Osteoporosis
b
A 67-year-old client asks the nurse about osteoporosis. The nurse responds that osteoporosis is defined and characterized as: a thickening of the outer cortex of the bones. b loss of bone mass or density. c new, but weaker, bone growth. d having only unmodifiable risk factors.
d Rationale: Alendronate is a potent drug that inhibits osteoclastic activity, or bone resorption, which tends to occur with aging and loss of estrogen among other causes. The drug is often used to help decrease the incidence of vertebral and other fractures in postmenopausal women. The actions of these drugs do not include preventing thrombus formation, the binding of bile acids, or acting as an anti-inflammatory agent.
A client attending a community information session on health topics and the elderly notes that her nurse practitioner recently placed her on Fosamax and asks for more of an explanation about what this drug does. The nurse would advise her that Fosamax (or, alendronate) is used for what purpose? a Binding bile acids in the gastrointestinal tract to enhance calcium resorption b Decreasing spinal fractures and preventing formation of thrombosis c Suppressing inflammation and the normal immune response and enhancing metabolic processes d Inhibiting osteoclastic activity, which causes bone resorption and decreasing the incidence of vertebral and other fractures
a,b,d
A client is seen in the nurse's clinic for the treatment of osteoporosis. Which food can the nurse recommend to provide calcium? (Select all that apply.) a Broccoli b Canned sardines c Organ meats d Yogurt e Wine
a,d,e
A client with osteoporosis asks the nurse about pharmacologic treatment for this condition. The nurse responds that pharmacologic treatment typically includes: (Select all that apply). a Bisphosphonates b Non-steroidal anti-inflammatories (NSAIDS) c Gold salts d Calcitonin e Oral calcium
b,c,d,e A client that consumes MORE THAN 3 glasses of wine a day would be at risk because EXCESSIVE alcohol use can increase bone loss. A client with a BMI of 21 is at risk due to low body weight and body build, suggesting decreased bone mass (the other answers are easy to rationalize
ATI: A nurse is admitting an older adult client who has suspected osteoporosis. Which of the following is an expected finding? (SELECT ALL THAT APPLY) a. history of consuming one glass of wine daily b. loss in height of 2 in (5.1 cm) c. Body mass index of 21 d. kyphotic curve at upper thoracic spine e. history of lactose intolerance
a,b,c,e DO NOT WALK ON ICY SURFACES DUH
ATI: A nurse is preparing discharge teaching on home safety for an older adult client who has osteoporosis. Which of the following information should the nurse include in the teaching? (select all that apply) a. remove throw rugs in walkways b. use prescribed assistive devices c. remove the clutter from the environment d. walk with caution on icy surfaces e. maintain lighting of doorway areas
b The client should remain in the supine position with the bed flat the first 1-2 hr following the procedure for hardening of the cement
ATI: A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following is an appropriate action by the nurse? a. apply heat to the puncture site b. place the client in the supine position c. turn the client every 1 hr d. ambulate the client within the first hour post procedure
b
ATI: A nurse is providing 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
a,c,d,e Prednisone and phenytoin affect the absorption and metabolism of Ca. Bones need weight bearing activity smoking increases risk
ATI: A nurse performing health screenings at a health fair. Which of the following clients are at risk for osteoporosis? (select all that apply) a. a 40-year old client who takes prednisone for asthma b. a 30-year old client who jogs 3 miles per day c. A 45-year old client who takes phenytoin for seizures d. A 65-year old client who has a sedentary lifestyle e. A 70-year old client who has smoked for 50 years
b
Although all of the following nursing diagnoses are important when planning care for the client with osteoporosis, which will the nurse select as the most significant in terms of long-term disability? a Acute pain b Risk for falls c Chronic pain d Activity intolerance
c
An older adult female client is diagnosed with osteoporosis. The client wants to know why this disorder has occurred. The nurse will base the response on which risk factor in the client's history? a Aerobic exercise three times per week b Diet rich in calcium c Lack of vitamin D d Low testosterone
b Rationale: Weight-bearing exercises, not isometrics, help prevent bone loss if done for at least 30 minutes at least 4 times a week; walking is a weight-bearing exercise. It is important to maintain adequate calcium intake when taking fluoride. Smoking should be stopped altogether.
The nurse determines that teaching goals have been met for a client with osteoporosis when the client states: a "I can stop taking calcium since I'm taking Vitamin D." b "I'll try and walk at least one mile a day." c "I can smoke if I cut back to half a pack of cigarettes a day." d "I should do 30 minutes of isometric exercises every day."
c
The nurse is caring for a client diagnosed with osteoporosis. In planning the client's care, which nursing diagnosis is the most appropriate? a Hyperthermia b Hypothermia c Impaired mobility d Impaired perfusion
a
The nurse is caring for a client with osteoporosis. Which medication taken by the client may have contributed to this diagnosis? a Prednisone b Vitamin D supplements c Acetaminophen d Calcium supplements
a,c,d
The nurse is providing care for a female client who reports lower back pain. The client states that the symptoms are postmenopausal, but she has been having difficulty staying asleep because of the discomfort. Which assessment should the nurse perform? (Select all that apply.) a Muscle strength b Hearing acuity c History of fractures d Pain e Visual acuity
a Rationale The DEXA measures bone density in the lumbar spine or hip. An ultrasound is administered to the heel of the foot to measure bone density. X-rays detect osteopenia and identify fractures. A quantitative ultrasound (QUS) is used to evaluate bone mineral density and the degree of osteoporosis.
The nurse is providing care to a client diagnosed with osteoporosis. Dual-energy x-ray absorptiometry (DEXA) has been ordered for the client. Which explanation of this diagnostic procedure is the most appropriate? a "The test measures bone density in the lumbar spine or hip. b "The test is administered to the heel of the foot to measure bone density. c "The test is used to evaluate bone mineral density and the degree of osteoporosis. d The test detects osteopenia and identifies fractures.
a
What will the nurse include in the health history of a client with osteoporosis? a Assessing level of activity b Assessing pain c Assessing muscle strength d Assessing height
c
When teaching the client with osteoporosis about preventive measures to avoid complications of osteoporosis, the nurse would emphasize which topic? a Infection b Blood clots c Fractures d Contractures
c The BMD test differentiates osteoporosis from other bone-related disorders. Ultrasound and x-rays may also be used in the diagnosis but their results will not be conclusive for osteoporosis. A CBC is not useful in the diagnosis of osteoporosis.
Which diagnostic test is used to differentiate osteoporosis from other bone-related disorders? a Complete blood cell count (CBC) b Ultrasound c Bone mineral density (BMD) test d X-ray
a,b,e High-protein diets can contribute to osteoporosis. Vitamin D can help the body absorb and use calcium. Cigarette smoking impairs the absorption of calcium and contributes to decreased bone density. Moderate alcohol consumption in postmenopausal women may increase bone mineral content by increasing levels of estrogen and calcitonin, although excessive consumption can encourage bone loss. Weight-bearing exercise decreases the risk of osteoporosis.
Which items can help reduce the risk of osteoporosis? (Select all that apply.) a Vitamin D b Moderate alcohol consumption c A high-protein diet d Moderate cigarette smoking e Weight-bearing exercise
a,b,e Rationale: Fosamax is in a class of drugs called bisphosphonates, which inhibit bone resorption. Because it is poorly absorbed, it should be taken on an empty stomach. The client should remain upright for 30 minutes and not eat or drink for 30 minutes after taking the medication to avoid esophagitis. It should also not be taken by women with a history of blood clots.
Which nursing intervention(s) is/are important when alendronate (Fosamax) is prescribed for an older client? (Select all that apply.) a Instruct the client to remain upright for 30 minutes and to not eat or drink anything else for 30 minutes. b Instruct the client to take Fosamax on an empty stomach, first thing in the morning and with water. c Monitor daily weight, and observe for signs of weight gain. d Instruct the client to take the medication with meals, highly fluid soups, or cereals. e Avoid taking Fosamax if the client has a history of blood clots.
b,e Rationale: Throughout life, new bone continually is deposited and reabsorbed in response to hormonal, dietary, and mechanical stimuli. Certain stimuli inhibits new bone growth (e.g., entering menopause for women, deficient calcium and vitamin D intake, cigarette smoking), or accelerates bone absorption (e.g., prolonged use of heparin). Body alignment does not directly affect bone density, although conditions that prevent weight-bearing activities diminish osteoblast production. Exercise, particularly weight-bearing exercise, is important for bone health; passive or non-weight bearing exercising does little to stimulate bone formation. A diet that is very high in protein may result in acidosis, which may cause calcium to be withdrawn from the bone as the kidneys buffer excess acid. In addition, long-term use of antacids containing aluminum promotes excretion of calcium needed for bone growth.
Which of the following is the major mechanism for maintaining bone density in the body? (Select all that apply.) a Active and passive exercises b Greater osteoblast formation and limited osteoclast formation c Appropriate body alignment d High protein diet e Avoiding prolonged use of antacids