Osteoporosis NCLEX Style Questions
11) Which change in bone structure contributes to osteoporosis? A) The diaphysis of the bone becomes longer. B) Trabeculae are increased in cancellous bone. C) The outer cortex of the bone becomes thicker. D) The diameter of the bone increases.
Answer: D Explanation: A) In osteoporosis, the diameter of the bone increases, thinning the outer supporting cortex. Trabeculae are lost from cancellous bone. Osteoporosis does not affect the length of the bone.
12) What is the primary cause of loss of height in individuals with osteoporosis? A) Collapse of vertebral bodies B) Decrease in length of long bones C) Flexion of the knees and hips D) Cervical lordosis
Answer: A Explanation: A) The loss of height in individuals with osteoporosis occurs primarily as a result of vertebral body collapse. Osteoporosis also contributes to cervical lordosis, and the knees and hips flex to help maintain the center of gravity; however, these do not contribute to overall loss of height. Osteoporosis does not cause a decrease in the length of long bones.
9) The nurse is caring for an older adult client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this medication? Select all that apply. A) "The most common adverse effect is hypercalcemia caused by taking too much of the supplement." B) "Oral calcium supplements are best taken on an empty stomach." C) "Adults 50 years of age and over should obtain at least 500 to 750 mg per day of elemental calcium." D) "If you have a condition called ventricular fibrillation, this medication might help." E) "Report symptoms of weakness, increased urination, and thirst."
Answer: A, E Explanation: A) Calcium gluconate and other calcium compounds are used to treat and prevent osteoporosis. Oral calcium supplements are best taken with meals or within 1 hour following meals. It is recommended that adults 50 years of age and over obtain at least 1000 to 1200 mg per day of elemental calcium. The most common adverse effect is hypercalcemia caused by taking too much of the supplement. Symptoms include lethargy, drowsiness, weakness, headache, anorexia, nausea and vomiting, increased urination, and thirst. Calcium supplementation is contraindicated in clients with ventricular fibrillation.
1) The nurse is assessing a postmenopausal client. Which question should the nurse ask to assess for signs of osteoporosis? A) "Have you experienced any palpitations?" B) "Are you having any low back pain?" C) "Are you having problems with swelling in your feet?" D) "Is constipation a problem for you?"
Answer: B Explanation: A client with osteoporosis will often present with low back pain as well as a decrease in height. Palpitations, constipation, and swelling are not early signs of osteoporosis. Page Ref: 857
6) An adult client who resides in a long-term care facility is diagnosed with osteoporosis. The client has a history of falls and dementia. Which nursing intervention will best aid in meeting an outcome goal of injury prevention for this client? A) Using furniture as obstacles to keep the client in the bed B) Keeping the bed in the lowest position C) Keeping a nightlight on in the hallway D) The use of wrist restraints
Answer: B Explanation: A) Keeping the bed in the lowest position will reduce the incidence of injury should the client attempt to get up. The use of restraints could increase the incidence of injury. Using the furniture as an obstacle could cause injury if the client is able to get up. In a long-term care facility, a nightlight should be provided in the room so the client can see to use the restroom.
2) A nurse is conducting a health history on an older adult client. Which assessment finding indicates the client is at risk for osteoporosis? A) Having a body mass index (BMI) that indicates obesity B) Using glucocorticoids for 10 years because of a chronic lung disorder C) Eating three to five servings of shrimp and liver per week D) Drinking three glasses of skim milk daily
Answer: B Explanation: A) Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis. Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis. A diet rich in shellfish and organ meats is high in purine, which may predispose the client to gout.
13) The nurse is caring for an 8-year-old client with cerebral palsy and limited walking ability. The parents are very protective and perform most activities for the child. Which intervention is essential in promoting bone growth and reducing the risk of osteoporosis? A) Provide client teaching related to using restraints to prevent falls. B) Provide client teaching related to assistive devices to encourage walking. C) Refer the client to a dietitian to increase calcium and vitamin D intake. D) Refer the client to an occupational therapist to increase limb movement
Answer: B Explanation: A) The most effective way to prevent osteoporosis is to perform weight-bearing activities and exercise. The client has limited walking ability rather than complete paralysis, so with practice, help from parents, and the appropriate use of assistive devices, the child could learn to walk independently. This would help stimulate bone growth. The nurse can inform the client and parents about the importance of calcium and vitamin D in the diet without referral to a dietitian. The nurse may need to refer the client to a physical therapist, not an occupational therapist, to help teach the client to walk independently. Appropriate restraints may be required to prevent falls for clients with cerebral palsy who do not have adequate body control. However, use of restraints will not increase bone growth in these clients.
14) The nurse is caring for a woman who is at 14 weeks' gestation with her first child. The woman asks the nurse, "Am I at risk for osteoporosis since my baby takes calcium from my body?" What response by the nurse is correct? A) "You may lose small amounts of bone mass with each pregnancy, but if you only have one child, the bone loss should not be significant enough to cause osteoporosis." B) "When bone mass is lost during pregnancy, it is very difficult to restore, and you may be at increased risk for osteoporosis later in life. You should take a calcium supplement to prevent this." C) "If you eat a diet that is rich in calcium, any bone mass that is lost during pregnancy and breastfeeding will be restored within several months of weaning the child." D) "The baby won't require enough calcium during development to affect your bone mass or cause osteoporosis."
Answer: C C) During pregnancy, the growing fetus requires calcium to develop the skeleton. Calcium is also required for milk production. If the mother does not eat a diet rich in calcium, the baby draws what it needs from the mother's bones, causing a decrease in bone mass. Any bone mass that is lost during pregnancy or breastfeeding is typically easily restored several months after the infant is weaned from the breast. Studies indicate that the more times women are pregnant, the greater the mother's bone density.
5) A client who is at risk for developing osteoporosis asks what can be done to decrease the risk of actually developing the disease. Which intervention would be the most beneficial for this client? A) Decreasing the amount of calcium in the client's diet B) Providing the client with assisted range of motion exercising twice daily C) Increasing regular weight-bearing activities D) Protecting the client's bones with strict bedrest
Answer: C Explanation: A) A standard intervention for those attempting to prevent osteoporosis is beginning an exercise plan that includes weight-bearing activities. Strict bedrest, decreasing calcium intake, and assisted range of motion exercises may make the osteoporosis worse.
7) The nurse is providing teaching to a young adult who is at risk for early-onset osteoporosis. Which intervention should the nurse suggest? A) The client should stop all physical activity. B) The client should reduce the intake of dairy in the diet. C) The client should increase intake of calcium and vitamin D. D) The client should start estrogen replacement therapy.
Answer: C Explanation: A) An appropriate goal for this client is a diet rich in calcium and vitamin D. Walking and weight-bearing exercise help prevent osteoporosis, so the client should not stop all physical activity. Dairy is rich in calcium, so reducing intake of dairy is not recommended. Due to the client's age, it is not likely that the client needs estrogen replacement therapy at this time.
8) A postmenopausal adult client is concerned about the development of osteoporosis and wants to begin preventative activities. Which statement by the nurse is appropriate? A) "You should first determine if you are at risk for the development of osteoporosis." B) "After menopause, the decline is too rapid to begin preventative interventions." C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." D) "Hormone replacement therapy should be initiated as soon as possible."
Answer: C Explanation: A) Osteoporosis risk factors increase after menopause. Preventative activities include implementing weight-bearing exercise and beginning calcium supplements. It is not too late to begin prevention activities. Without additional information, it is not possible to determine if the client is a candidate for hormone replacement therapy. The client in the scenario has two risk factors presented. Although a full analysis would be beneficial, it does not answer the client's request for information.
3) The nurse is planning care for a female adult client who is high-risk for developing osteoporosis. Which interventions will decrease the client's risk of developing this health problem? Select all that apply. A) Increasing the intake of alcoholic beverages B) Isometric exercise for at least 30 minutes three times per week C) Weight-bearing exercises such as walking D) Having a yearly dual-energy x-ray absorptiometry (DEXA) test E) A diet with adequate amounts of calcium and vitamin D
Answer: C, E Explanation: A) Interventions that may decrease this client's risk of developing osteoporosis include regular weight-bearing exercise, such as walking, as this activity slows bone loss. Other intervention include encouraging clients to consume adequate amounts of calcium and vitamin D in their diets to prevent osteoporotic fracture. A DEXA test measures bone density, but it does not decrease the client's risk for developing osteoporosis. Measures to prevent or treat osteoporosis include limiting the intake of beverages containing alcohol, caffeine, and phosphorus. Isometric exercises are not effective against osteoporosis.
10) A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and cigarettes? Select all that apply. A) "Smoking decreases nerve supply to the bones." B) "Nicotine increases calcium absorption, leading to decreased bone density." C) "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral content." D) "Alcohol has a direct toxic effect on osteoclast activity, suppressing bone formation." E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis."
Answer: C, E Explanation:A) Both cigarette smoking and excess alcohol intake are risk factors for osteoporosis. Smoking decreases the blood supply to bones, and nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density. Alcohol has a direct toxic effect on osteoblast activity, suppressing bone formation during periods of alcohol intoxication. In addition, heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis. Interestingly, moderate alcohol consumption in postmenopausal women actually may increase bone mineral content, possibly by increasing levels of estrogen and calcitonin
4) The nurse identifies the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements as appropriate for a client with osteoporosis. Which client statement indicated to the nurse that this nursing diagnosis was appropriate? A) "I like to remove all of the fat from the meat I eat." B) "I am trying to eat a low-carb diet." C) "I plan to start eating out less." D) "I am allergic to dairy products."
Answer: D Explanation: A) The client who is allergic to dairy products may not take in much calcium, which increases the risk of osteoporosis, so focusing on diet would be a priority for this client. The statements about removing fat, eating a low-carb diet, and eating out less are healthy changes for many individuals that help reduce calorie intake, but they would not address one of the root causes of osteoporosis, deficient calcium intake.