Osteoporosis Nclex Questions

Intervention to prevent osteoporosis in women should start at which age?

20-35 years

The nurse should include which of the following client teachings for prevention of rapid progression of osteoporosis? a) avoid taking skim milk b) avoid taking protein-rich foods c) avoid calcium supplement d) avoid alcohol

D - avoiding alcohol and cigarette smoking will prevent rapid progression of osteoporosis. Skim milk is indicated among elderly because it is low in fats. Protein foods are necessary for calcium absorption. Calcium supplements help maintain integrity of the bones

Alendronate is used in treatment of osteoporosis because it?

Inhibits osteoclastic activity

Which of these is a risk factor for osteoporosis a-Age and family history b-Obesity and smoking c-All of the above

All of the above

Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? a-Take the medication in the morning with meals. b-Take the medication 2 hours before bedtime. c-Take the medication with a glass of water after rising in the morning. d-Take the medication during lunch.

C: Alendronate needs to be taken with a glass of water after rising in the morning in order to prevent gastrointestinal effects. A, B, D: Not taking Alendronate on the specified time of the day could cause GI upset.

All of the following are risk factors for osteoporo-sis EXCEPT: (A) Low calcium intake (B) Smoking (C) Alcohol use (D) Turner's syndrome (E) Obesity

(E) Obesity. Risk factors for osteoporosis may be inherited or acquired. 1,2 Inherited factors include female sex and white or Asian ancestry. Women with Turner's syndrome or any condition leading to low estrogen levels are at increased risk of osteoporosis. Women with a personal history of fracture as an adult or history of osteoporosis in a first-degree rela- tive also are at increased risk. Acquired risk factors include current smoking ( ≥ 1 pack per day), alco- hol use ( ≥ 2 drinks per day), low calcium intake (< 1200 mg per day), and sedentary lifestyle. Finally, women with low body weight (< 127 lb) are at in- creased risk for osteoporosis. Guidelines for osteo- porosis screening and prevention are available only for women at this time.

The daily requirement of calcium for an adult woman is

1200 mg

The nurse is instructing a 65-year-old female client diagnosed with osteoporosis. The most important instruction regarding exercise would be to: a-Exercise doing weight bearing activities. b-Exercise to reduce weight. c-Avoid exercise activities that increase the risk of fracture. d-Exercise to strengthen muscles and thereby protect bones.

A: Weight bearing exercises are beneficial in the treatment of osteoporosis. B, C, D: Although loss of bone cannot be substantially reversed, further loss can be greatly reduced if the client includes weight bearing exercises along with estrogen replacement and calcium supplements in their treatment protocol.

A client with osteoporosis is asking the nurse regarding the use of Salmon calcitonin (Miacalcin) nasal spray. The nurse tells the client to do the following, except? a-Delivery system contains enough medication for at least 30 doses. Discard any unused solution after 30 doses. b-If you do not feel the spray while using it, repeat the dose on the other nostrils. c-Miacalcin is usually given as one spray per day into only one of your nostrils. d-Take extra vitamin D while you are using Miacalcin.

B: Miacalcin spray delivers a fine mist into the nose. Even if the client does not feel the spray while using it, the medication is still being absorbed by the nasal passages. A: Discard any unused solution after 30 doses because spray may not deliver correct dose. C: Use the other nostril the next day and continue alternating back and forth for each daily dose. D: Vitamin D helps in treating osteoporosis by helping in maintaining healthy bones.

A nurse is conducting a health screening among females at the mall to assess those who are at risk for developing osteoporosis. Which of the following questions is most appropriate to be asked by the nurse in relation to development of osteoporosis? a) at what age did you have your menstruation? b) did you have any fracture? c) are you taking corticosteroids? d) are you on the diet high in vitamin D?

C - corticosteroids promote calcium loss. This increases the risk for osteoporosis.

What is the best way to diagnose osteoporosis

Bone density scan

Postmenopausal women are more prone to suffer from osteoporosis due to?

Decreased estrogen level

A 50 - year - old African American woman visits your office for an annual examination. She takes inhaled steroids and Beta- agonists for mild intermittent asthma. Her past medical history is negative for any fracture. She has no family history of osteoporosis. She exercises regularly. Her menses are regular. Based on her history, what are your recommendations for osteoporosis prevention and screening? (A) Take 800 mg of calcium and 800 IU vitamin D daily (B) Take 1200 mg of calcium and 400 IU vitamin D daily (C) Bone mineral density (BMD) screening (D) Begin calcitonin therapy to increase bone density (E) Begin alendronate therapy to increase bone density

(B) Take 1200 mg of calcium and 400 IU vitamin D daily. This patient has no risk factors for osteoporosis. Although oral steroids are a recognized cause of increased bone loss in adults, inhaled steroids are not. The National Osteoporosis Foundation (NOF)advises that all individuals consume at least 1200 mg of calcium and 400 to 800 IU vitamin D daily. The US Preventive Services Task Force recommends that physicians conduct routine BMD screening for all women older than 65 years. For women with risk factors for osteoporosis, screening is recommended beginning at age 60 years. Alendronate is a Food and Drug Administration (FDA)-approved medication for prevention and treatment of osteoporosis. Calcitonin is approved for treatment of osteoporosis only, not prevention.

An 80 - year - old Asian woman presents to your office with back pain. She notes that the pain began on the previous day after stepping off a curb. She has been unable to sleep due to the pain. Physical examination reveals she has a dorsal kyphosis and tenderness over a midthoracic spinous process. Results of neurologic examination are negative for signs of cord compression. You prescribe a mild narcotic pain reliever and order thoracic spine films. Which of the following medications would be of most immediate benefit to this patient? (A) Calcium supplements (B) Residronate (C) Calcitonin (D) Estrogen (E) Alendronate

(C) Calcitonin. Sudden onset of severe back pain following minimal or no trauma suggests an osteo- porotic vertebral fracture. The presence of a dorsal kyphosis also points to osteoporosis. Treatment with narcotic analgesia is appropriate for a presumed ver- tebral fracture. Plain radiographs may or may not reveal the acute fracture but are useful to rule out other bone pathology, such as metastatic disease. This patient should have calcium supplementation, but other medication is indicated for treatment of osteoporosis. Estrogen, alendronate, and risedronate are FDA- approved for the prevention and treatment of osteoporosis but do not provide immediate relief. However, the FDA recommends nonestrogen treatments be considered first for osteoporosis. In addition to reducing vertebral fractures, calcitonin has been shown to produce significant alleviation of the acute pain from osteoporotic vertebral fractures.

Which of the following medical conditions or med- ications can lead to secondary osteoporosis? (A) Hypothyroidism (B) Zinc deficiency (C) Type 2 diabetes mellitus (D) Gonadotropin- releasing hormone (GnRH) agonists (E) Angiotensin- converting enzyme (ACE) inhibitors

(D) GnRH agonists. Osteoporosis can occur sec- ondary to any condition or medication that causes accelerated bone loss. 2 Conditions that may cause secondary osteoporosis include athletic amenor- rhea, anorexia nervosa, hyperthyroidism, type 1 dia- betes mellitus, and malabsorption syndromes. Med- ications that can cause secondary osteoporosis include excessive use of thyroid hormone, oral corti- costeroids (taken for > 3 months' duration), GnRH agonists, phenytoin, phenothiazines, long - term heparin, and phenobarbital. ACE inhibitors and zinc deficiency do not cause osteoporosis.

A 65 - year - old white woman presents for interpretation of BMD testing. Her personal medical history is unremarkable, but her mother died at age 75 years due to complications of a hip fracture. Her T score is - 2. Which of the following choices is the correct interpretation of this patient's T score and treatment? (A) Normal BMD; calcium supplementation (B) Normal BMD; alendronate for prevention (C) Osteopenia; zinc supplementation for preven- tion (D) Osteopenia; alendronate for treatment (E) Osteoporosis; residronate for treatment

(D) Osteopenia; alendronate for treatment. The T score compares the patient's BMD in standard deviations with the average BMD of a young adult of the same gender. T score between 0 and - 1 indi- cates normal bone density. A T score between - 1 and - 2.5 are consistent with osteopenia. T score 2.5 standard deviations or more below the standard (T score ≤- 2.5) indicates osteoporosis. This patientis at increased risk for osteoporosis owing to her race and family history. Her BMD testing results indicate that she has osteopenia.

You are teaching a patient with osteopenia. What is important to include in the teaching plan? a )Lose weight. b )Stop smoking. c )Eat high protein diet. d )Start swimming for exercise.

Answer b

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.

Answer is: b

Which patient would be at greatest risk for developing osteoporosis? a )A 73-year-old man who has five alcoholic drinks per week and limits sun exposure to prevent recurrence of skin cancer. b )An 84-year-old man who has recently been diagnosed with hypothyroidism and is prescribed levothyroxine (Synthroid). c )A 69-year-old woman who had a renal transplant 5 years ago and has been taking prednisone to prevent organ rejection. d )A 55-year-old woman who recently had a hysterectomy with bilateral salpingo-oophorectomy and refuses estrogen therapy.

Answer is: c

A patient started Alendronate (Fosamax) once a week for the treatment of osteoporosis. The nurse determines that further instruction about the drug is needed when what is said by the patient? a-"I should take the drug with a meal to prevent stomach irritation". b-"This drug will prevent further bone loss and increase my bone density". c-"I need to sit or stand upright for at least 30 minutes after taking the drug". d-"I will still need to take my calcium supplements while taking this new drug ".

Answer: a The Bisphosphonate, such as Alendronate, must be taken at least 30 minutes before food or other medications to promote absorption

A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? SELECT ALL THAT APPLY a)"It's common in females after menopause." b) "It's a degenerative disease characterized by a decrease in bone density." c) "It's a congenital disease caused by poor dietary intake of milk products." d) "It can cause pain and injury." e) "Passive range-of-motion exercises can promote bone growth." f) "Weight-bearing exercise should be avoided."

Answer: a, b, d Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth.

Identify methods to specifically prevent osteoporosis in postmenopausal women (Select all that apply)? a-Eating more beef. b-Eating 8 oz. of yogurt daily. c-performing weight bearing exercises. d-Spending 15 minutes in the sun each day. e-Taking postmenopausal estrogen replacement.

Answers are: b,c To specifically prevent osteoporosis in postmenopausal women, increased calcium and vitamin D intake and weight bearing exercises (e.g. walking) are the best methods.

Which female patients are at risk for developing osteoporosis (Select all that apply) ? a-60 year old white aerobic instructor. b-55 year old Asian American cigarette smoker. c-62 year old African American on estrogen therapy. d-68 year old white who is underweight and inactive e-58 year old Native American who started menopause prematurely.

Answers are: b,d,e Risk factors for osteoporosis include age greater than 65, white or Asian ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen deficiency including premature menopause.

The nurse knows that a 60-year-old female client's susceptibility to osteoporosis is most likely related to: a-Lack of exercise. b-Hormonal disturbances. c-Lack of calcium. d-Genetic predisposition

B: After menopause, women lack hormones necessary to absorb and utilize calcium. A&C: Doing weight-bearing exercises and taking calcium supplements can help to prevent osteoporosis but are not causes, so answers A and C are incorrect. D: Body types that frequently experience osteoporosis are thin Caucasian females, but they are not most likely related to osteoporosis, so answer D is incorrect.

Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis? a-A female patient being treated for high blood pressure with an ACE inhibitor. b-A patient who is allergic to iodine/shellfish. c-A patient on a calorie restricted diet. d-A patient on bed rest who must maintain a supine position

D: Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in supine position. A&B: ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship. C: The patient should not eat or drink for 30 minutes after administration and should not lie down.