Ch. 63
During a health screening event, which assessment finding would alert the nurse to the possible presence of osteoporosis? 1 A measurable loss of height 2 The presence of bowed legs 3 Poor appetite and aversion to dairy products 4 Development of unstable, wide-gait ambulation
Correct1 A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis, in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis, but are not indicative of osteoporosis. A wide gait is used to support balance and does not indicate osteoporosis.
The nurse is admitting a patient to the acute care unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action aggravates the pain? 1 Bending or lifting 2 Application of warm moist heat 3 Sleeping in a side-lying position 4 Sitting in a fully extended recliner
Correct1 Back pain that is related to a herniated lumbar disc often is aggravated by events and activities that increase the stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test). Application of moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.
A patient has been taking bisphosphonates for the treatment of osteoporosis and has demonstrated a low tolerance to the drug. What alternative medication does the nurse anticipate will be prescribe? 1 Calcitonin 2 Corticosteroids 3 Cholestyramine 4 Divalproex sodium
Correct1 Calcitonin is recommended for patients who are unable to tolerate bisphosphonates. Patients on corticosteroids are put on bisphosphonates because long-term corticosteroid use to osteoporosis and hence it cannot be alternative. Cholestyramine is known for the risks associated with osteomalacia. Divalproex sodium does not contain a bisphosphonate compound.
The patient asks the nurse which foods are good sources of calcium. Which food does the nurse recommend? 1 Milk 2 Carrot 3 Lettuce 4 Potatoes
Correct1 Milk is a good source of calcium. Carrots, potatoes, and lettuce are poor sources of calcium. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.
The nurse is admitting a patient to the clinic that is suspected of having osteomalacia. Which diagnostic test should the nurse prepare the patient for to confirm the diagnosis? 1 X-ray 2 Quantitative ultrasound (QUS) 3 Magnetic resonance imaging (MRI) scan 4 Dual-energy x-ray absorptiometry (DXA)
Correct1 X-rays reveal ribbons of bone decalcification, confirming the presence of the disease. QUS and DXA are used to measure the bone mineral density in patients with osteoporosis. An MRI scan is not required, because x-rays detect the bone defects.
A patient reports swelling of the bursa and the formation of a callus over a bony enlargement of the forefoot. Which disorder does the nurse determines correlates with these findings? 1 Hammertoe 2 Hallux valgus 3 Hallux rigidus 4 Morton's neuroma
Correct2 A patient with Hallux valgus disorder, or a bunion, has a painful deformity of the great toe towards the second toe. Swelling of bursa and the formation of a callus over a bony enlargement are the common symptoms of a bunion. A Morton's neuroma is characterized by a neuroma developing in the web space between the third and fourth metatarsal heads. The neuroma causes sharp and sudden attacks of pain and a burning sensation in the patient. With hammertoe, the patient has difficulty walking or wearing shoes and pain and a burning sensation on the bottom of the foot. Hallux rigidus is associated with painful stiffness at the metatarsophalangeal joint. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options .
A patient is admitted to the nursing unit with a history of a herniated lumbar disc and lower-back pain. The nurse would suspect which causative factor of increasing pain? 1 Humid weather 2 Bending forward 3 Frequent position changes 4 Sleeping on a firm mattress
Correct2 Back pain that is related to a herniated lumbar disc often is aggravated by events and activities that increase stress and strain on the spine, such as bending or lifting, coughing, sneezing, or lifting the leg with the knee straight (straight-leg-raise test). Sleeping on a firm mattress and frequent position changes are recommended to reduce pain, and warm weather will not increase pain.
Bone remodeling is consistent in reducing fractures unless the patient has which condition? 1 Cancer 2 Osteoporosis 3 Osteomyelitis 4 Osteochondroma
Correct2 Bone remodeling is not consistent in patients with osteoporosis, since bone loss exceeds building of bone with osteoclasts. Cancer does not cause bone remodeling to occur, but cancer treatment may alter the rate of osteoclasts. Osteomyelitis is an infection of the bone and does not affect remodeling. Osteochondroma is a common benign bone tumor, an overgrowth of cartilage and bone near the end of the growth plate, and does not affect remodeling.
A patient taking calcitonin reports facial flushing and nausea and is considering discontinuation of the medication. What can the nurse suggest that will reduce these side effects? 1 Administering the drug by oral route 2 Administering the drug intramuscular (IM) 3 Administering the drug using the intravenous (IV) route 4 Having the patient use the intranasal route for administration.
Correct2 Intramuscular (IM) administration of salmon calcitonin at night reduces the side effects of facial flushing. Salmon calcitonin is not available in oral or intravenous forms. Nasal sprays are effective in inhibiting nausea, but facial flushing is a side effect.
Which factor makes women more prone to osteoporosis compared to men? 1 Large-boned frame 2 Estrogen deficiency 3 High-impact aerobics 4 Bisphosphonates intake
Correct2 Postmenopausal women are at a greater risk for osteoporosis due to decreased estrogen. Women with larger boned frames with more bone mass are less prone to osteoporosis. High-impact aerobics can result in stress fractures due to extra pressure on the bones. Postmenopausal women are prescribed bisphosphonates to treat estrogen deficiency.
A patient with acute osteomyelitis asks the nurse how this problem will be treated. Which response by the nurse is most appropriate? 1 "Oral antibiotics often are required for several months." 2 "Intravenous (IV) antibiotics usually are required for several weeks." 3 "Surgery almost always is necessary to remove the dead tissue that is likely to be present." 4 "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."
Correct2 The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Oral antibiotics are not effective. Surgery may be used for chronic osteomyelitis, which may include debridement of the devitalized and infected tissue and irrigation of the affected bone with antibiotics. Antibiotics are not commonly injected into the affected area.
A patient with osteomyelitis asks the nurse how this problem will be treated first. What is the best response by the nurse? 1 "You will need oral antibiotics and antifungals for two to three months." 2 "Intravenous antibiotics are the first treatment choice for this condition." 3 "It is likely that a portion of your bone will be removed to treat the infection." 4 "Surgery to remove the damaged tissue is the best way to treat this condition."
Correct2 The standard treatment for osteomyelitis consists of several weeks of intravenous antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Oral antibiotics are not as effective as intravenous antibiotics for this severe infection. If the antibiotics fail to resolve the infection, surgery may be indicated; however, this is not the first line of treatment.
The nurse is assessing a patient who is taking alendronate for osteoporosis. What should the nurse inform the patient to be aware of when taking this medication? 1 Helps replace low calcium levels 2 Can lead to uncontrolled weight gain 3 Must be taken with a full glass of water 4 Is always given after primary treatment with estrogen therapy
Correct3 Gastritis is a common side effect of this drug, so the patient has to be instructed to take the medication with a full glass of water. Alendronate does not have any effect on blood calcium levels. Anorexia and weight loss, not weight gain, are associated with this drug. Estrogen therapy is no longer given as primary treatment for menopausal symptoms because of an increased risk of heart disease, and of breast and uterine cancer.
A patient diagnosed with osteomalacia is prescribed nutritional therapy and phosphorus supplements. Which other nonpharmacologic instruction is appropriate for the nurse to include on the patient's care plan? 1 Instructing the patient to wear a corset 2 Instructing the patient to use a firm mattress 3 Encouraging the patient to expose self to sunlight 4 Encouraging the patient to perform high-impact aerobics
Correct3 Osteomalacia is caused by vitamin D deficiency, which can be helped by exposure to sunlight and ultraviolet rays. In Paget's disease, the patient may be required to wear a corset or light brace to relieve back pain and provide support when in an upright position. Along with the corset, a firm mattress should be used to provide back support and relieve pain. The patient with osteomalacia should be discouraged from high-impact aerobics and activities such as running, lifting, and twisting, because they put too much stress on the bones. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings.
The nurse is educating an older adult patient with osteoporosis that has a sedentary lifestyle. What should the nurse include when discussing this with the patient? 1 "Avoid exposure to sunlight." 2 "Reduce intake of meat and fish." 3 "Quit smoking and reduce alcohol intake." 4 "Refrain from any weight-bearing exercise."
Correct3 The nurse should instruct the patient to quit smoking and reduce intake of alcohol, because both can increase the risk of bone loss. The patient should be advised to be more active and spend at least 20 minutes a day in the sun. A daily intake of food should include eggs, meat, fish, and cereals fortified with calcium and vitamin D. The patient should gradually begin weight-bearing exercises to promote bone growth.
The nurse is planning health promotion teaching for a patient with asthma, low back pain from a herniated lumbar disc, and hypertension. The nurse determines which exercise would be best to include in an individualized exercise plan for the patient? 1 Tennis 2 Running 3 Walking 4 Weightlifting
Correct3 The patient would benefit from an aerobic exercise that takes into account the patient's health status and fits the patient's lifestyle. The best exercise of those listed is walking, which builds strength in the back and leg muscles and is an aerobic exercise as well. Running, weightlifting, and tennis may result in improper body mechanics, too much stress on the body, and increased low back pain. Running also may result in asthma exacerbation.
The patient is prescribed calcium supplements. What does the nurse recommend to help increase calcium absorption into the bone? 1 Aspirin 2 Steroids 3 Vitamin D 4 Calcium citrate
Correct3 Vitamin D increases calcium absorption into the bone. Calcium citrate is poorly absorbed. Steroids reduce bone metabolism. Aspirin does not have an effect on calcium.
A patient is at risk for bone fracture related to osteoporosis. Which weight-bearing activity does the nurse instruct the patient to use to reduce risk of bone fracture? 1 Do chair aerobics. 2 Swim laps in the pool. 3 Walk 30 minutes daily. 4 Do isometric exercises.
Correct3 Weight-bearing exercises involve activities while standing or moving on the feet. Walking is a weight-bearing activity using the weight of the body. Swimming, isometric exercise, and chair aerobics do not use the weight of the body, making them less effective in preventing bone fractures. Test-Taking Tip: Multiple choice questions can be challenging because students think they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.
The nurse knows the risk of bone fractures increases for women as they age. Bone density tests are recommended for all women over which age? 1) 45 2) 50 3) 55 4) 65
Correct4 Bone density tests are recommended for all women over age 65. Women under 65 are recommended to have bone density tests only if they have risk factors like low body weight, smoking, and a history of fracture.
A patient is diagnosed with osteomalacia. Which clinical manifestation does the nurse determine correlates with this diagnosis? 1 Dementia 2 Headaches 3 Loss of hearing 4 Weakness in the pelvic girdle
Correct4 Muscular weakness in the pelvic girdle is a clinical manifestation of osteomalacia. This makes simple tasks such as getting up from a chair difficult. Patients with Paget's disease report dementia, headaches, and loss of hearing. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.
The nurse is caring for a patient in the postoperative phase of spinal surgery. What nursing action is most appropriate when turning a patient? 1 Placing a pillow between the patient's legs and turning the body as a unit. 2 Having the patient turn to the side by grasping the side rails to help turn over. 3 Elevating the head of bed 30 degrees and having the patient extend the legs while turning. 4 Turning the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed.
Correct: 1 Placing a pillow between the legs and turning the patient as a unit log rolling helps to keep the spine in good alignment and reduces pain and discomfort following spinal surgery. Having the patient turn by grasping the side rail to help puts strain on the back. Turning with head of bed at 30 degrees with legs extended will misalign the spine and likely cause damage. Elevating the head of the bed and turning the head, shoulders, and hips separately will cause pain and misalign the spine.