6: (see full question) Phosphorus, most of which is located intracellularly as the phosphate ion, performs many metabolic processes. Choose the following that apply as metabolic processes related to phosphorous. You selected: • Contracts cardiac muscle • Causes nerve-cell excitability • Regulates cell membrane permeability Incorrect Correct response: • Essential component of deoxyribonucleic acid and ribonucleic acid • Combines with fatty acids to form phospholipids Explanation: Phosphorus is an essential component of DNA and also forms phospholipids. Calcium regulates cell membrane permeability and function, nerve-cell excitability and transmission of imp ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 7: (see full question) What happens when the calcium in the blood goes too high? You selected: The thyroid begins releasing calcium. Incorrect Correct response: The parathyroid glands stop making parathyroid hormone. Explanation: When blood calcium levels increase above a certain point, calcium-sensing receptors in the parathyroid gland are activated to decrease hormone production. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 8: (see full question) Increased calcium intake has been advised for a patient at risk for osteoporosis. The nurse discusses various interactions with calcium, including which of the following? Select all that apply. You selected: • Thiazides decrease effectiveness of calcium. • Rhubarb increases effectiveness of calcium. • Atenolol decreases calcium absorption. Incorrect Correct response: • Patients taking ciprofloxacin (Cipro) should take calcium at least 2 hours apart from this drug. • Patients taking digoxin (Lanoxin) are at increased risk for digitalis dysrhythmias. • Atenolol decreases calcium absorption. Explanation: Atenolol and fluoroquinolones such as ciprofloxacin decrease intestinal absorption of calcium. Calcium and digoxin have similar cardiac effects; the combination increases risk for ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 785. Question 9: (see full question) Calcitonin-salmon (Miacalcin) is prescribed for a patient. The nurse knows that which of the following statements regarding calcitonin-salmon are correct? Select all that apply. You selected: • Calcitonin-salmon is used to manage Paget's disease. • Calcitonin-salmon inhibits bone degradation. Incorrect Correct response: • Calcitonin-salmon inhibits bone degradation. • Calcitonin-salmon can alleviate pain of metastatic bone cancer. • Calcitonin-salmon is used to manage Paget's disease. Explanation: Calcitonin-salmon helps to maintain structure of bone. It is used for osteoporosis, Paget's disease, and hypercalcemia, and is administered by subcutaneous (SC) or intramuscular (I ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 10: (see full question) The nurse is concerned that a client has taken too much vitamin D. What symptoms will the client exhibit who has vitamin D excess? (Select all that apply.) You selected: • Irritability • Polydipsia • Muscle pain Correct Explanation: Excess amounts of vitamin D may cause headache, somnolence, weakness, irritability, hypertension, cardiac dysrhythmias, kidney stones, polydipsia, polyuria, and bone and muscl ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 787. Question 11: (see full question) Which of the following would lead a nurse to suspect that a client receiving bisphosphonate therapy is experiencing hypercalcemia? You selected: Lethargy Correct Explanation: Lethargy would suggest hypercalcemia. Paresthesias, muscle cramps, and carpopedal spasms suggest hypocalcemia. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 12: (see full question) Calcium levels are directly related to which of the following blood components? You selected: Potassium Incorrect Correct response: Serum albumin Explanation: The skeleton acts as a major mineral storage site for the element and releases Ca2+ ions into the bloodstream under controlled conditions. Circulating calcium is in the free, ioniz ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 13: (see full question) A patient with osteoporosis has bones that become progressively porous, brittle, and especially prone to fracture. This increased susceptibility to fracture manifests most commonly as: You selected: compression fracture of the vertebrae. Correct Explanation: Although all bones in the affected patient are more prone to fracture, common fracture sites are the vertebrae of the lower dorsal and lumbar spines, wrists, and hips. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 14: (see full question) While reviewing the medication history of a client receiving alendronate, the nurse notes that the client also takes a multivitamin. Which instruction would be most appropriate? You selected: "Separate taking the two drugs by about a half hour." Correct Explanation: Alendronate can interact with a multivitamin, decreasing the absorption of the bisphosphonate. Therefore, the drugs should be separated by at least a half hour. The multivitam ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 789. Question 15: (see full question) The patient is advised to increase daily intake of vitamin D. The nurse will counsel the patient that this will improve intestinal absorption of which of the following? You selected: Calcium Correct Explanation: Vitamin D is essential for proper absorption of calcium from the small intestine. This vitamin does not affect absorption of magnesium, sodium, or potassium. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 16: (see full question) Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to You selected: take calcium and vitamin D supplements. Incorrect Correct response: stand or sit upright for at least 30 minutes after taking alendronate. Explanation: To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug hel ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 789. Question 17: (see full question) After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example? You selected: Pamidronate Correct Explanation: Pamidronate is an example of a bisphosphonate. Teriparatide and dihydrotachysterol are antihypocalcemic agents. Calcitonin-salmon is a calcitonin used to treat hypercalcemia. ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 789. Question 18: (see full question) A patient is diagnosed with hypercalcemia. The nurse knows that which statement regarding hypercalcemia is correct? You selected: Hypercalcemia can lead to calcium deposits that damage the kidneys. Correct Explanation: Vitamin D deficiency will result in hypocalcemia. Cisplatin tends to cause hypocalcemia. Hypocalcemia increases muscle tone, which can lead to twitching of facial muscles. Hypercal ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 19: (see full question) You are a registered nurse caring for patients with altered calcium levels. Which of the following nursing diagnoses would you expect to include in your plan of care? Choose all that apply. You selected: • Risk for Injury: Hypercalcemia related to overuse of supplements; hypocalcemia from aggressive treatment of hypercalcemia • Risk for Injury: Tetany, sedation, seizures from hypocalcemia Incorrect Correct response: • Deficient Knowledge: Recommended daily amounts and dietary sources of calcium and vitamin D • Risk for Injury: Tetany, sedation, seizures from hypocalcemia • Risk for Injury: Hypercalcemia related to overuse of supplements; hypocalcemia from aggressive treatment of hypercalcemia Explanation: Tetany is a sign of hypocalcemia. All other nursing diagnoses are correct and appropriate. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 20: (see full question) The nurse is caring for a 77-year-old client and understands that calcium deficiency commonly occurs in the elderly because of what factors? (Select all that apply.) You selected: • Impaired absorption of calcium from the intestine • Impaired liver or kidney metabolism of vitamin D • Lack of exposure to sunlight Correct Explanation: Calcium deficiency commonly occurs in the elderly because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784.

Question 1: (see full question) The nurse is caring for a client who would like to increase her phosphorus intake. The nurse instructs the client to increase the amount of what foods that are high in phosphorus? You selected: Potatoes Incorrect Correct response: Dairy products Explanation: Dairy products are high in phosphorus. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 2: (see full question) Calcium supplements must be given with caution for clients taking which medication? You selected: Digitalis Correct Explanation: Calcium preparations and digoxin have similar effects on the myocardium. Therefore, if calcium is given to a patient taking digoxin, the risks of digitalis toxicity and cardiac dys ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 785. Question 3: (see full question) The nurse is caring for a client who is interested in taking a calcium supplement for bone health. The nurse is aware that calcium is contraindicated if the client has what condition? (Select all that apply.) You selected: • Cancer with bone metastases • Ventricular fibrillation • Kidney stones Correct Explanation: Contraindications to calcium preparations include cancer with bone metastases, as well as ventricular fibrillation, hypercalcemia, hypophosphatemia, and renal calculi. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 4: (see full question) A client is prescribed calcitonin. The nurse would teach the client to administer the drug by which route? You selected: Subcutaneous Correct Explanation: Calcitonin is administered subcutaneously, intramuscularly, or intranasally. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 5: (see full question) A patient confides in the nurse that she is in menopause and that she does not want to take hormone replacement therapy because she has a family history of breast cancer. She tells the nurse she is taking soy, calcium, and a vitamin as an alternative therapy. What would the nurse advise the patient to do? You selected: Discontinue her calcium supplement Correct Explanation: The nurse may advise the patient to stop using a calcium supplement. Calcium, iron, or zinc products could decrease effects of estrogen. However, the patient may have to decide whe ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 782. Question 6: (see full question) Raloxifene (Evista) is prescribed for a patient with osteoporosis. The nurse knows that adverse effects of raloxifene include which of the following? You selected: Deep venous thrombosis Correct Explanation: Raloxifene can cause intravascular clotting that can progress to pulmonary embolus or stroke. Alendronate (Fosamax) can damage the esophagus and cause deterioration of the mandible ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, pp. 788-791. Question 7: (see full question) To interpret serum calcium levels accurately, serum albumin levels and acid-base status must be considered. True or false? You selected: False Incorrect Correct response: True Explanation: Low serum albumin decreases the total serum level of calcium by decreasing the amount of calcium bound to protein; however, the ionized concentration is unaffected by serum albumin ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 8: (see full question) A 43-year-old male client takes prednisone 7.5 mg daily to treat his temporal arteritis. His dose varies from 7.5 to 10 mg based on symptoms and laboratory test analysis. His disease process has been managed successfully with this drug regimen for 7 years. To prevent osteoporosis, what would his physician order? (Select all that apply.) You selected: • A bisphosphonate drug • Testosterone • A calcium supplement Incorrect Correct response: • A calcium supplement • A bisphosphonate drug • Regular weight-bearing exercise Explanation: Preventive measures are necessary for clients on chronic corticosteroid therapy (e.g., prednisone 7.5 mg daily; equivalent amounts of other systemic drugs; high doses of inha ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 782. Question 9: (see full question) Which of the following clinical manifestations are indicative of hypercalcemia? Choose all that apply. You selected: • lethargy • calcium serum level > 10.5 mg/dL • tetany Incorrect Correct response: • calcium serum level > 10.5 mg/dL • coma • lethargy Explanation: Severe hypercalcemia may produce lethargy, syncope, disorientation, hallucinations, coma, and death. Clinical manifestations are characterized by increased neuromuscular irritabili ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, pp. 783-784. Question 10: (see full question) The following are examples of calcium preparations. Which of them are preparations to be given intravenously? Choose all that apply. You selected: • Calcium carbonate (Os-Cal, Tums) • Calcium acetate (PhosLo) • Calcium citrate (Citracal) Incorrect Correct response: • Calcium chloride Explanation: Calcium chloride is the only IV preparation listed. Calcitriol is a vitamin D preparation given orally. All others are examples of calcium taken orally. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 285. Question 11: (see full question) Which of the following are appropriate goals to set with your patient who is suffering from an alteration in calcium levels? Choose all that apply. You selected: • The patient will decrease dietary intake of calcium-containing foods to prevent or treat osteoporosis. • The patient will achieve and maintain normal serum levels of calcium. Incorrect Correct response: • The patient will achieve and maintain normal serum levels of calcium. • The patient will comply with instructions for safe drug use. • The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia. Explanation: All are correct except the patient will want to increase dietary intake of calcium-containing foods to prevent and treat osteoporosis. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 12: (see full question) A client is prescribed a selective estrogen receptor modifier for treatment of osteoporosis. The nurse would identify which drug as belonging to this class? You selected: Raloxifene Correct Explanation: An example of a selective estrogen receptor modifier is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; and tamoxifen is an a ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 13: (see full question) The nurse knows that phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia. Hypophosphatemia is assumed when the serum phosphorus is less than what level? You selected: Less than 5 mg/dL Incorrect Correct response: Less than 3 mg/dL Explanation: Phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia (serum phosphorus less than 3 mg/dL) and renal function is normal, to minimize the risk o ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 14: (see full question) The nurse and patient discuss factors that can decrease the effectiveness of dietary calcium. The nurse knows that such factors include which of the following? Select all that apply. You selected: • Chronic corticosteroid administration • Renal failure • Administration of thiazide diuretics Incorrect Correct response: • Chronic corticosteroid administration • Administration of phenytoin (Dilantin) • Ingestion of bran cereals • Renal failure Explanation: Corticosteroids inhibit intestinal absorption of calcium. Phenytoin enhances hepatic inactivation of vitamin D, resulting in lower blood levels of this vitamin, which is essential ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, pp. 782, 786, 787. Question 15: (see full question) A positive Chvostek's sign suggests hypercalcemia. You selected: True Incorrect Correct response: False Explanation: Hypocalcemia is indicated by a positive Chvostek's sign. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 16: (see full question) When studying PTH, the students learn it has many actions. What are these actions? (Mark all that apply.) You selected: • Increased intestinal absorption of calcium • Stimulation of osteoclasts • Stimulation of calcitriol production Correct Explanation: PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorptio ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 17: (see full question) The nurse is caring for a client who has hypocalcemia. The client also has hypomagnesemia. The nurse knows that medications to correct these conditions will be administered in what manner? You selected: The nurse will administer both the calcium and the magnesium at the same time. Incorrect Correct response: The nurse will hold the calcium until the magnesium level is normal. Explanation: Hypomagnesemia must be corrected before the hypocalcemia can be corrected. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 786. Question 18: (see full question) Prevention of osteoporosis includes which of the following measures? You selected: Maintaining adequate calcium and vitamin D intake. Correct Explanation: Measures that can reduce the risk of developing osteoporosis include maintaining adequate dietary intake of calcium and vitamin D. The other options describe measures that can redu ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 782. Question 19: (see full question) Electrocardiographic changes indicative of hypercalcemia include a shortened Q-T interval and an inverted T wave. True or false? You selected: True Correct Explanation: Electrocardiographic changes indicative of hypercalcemia include a shortened Q-T interval and an inverted T wave. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 20: (see full question) The nurse is caring for a client who is being monitored for hypercalcemia. The nurse understands that what calcium level is considered a medical emergency? You selected: 10.5 mg/dL Incorrect Correct response: 12 mg/dL Explanation: Calcium levels at 12 mg/dL or above are considered medical emergencies, and rehydration must be started immediately. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792.

Question 1: (see full question) A patient with osteoporosis has bones that become progressively porous, brittle, and especially prone to fracture. This increased susceptibility to fracture manifests most commonly as: You selected: boxer's fracture. Incorrect Correct response: compression fracture of the vertebrae. Explanation: Although all bones in the affected patient are more prone to fracture, common fracture sites are the vertebrae of the lower dorsal and lumbar spines, wrists, and hips. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 2: (see full question) A home care nurse is caring for a 70-year-old female client who has been diagnosed with osteoporosis. When developing a plan of care for this client, the nurse should include measures to prevent what complication of the disease? You selected: Bone fracture Correct Explanation: Bone fracture is a major complication of osteoporosis, a disease characterized by reduced bone mineral density. Low levels of estrogen and calcium increase the risk of developing t ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 3: (see full question) The home care nurse is caring for an elderly female patient who has been diagnosed with osteoporosis. When explaining the disease and its treatment to the patient, what should the nurse identify as a potentially serious complication? You selected: Bone fracture Correct Explanation: Bone fracture is a major complication of osteoporosis, a disease characterized by reduced bone mineral density. Estrogen deficiency and negative calcium balance contribute to osteo ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 4: (see full question) While reviewing the medication history of a client receiving alendronate, the nurse notes that the client also takes a multivitamin. Which instruction would be most appropriate? You selected: "Take the alendronate with an antacid before the multivitamin." Incorrect Correct response: "Separate taking the two drugs by about a half hour." Explanation: Alendronate can interact with a multivitamin, decreasing the absorption of the bisphosphonate. Therefore, the drugs should be separated by at least a half hour. The multivitam ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 789. Question 5: (see full question) The nurse is caring for a 77-year-old client and understands that calcium deficiency commonly occurs in the elderly because of what factors? (Select all that apply.) You selected: • Lack of exposure to sunlight • Impaired absorption of calcium from the intestine Incorrect Correct response: • Impaired absorption of calcium from the intestine • Lack of exposure to sunlight • Impaired liver or kidney metabolism of vitamin D Explanation: Calcium deficiency commonly occurs in the elderly because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 6: (see full question) The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)? You selected: Calcium Correct Explanation: When bisphosphonates are administered, serum calcium levels are monitored before, during, and after therapy. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, pp. 788-789. Question 7: (see full question) A client is prescribed calcitriol. Which instruction would be most important for the nurse to include in the teaching plan? You selected: "Have your calcium levels check periodically." Correct Explanation: Calcitriol increases serum calcium levels; therefore, periodic monitoring is important to ensure effectiveness of therapy without causing hypercalcemia. Antacids containing ma ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 788. Question 8: (see full question) Which of the following has the sole purpose of controlling calcium within the blood? You selected: Parathyroid glands Correct Explanation: Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 9: (see full question) A female client presents to the physician's office for a routine physical examination. The nurse assesses her current over-the-counter drug history and discovers that she takes vitamin D 600 international units daily. The nurse recognizes that the client is at risk for what condition? You selected: Hypocalcemia Incorrect Correct response: Hypercalcemia Explanation: Clients diagnosed with osteoporosis require adequate calcium and vitamin D (at least the recommended dietary allowance), whether obtained from the diet or from supplements. C ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784-785. Question 10: (see full question) Furosemide (Lasix) is a loop diuretic that can be used to treat hypercalcemia. True or false? You selected: True Correct Explanation: Furosemide (Lasix) is a loop diuretic that increases calcium excretion in urine by preventing its resorption in renal tubules. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 792. Question 11: (see full question) Teriparatide (Forteo) is a recombinant DNA version of parathryroid hormone (PTH). How is this drug different than others that are used in the treatment of osteoporosis? Choose all that apply. You selected: • Increases bone formation • Does not accumulate in bone or other tissues • Slows bone loss Incorrect Correct response: • Increases bone formation • Does not accumulate in bone or other tissues • Does not require dose adjustment with renal or hepatic impairment • Increases serum levels of calcium and calcitriol Explanation: Other drugs for osteoporosis slow bone loss, whereas teriparatide increases bone formation by increasing the number of bone-building cells (osteoblasts). Teriparatide also increase ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 12: (see full question) A patient is diagnosed with hypercalcemia. The nurse knows that which statement regarding hypercalcemia is correct? You selected: Hypercalcemia causes twitching of facial muscles. Incorrect Correct response: Hypercalcemia can lead to calcium deposits that damage the kidneys. Explanation: Vitamin D deficiency will result in hypocalcemia. Cisplatin tends to cause hypocalcemia. Hypocalcemia increases muscle tone, which can lead to twitching of facial muscles. Hypercal ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 13: (see full question) Calcium preparations can be given by two different routes. Which of the following are those routes? You selected: • Intravenous • Oral Correct Explanation: An intravenous (IV) calcium salt (usually calcium gluconate) is given for acute, symptomatic hypocalcemia. An oral preparation (e.g., calcium carbonate, citrate) is given for asymp ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 783. Question 14: (see full question) A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate? You selected: Low bone density and a family history of osteoporosis Correct Explanation: Bisphosphonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal wom ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 788. Question 15: (see full question) Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to You selected: take calcium and vitamin D supplements. Incorrect Correct response: stand or sit upright for at least 30 minutes after taking alendronate. Explanation: To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug hel ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 789. Question 16: (see full question) Paget's disease is an inflammatory skeletal disease that affects younger people. True or false? You selected: False Correct Explanation: Paget's disease is an inflammatory skeletal disease that affects older people. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 17: (see full question) A patient asks the nurse to explain parathyroid hormone. The nurse knows that parathyroid hormone has which of the following effects? You selected: Bone decalcification Correct Explanation: When blood levels of calcium decline, secretion of parathyroid hormone increases. Calcium moves from bone to blood, intestinal absorption of calcium increases, renal excretion of c ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 18: (see full question) A patient questions the nurse regarding daily intake of vitamin D recommended to decrease risk for osteoporosis. The nurse knows that for people older than 70 years, the recommended daily intake of vitamin D is ____ international units (IU). You selected: 800 Correct Explanation: Vitamin D is essential for intestinal absorption and maintenance of adequate blood levels of calcium. The recommended daily intake for those 1 to 70 years is 600 IU. For people old ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 787. Question 19: (see full question) The nurse is caring for four clients. Which client is at the highest risk for osteoporosis? You selected: The female client aged 76 Correct Explanation: Postmenopausal women are at high risk for osteoporosis. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 20: (see full question) The nurse is educating a client who has received a prescription for ibandronate for osteoporosis. What prescription instruction is correct for this drug? You selected: Take 150 mg once a month on the same day of the month Correct Explanation: Ibandronate 150 mg PO is taken once a month on the same day of the month. Alendronate is taken once a week. Tiludronate and risedronate are taken once a day.

Question 1: (see full question) A client relates she has a history of osteoporosis. She says that she was told she has too much parathyroid hormone production and asks the nurse to explain how this happens. The nurse's best response would be: You selected: When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. This condition is called osteoporosis. Correct Explanation: Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 2: (see full question) A patient does not understand why the physician has advised her to spend more time outdoors on sunny days. The nurse explains that exposure to sunlight enables the body to synthesize which of the following? You selected: Parathyroid hormone Incorrect Correct response: Vitamin D Explanation: Exposure of skin to sunlight promotes vitamin D formation, but has no effect on levels of calcitonin, parathyroid hormone, or phosphorous. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 3: (see full question) Bisphosphonates are drugs that bind to bone and inhibit calcium resorption from bone. These drugs are used to treat hypercalcemia. Which of the following are bisphosphontes? Choose all that apply. You selected: • risedronate (Actonel) • alendronate (Fosamax) • ibandronate (Boniva) Correct Explanation: Fosamax, Boniva, and Actonel are all examples of bisphosphonates. Raloxifene is a selective estrogen receptor modulator; teripazatide is a parathyroid hormone. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 789. Question 4: (see full question) When studying PTH, the students learn it has many actions. What are these actions? (Mark all that apply.) You selected: • Increased excretion of calcium from kidneys • Increased intestinal absorption of calcium • Decreased retention of vitamin D Incorrect Correct response: • Stimulation of osteoclasts • Increased intestinal absorption of calcium • Stimulation of calcitriol production Explanation: PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorptio ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 5: (see full question) The nurse and patient are discussing the importance of various vitamins. The nurse knows which of the following vitamins is essential for proper intestinal absorption of calcium? You selected: Vitamin D Correct Explanation: Vitamin D promotes absorption of calcium from the small intestine and helps to maintain adequate blood levels of this mineral to foster bone growth. Vitamins A, E, and K do not dir ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 6: (see full question) The following are examples of calcium preparations. Which of them are oral preparations for calcium supplementation? Choose all that apply. You selected: • Calcium carbonate (Os-Cal, Tums) • Calcitriol (Rocaltrol) • Calcium citrate (Citracal) Incorrect Correct response: • Calcium acetate (PhosLo) • Calcium carbonate (Os-Cal, Tums) • Calcium citrate (Citracal) Explanation: Calcium chloride is an IV preparation and calcitriol is a vitamin D preparation given orally. All others are appropriate examples of calcium taken orally. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 785. Question 7: (see full question) The nurse and a patient diagnosed with osteoporosis are discussing the process of bone formation and loss. The nurse will teach that bone metabolism is influenced by which of the following? Select all that apply. You selected: • Parathyroid hormone • Vitamin K • Calcitonin Incorrect Correct response: • Calcitonin • Parathyroid hormone • Calcitriol Explanation: Calcitonin and parathyroid hormone are hormones that foster development of bone. Calcitriol, the active form of vitamin D, promotes absorption of calcium from the intestine. Vitami ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 779. Question 8: (see full question) Raloxifene (Evista) is prescribed for a patient with osteoporosis. The nurse knows that adverse effects of raloxifene include which of the following? You selected: Orthostatic hypotension Incorrect Correct response: Deep venous thrombosis Explanation: Raloxifene can cause intravascular clotting that can progress to pulmonary embolus or stroke. Alendronate (Fosamax) can damage the esophagus and cause deterioration of the mandible ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, pp. 788-791. Question 9: (see full question) Which of the following drugs are used to treat osteoporosis and can actually increase bone formation? Choose all that apply. You selected: • calcitriol (Rocaltrol) Incorrect Correct response: • teriparatide (Forteo) Explanation: Teriparatide increases bone formation by increasing the number of bone-building cells (osteoblasts). Teriparatide also increases serum levels of calcium and calcitriol. Phosphate s ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 10: (see full question) Osteoporosis is characterized by decreased bone density (osteopenia) and weak, fragile bones. Which of the following are risk factors for osteoporosis? Choose all that apply. You selected: • African-American race • Female gender Incorrect Correct response: • Female gender • Lean body mass • Smoking Explanation: Risk factors include female sex, advanced age, small stature, lean body mass, white or Asian race, positive family history, low calcium intake, menopause, sedentary lifestyle, null ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 11: (see full question) Which of the following are strong sources of calcium? Choose all that apply. You selected: • Oysters • Milk • Sunlight Incorrect Correct response: • Milk • Spinach • Oysters Explanation: The best sources of calcium are milk and milk products. Other sources of calcium include vegetables (e.g., broccoli, spinach, kale, mustard greens) and seafood (e.g., clams, oyster ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 786. Question 12: (see full question) A patient confides in the nurse that she is in menopause and that she does not want to take hormone replacement therapy because she has a family history of breast cancer. She tells the nurse she is taking soy, calcium, and a vitamin as an alternative therapy. What would the nurse advise the patient to do? You selected: Increase her iron supplement Incorrect Correct response: Discontinue her calcium supplement Explanation: The nurse may advise the patient to stop using a calcium supplement. Calcium, iron, or zinc products could decrease effects of estrogen. However, the patient may have to decide whe ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 782. Question 13: (see full question) The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect? You selected: Osteoporosis Correct Explanation: Both men and women who take corticosteroids are at risk for osteoporosis. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 14: (see full question) A client is prescribed a selective estrogen receptor modifier for treatment of osteoporosis. The nurse would identify which drug as belonging to this class? You selected: Calcium gluconate Incorrect Correct response: Raloxifene Explanation: An example of a selective estrogen receptor modifier is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; and tamoxifen is an a ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 791. Question 15: (see full question) When is calcitonin released by the body? You selected: When PTH secretion mobilizes calcium Incorrect Correct response: When serum calcium levels rise Explanation: The release of calcitonin is not controlled by the hypothalamic-pituitary axis, but is regulated locally at the cellular level. Calcitonin is released when serum calcium leve ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 780. Question 16: (see full question) The nurse is caring for a client who is interested in taking a calcium supplement for bone health. The nurse is aware that calcium is contraindicated if the client has what condition? (Select all that apply.) You selected: • Kidney stones • Cancer with bone metastases Incorrect Correct response: • Kidney stones • Cancer with bone metastases • Ventricular fibrillation Explanation: Contraindications to calcium preparations include cancer with bone metastases, as well as ventricular fibrillation, hypercalcemia, hypophosphatemia, and renal calculi. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 784. Question 17: (see full question) You are caring for a patient with a serum calcium level of 8.1 mq/dL. Which of the following assessment data would you expect to find after your examination? Choose all that apply. You selected: • Coma • Spasms of the hand muscles • Seizures • Reports of tingling around the mouth Incorrect Correct response: • Reports of tingling around the mouth • Spasms of the hand muscles • Seizures Explanation: Hypocalcemia is an abnormally low blood calcium level (i.e., < 8.5 mg/dL). Clinical manifestations are characterized by increased neuromuscular irritability, which may progress to tetany. Tetany is characterized by numbness and tingling of the lips, fingers, and toes; twitching of facial muscles; spasms of skeletal muscle. Lethargy and coma would be found with hypercalcemia. ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 783. Question 18: (see full question) A patient asks the nurse to explain the physiological actions of phosphorous. The nurse knows which of these statements regarding phosphorous is correct? You selected: Vitamin D is essential for phosphorous absorption. Incorrect Correct response: Milk is the best source of phosphorous. Explanation: Most phosphorous is bound to calcium in bones and teeth. Milk contains equal amounts of phosphorous and calcium, which promotes absorption of phosphorous. Vitamin D enhances but is ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 781. Question 19: (see full question) Calcium supplements must be given with caution for clients taking which medication? You selected: Atropine Incorrect Correct response: Digitalis Explanation: Calcium preparations and digoxin have similar effects on the myocardium. Therefore, if calcium is given to a patient taking digoxin, the risks of digitalis toxicity and cardiac dys ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 42: Drug Therapy to Regulate Calcium and Bone Metabolism, p. 785. Question 20: (see full question) A patient is receiving teriparatide. The nurse would expect to administer this drug by which route? You selected: Oral Incorrect Correct response: Subcutaneous Explanation: