Exemplar- Osteoporosis

A nurse is reinforcing discharge teaching on home safety for an older adult client who has osteoporosis. Which of the following information should the nurse include? (Select all that apply.) A. Remove throw rugs in walkways B. Use prescribed assistive devices. C. Remove clutter from the environment. D. Walk with caution on icy surfaces. E. Maintain lighting of doorway areas.

A , B , C , E

A nurse is assisting with health screenings at a health fair. The nurse should identify that which of the following clients are at risk for osteoporosis? (Select all that apply.) A. 40-year-old client who takes prednisone for asthma B. 30-year-old client who jogs 3 miles daily C. 45-year-old client who takes phenytoin for seizures D. 65-year-old client who has a sedentary lifestyle E. 70-year-old client who has smoked for 50 years

A , C , D , E

A nurse is caring for a client who is taking alendronate to treat postmenopausal osteoporosis. The nurse should explain to the client that alendronate increases bone mass by which of the following? A.Decreases activity of osteoclasts B.Increases calcium excretion C.Promotes intestinal absorption of calcium and phosphorus D.Reduces action of osteoblasts

A.Decreases activity of osteoclast

A nurse should instruct a client who is taking alendronate to monitor for which of the following adverse affects? S.A.T.A A.Jaw pain B.Drowsiness C.Blurred vision D.Tinnitus E.Muscle pain

A.Jaw pain. C.Blurred vision. E.Muscle pain.

A nurse is teaching a client about calcitonin-salmon Intranasal spray to treat osteoporosis. Which of the following information should the nurse include? S.A.T.A A. Report rash or itching B. Deliver two sprays to each nostril C. Prime the pump before the first dose D. Report nasal irritation E. Hold the pump horizontally

A.Report rash or itching. C.Prime the pump before the first dose. D.Report nasal irritation.

A nurse is assisting in the care of a client immediately following vertebroplasty of the thoracic spine. Which of the following actions should the nurse take? A. Apply heat to the puncture site. B. Place the client in a supine position. 1 hr C. Turn the client every D. Ambulate the client within the first hour postprocedure

B

A nurse is reinforcing dietary teaching about calcium-rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions?A. White bread B. White beans C. White meat of chicken D. White rice

B

A nurse is assisting in the admission of an older adult client who has suspected osteoporosis. Which of following findings should the nurse expect? (Select all that apply.) A. History of consuming one glass of wine daily B. Loss in height of 5.1 cm (2 in) C. Body mass index (BMI) 21 D. Kyphotic curve at upper thoracic spine E. History of lactose intolerance

B , C , D ,E

A nurse is providing dietary teaching about calcium-rich foods to a client to has osteoporosis. Which of the following foods should the nurse include in the instructions? A. White Bread b. Kale C. Apples D. Brown Rice

B. Kale

A nurse is teaching a client who has a prescription for prednisone and takes 1500mg/day of calcium carbonate to reduce the risk of osteoporosis. Which of the following information should the nurse include? S.A.T.A A.Take the calcium tablets with food. B.Drink 240 mL (8 oz) of water with the calcium tablets. C.Chew calcium tablets before swallowing them. D.Take the drugs 1 hr apart. E.Divide the daily dosage of calcium into three 500-mg doses.

B.Drink 240 ML (8 oz) of water with the calcium tablets. C.Chew calcium tablets before swallowing them. D.Take the drugs 1 hr apart. E.Divide the daily dose of calcium into three 500 mg doses.

A nurse is teaching a client about raloxifene. Which of the following information should be included? S.A.T.A A.Perform a breast self-examination twice per month. B.Increase physical activity by taking walks. C.Use a contraceptive if there is any possibility of pregnancy. D.Take the drug on an empty stomach. E.Increase intake of calcium and vitamin D.

B.Increase physical activity by taking walks. C.Use a contraceptive if there's any possibility of pregnancy. E.Increase intake of calcium and vitamin D.

A nurse is educating clients at a health fair about dual-energy x-ray absorptiometry (DXA) scans. Which of the following information should the nurse include? (SATA) A. the test requires the use of contrast material B. the hip and spine are the usual areas to be scanned C. the scan is used to detect osteoarthritis D. Bone pain may indicate a need for a scan E. at age 40 years, a basline scan is recommended

BDE

A nurse is providing teaching to a client who has osteoporosis. Which of the following information should the nurse include in the teaching? A. Increase daily intake of foods containing vitamin A. B. Limit alcohol consumption to 10 oz daily. C. Perform exercises to strengthen the abdominal core. D. Start a daily jogging regimen.

C. Perform exercises to strengthen the abdominal core. - Increase daily intake of foods containing vitamin A.The nurse should instruct the client to increase daily intake of calcium and vitamin D to decrease the rate of bone loss. - Limit alcohol consumption to 10 oz daily. The nurse should instruct the client to limit alcohol consumption to 5 oz daily to decrease the rate of bone loss .- Perform exercises to strengthen the abdominal core.The nurse should instruct the client to perform exercises to strengthen the abdominal and back muscles to maintain stability of the spinal column and prevent vertebral fractures. - Start a daily jogging regimen.The nurse should instruct the client to avoid jarring exercises, such a jogging or horseback riding, to prevent potential vertebral compression fractures.

A nurse is teaching a client about raloxifene therapy To prevent osteoporosis. The nurse should instruct the client to monitor for which of the adverse reactions? A. Loss of hair B. Numbness of the fingertips C. Calf Pain D. Blisters on mucous membranes

C.Calf Pain

A nurse is caring for a client who was diagnosed with postmenopausal osteoporosis. Which of the following actions should the nurse take prior to administering calcitonin-salmon to the client for the first time? A.Check the client's urine for sedimentation. B.Assess the client's liver function. C.Use skin testing to check the client for allergies. D.Evaluate the client's breath sounds.

C.Use skin testing to check the client for allergies

A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Extended periods of immobility increase your risk of osteoporosis." B. "Prolonged periods of sun exposure increase your risk of osteoporosis." C. "Eating a diet high in protein can reduce your risk of osteoporosis." D. "Corticosteroid therapy will reduce your risk of osteoporosis."

Correct Answer: A. "Extended periods of immobility increase your risk of osteoporosis." Osteoporosis is a disorder of weakened bones due to a loss of bone mass and a change in bone structure. Immobility can result in osteoporosis; therefore, weight-bearing exercise, such as walking, can help prevent osteoporosis.

A nurse is teaching to a client who has systemic lupus erythematosus about a new prescription for oral glucocorticoid therapy. Which of the following client statements indicates an understanding of the teaching? A."I should take a calcium supplement while on this medication." B."Regular liver function studies will have to be done while I am taking this medication." C."I can take NSAIDs to treat mild pain while using this medication." D."I will be sure to eat 6 small meals a day to prevent hypoglycemia from this medication."

Correct Answer: A. "I should take a calcium supplement while on this medication." An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease the risk of fractures.

A nurse is teaching a client who has osteoporosis about a new prescription for risedronate. Which of the following client statements indicates an understanding of the teaching? A. "I will take this medication with a full cup of water." B. "I will lie down after I take this medication." C. "I will take this medication with food." D. "I will take this medication at bedtime."

Correct Answer: A. "I will take this medication with a full cup of water." The nurse should instruct the client that risedronate should be taken with at least 180 to 240 mL (6 to 8 oz) of water.

A nurse is providing discharge instructions about calcium supplements to an older adult female client who has osteoporosis and recently underwent a repair of a fracture in her right hip. Which of the following instructions should the nurse include? A. "You should take your calcium supplement with a large glass of water." B. "You should increase your intake of grain cereals while taking calcium supplements." C. "You should take at least 2600 mg of calcium supplements daily." D. "You will not need to take vitamin D with your calcium supplement after menopause."

Correct Answer: A. "You should take your calcium supplement with a large glass of water." The nurse should instruct the client to take calcium supplements with a large glass of water with or after meals to promote absorption of the supplement.

A nurse is talking with an older adult client who has an elevated risk for osteoporosis about strategies for preventing bone loss. Which of the following instructions should the nurse provide? A. Begin a program of brisk walking B. Take 800 mg of calcium per day C. Drink plenty of sparkling water D. Drink 8 oz of red wine each day

Correct Answer: A. Begin a program of brisk walking Weight-bearing exercises help maintain bone mass and prevent osteoporosis. Walking is generally a safe activity for older clients.

A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy vegetables

Correct Answer: A. Fortified milk Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D.

A nurse in a provider's office is measuring a client and notes a loss in height from the previous year. The nurse should identify this finding as a manifestation of which of the following musculoskeletal system disorders? A. Osteoporosis B. Scoliosis C. Kyphosis D. Lordosis

Correct Answer: A. Osteoporosis A loss of height is often an early indication of osteoporosis. This occurs due to loss of calcium in the vertebrae, which can cause them to fracture and collapse.

A nurse is reviewing the medical record of a client who has postmenopausal osteoporosis and a prescription for raloxifene. Which of the following findings in the client's medical record should the nurse identify as a contraindication to receiving this medication? A. Breast cancer B. History of deep-vein thrombosis (DVT) C. Allergy to calcitonin D. Current diagnosis of cholecystitis

Correct Answer: B. History of deep-vein thrombosis (DVT) The nurse should identify that a history of DVT is a contraindication for receiving raloxifene because this medication can cause DVT in clients who have a prior history. Therefore, the nurse should notify the provider of this finding and request an alternative medication prescription for the client.

A nurse in a provider's office is reviewing a client's medication history. The client asks the nurse if she should begin taking high-dose vitamins as she ages. Which of the following pieces of information should the nurse provide about high doses of vitamin supplements? A. High doses of water-soluble vitamins enhance their therapeutic actions. B. High doses of water-soluble vitamins can have adverse effects. C. High doses of vitamin supplements are restricted to use during pregnancy. D. Tolerance might develop, resulting in an increased vitamin need.

Correct Answer: B. High doses of water-soluble vitamins can have adverse effects. High doses of vitamins can cause harm to the body. Any vitamin supplements consumed should not exceed the recommended dietary allowance. Elevated levels of vitamin A can increase the risk of developing osteoporosis and cause birth defects when taken during pregnancy. Excessive intake of beta-carotene can increase the risk of lung cancer in clients who smoke. In addition, increased doses of vitamin E can increase the risk of death in clients who have chronic illnesses.

A nurse is preparing to administer raloxifene to a client. Which of the following conditions is a contraindication for the administration of this medication? A. Osteoporosis B. Hyperthyroidism C. Myocardial infarction D. Deep-vein thrombosis

Correct Answer: D. Deep-vein thrombosis The nurse should identify that raloxifene, like estrogen, increases the risk of deep-vein thrombosis, pulmonary embolism, and stroke. Raloxifene is contraindicated for clients who have a history of venous thrombotic events.

A nurse in a provider's office is providing teaching to a client with osteoporosis who has a new prescription for alendronate sodium. Which of the following pieces of information should the nurse include? A. Alendronate sodium can be administered by IV once yearly. B. Take alendronate sodium with a full glass of water on an empty stomach. C. Side effects of alendronate sodium include leukopenia. D. Alendronate sodium should be taken with calcium-containing foods to increase absorption.

Correct Answer: B. Take alendronate sodium with a full glass of water on an empty stomach. Alendronate sodium should be taken with at least 230 mL (8 oz) of water 30 min before ingesting foods. An upright position is recommended after taking alendronate sodium to decrease the risk of esophagitis.

A nurse is teaching an older adult client about osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Cottage cheese is a good source of calcium." B. "Increase your caffeine intake." C. "Brisk walking will help prevent bone loss." D. "Hormone replacement therapy with estrogen will increase your risk of osteoporosis."

Correct Answer: C. "Brisk walking will help prevent bone loss." The nurse should encourage weight-bearing exercises to help minimize bone loss in the older adult client. A sedentary lifestyle, however, leads to a loss of minerals in the bones, especially calcium and phosphorus

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? A. "I will administer a spray into each nostril daily." B. "I should expect nasal bleeding for the first week." C. "I will need to depress the side arms to activate the pump." D. "I should expect to take this medication for a short-term course of treatment."

Correct Answer: C. "I will need to depress the side arms to activate the pump." The nurse should instruct the client to activate the pump for the initial use by holding the bottle upright and depressing both white side arms toward the bottle 6 times.

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following client statements indicates that the teaching was effective? A. "I should take the medication with a glass of orange juice." B. "I will allow the medication to dissolve in my mouth." C. "I will sit upright for 30 minutes after taking the medication." D. "I should take the medication right after eating breakfast."

Correct Answer: C. "I will sit upright for 30 minutes after taking the medication." The nurse should instruct the client to sit upright or stand for at least 30 minutes after taking the medication to prevent esophagitis.

A nurse is preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure. B. Take a calcium supplement once each day if at risk for osteoporosis. C. Walking is the preferred mode of exercise to maintain strong bones. D. Caffeine intake minimizes the risk of developing osteoporosis.

Correct Answer: C. Walking is the preferred mode of exercise to maintain strong bones. The nurse should emphasize that regular walks are the preferred weight-bearing exercise to build and maintain strong bones.

A nurse is teaching a client who has a new prescription for alendronate for the treatment of osteoporosis. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take the medication in the evening." B. "I will drink a full glass of milk with the medication." C. "I will take the medication at mealtime." D. "I will sit upright after taking the medication."

Correct Answer: D. "I will sit upright after taking the medication." A client taking alendronate should sit upright for 30 minutes after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

A nurse is assessing an older adult client. Which of the following findings should the nurse report to the provider? A. Decreased cough reflex B. Decreased urinary bladder capacity C. Decreased sebum production D. Decreased spinal column movement

Correct Answer: D. Decreased spinal column movement The nurse should report an onset of lower back tenderness and restricted spinal column movement, which can indicate a compression fracture due to osteoporosis.

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa

Correct Answer: D. History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to decreased bone density, increasing the risk of fractures.

A nurse is assessing a client who has several risk factors for osteoporosis. Which of the following findings indicates that the client requires further evaluation for this disorder? A. Leg cramps with exercise B. Stress incontinence C. Abdominal distention D. Lower back pain

Correct Answer: D. Lower back pain Lower back pain is common among clients who have osteoporosis, especially when they lift, stoop, or bend. Back pain and tenderness that cause movement restriction might indicate vertebral compression fractures, which are the most common type of fracture resulting from osteoporosis.

A nurse is caring for a client who is taking a prescription for glucocorticoid adrenal replacement medication for the long-term treatment of Addison's disease. Which of the following findings indicates that the client is experiencing an adverse effect of the medication? A. Weight loss B. Hypotension C. Lethargy D. Osteoporosis

Correct Answer: D. Osteoporosis Long-term use of steroid medications such as glucocorticoid medication can inhibit bone growth and result in the adverse effect of osteoporosis with long-term treatment.

A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900 mg per day D. Perform weight-bearing exercises

Correct Answer: D. Perform weight-bearing exercises The nurse should instruct the client to perform weight-bearing exercises to promote bone formation and increase strength and mobility.

A nurse is caring for a female client who has osteoporosis and is taking raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? A. Severe leg cramps B. Urinary frequency C. Jaw pain D. Sudden onset of dyspnea

Correct Answer: D. Sudden onset of dyspnea The nurse should identify that raloxifene is a selective estrogen receptor modulator (SERM), which can have estrogenic effects in some tissues and anti-estrogenic effect in other tissues. Clients who are taking raloxifene have an increased risk of thromboembolic events such as deep-vein thrombosis, pulmonary embolism, or stroke. Therefore, the nurse should notify the provider if the client is experiencing this adverse effect of raloxifene.

A nurse is determining a client's risk of developing osteoporosis. The nurse should identify which of the following as risk factors for bone loss? (Select all that apply.) A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking

Correct Answers: A. Small body frame D. Low vitamin D intake E. Smoking Females have a higher risk of developing osteoporosis than males. Other risk factors include family history, low body mass index, and a small body frame. Consuming inadequate levels of calcium and vitamin D, smoking, and ingesting high amounts of alcohol or caffeine also increase the risk of developing osteoporosis.

A nurse is preparing to administer alendronate to a client who has osteoporosis. The nurse should recognize which of the following as an adverse effect of alendronate? A.Venous thromboemboli B.Ventricular dysrhythmias C.Breast cancer D.Joint pain

D.Joint Pain

A nurse is teaching a client who has a prescription for calcitonin-salmon how about Manna for stations of hypercalcemia. Shut the following manifestations should the nurse include in the teaching? A.Muscle twitching B.Laryngospasm C.Paresthesia D.Vomiting

D.Vomiting

A nurse is teaching a client who is scheduled for dual-energy x-ray absorptiometry (DXA) to screen for osteoporosis. Which of the following instructions should the nurse include in the teaching? a. "You will need to remove all jewelry before the test." b. "You will need to lie flat for 4 hours following the test." c. "You will need to empty your bladder before the test." d. "You will need to fast for 12 hours before the test."

a. "You will need to remove all jewelry before the test."

A nurse is teaching an older adult who is at risk for osteoporosis about beginning a program of regular physical activity. Which of the following types of activity would the nurse recommend? a. walking briskly b. riding a bicycle c. performing isometric exercises d. engaging in high-impact aerobics

a. walking briskly Weight-bearing exercises are essential for maintaining bone mass, which helps to prevent osteoporosis. Walking engages older adult clients in this preventive and therapeutic strategy.

A nurse in a provider's office is collecting a health history from a client who is at risk for primary osteoporosis. Which of the following findings is a risk factor for the development of osteoporosis? a. Obesity b. Sedentary lifestyle c. Long-term use of diuretics d. Prolonged stress

b. Sedentary lifestyle

Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The nurse teaches the patient that: a. the drug must be taken with food to prevent GI side effects. b. bisphosphonates prevent calcium from being taken from the bones. c. lying down after taking the drug prevents light-headedness and dizziness. d. taking the drug with milk enhances the absorption of calcium from the bowel

b. bisphosphonates prevent calcium from being taken from the bones.

A nurse is teaching a client about preventing osteoporosis. Which of the following statements by the client indicates a need for further teaching? a. "I will reduce my intake of sodium." b. "I will decrease my intake of caffeine." c. "I will limit my intake of soft drinks." d. "I will reduce my intake of vitamin K-rich foods."

d. "I will reduce my intake of vitamin K-rich foods."