Chapter 44: Drug Therapy to Regulate Calcium and Bone Metabolism

A 43-year-old male client takes prednisone 7.5 mg daily to treat his temporal arteritis. His dose varies from 7.5 to 10 mg based on symptoms and laboratory test analysis. His disease process has been managed successfully with this drug regimen for 7 years. To prevent osteoporosis, what would his health care provider order? (Select all that apply.) a. A calcium supplement b. Testosterone c. A bisphosphonate drug d. Regular weight-bearing exercise e. A soy supplement

a. A calcium supplement c. A bisphosphonate drug d. Regular weight-bearing exercise Preventive measures are necessary for clients on chronic corticosteroid therapy (e.g., prednisone 7.5 mg daily; equivalent amounts of other systemic drugs; high doses of inhaled drugs). For both men and women, most of the guidelines for prevention of osteoporosis apply (e.g., calcium supplements, regular exercise, a bisphosphonate drug). In addition, low doses and nonsystemic routes help prevent osteoporosis and other adverse effects. For men, corticosteroids decrease testosterone levels by approximately one half, and replacement therapy may be needed.

A client has a blood calcium level of 4.6 mg/dL and is experiencing twitching of the facial muscles and tingling of the lips, fingers and toes. What is the priority action by the nurse? a. Administer calcium gluconate IV as prescribed. b. Request a prescription for ibandronate IV. c. Give calcitonin IV as prescribed d. Administer prednisone PO as prescribed.

a. Administer calcium gluconate IV as prescribed. The client's critically low calcium level is causing neuromuscular irritability as evidenced by the tetany and reports of tingling in the fingers, toes, and lips. The client needs calcium supplementation with an IV preparation that will work rapidly to elevate the calcium levels. Therefore, the nurse would administer prescribed calcium gluconate. Ibandronate is a biphosphate used for the treatment of osteoporosis; it would not be effective for emergency treatment of low calcium levels. Calcitonin and prednisone are indicated for treatment of hypercalcemia.

The nurse is reviewing the client's medication history. The client is to receive ibandronate. Which supplements would the nurse identify as possibly interfering with the drug's absorption? (Select all that apply.) a. Antacids b. Iron c. Calcium d. Multiple vitamins e. Aspirin

a. Antacids b. Iron c. Calcium d. Multiple vitamins Antacids decrease the absorption of oral bisphosphonates, such as ibandronate. Iron decreases the absorption of oral bisphosphonates, such as ibandronate. Calcium decreases the absorption of oral bisphosphonates, such as ibandronate. Multiple vitamins decrease the absorption of oral bisphosphonates, such as ibandronate. Aspirin increases the GI distress associated with bisphosphonates, but does not affect absorption.

A nurse's assessment of a client has revealed signs and symptoms of Paget's disease. Which of the following is one of the signs the nurse may have observed? a. Bone deformity b. Nearsightedness c. Shuffling gait d. Decreased pain response

a. Bone deformity Paget's disease is an inflammatory skeletal disease that affects older people. Its etiology is unknown. It is characterized by a high rate of bone turnover and results in bone deformity and pain.

Which of the following are examples of vitamin D preparations for oral intake? Choose all that apply. a. Calcitriol (Rocaltrol, Calcijex) b. Cholecalciferol (Delta-D) c. Paricalcitol (Zemplar) d. Calcium acetate (PhosLo) e. Calcium carbonate (Os-Cal, Tums)

a. Calcitriol (Rocaltrol, Calcijex) b. Cholecalciferol (Delta-D) c. Paricalcitol (Zemplar) Calcium acetate (PhosLo) and calcium carbonate (Os-Cal, Tums) are both examples of calcium supplements. All the others are examples of vitamin D preparations.

A client is taking prednisone 10 mg per day. Which laboratory study does the nurse identify as directly correlated with the use of this medication? a. Calcium level of 6.2 mg b. Potassium level of 4.2 mEq/L c. Phosphorus level of 3.5 mg/dL d. Sodium level of 145 mEq/L

a. Calcium level of 6.2 mg Normal serum calcium is 8.5 to 10.5 mg/dL. A low calcium level directly corresponds to the chronic use of corticosteroids; steroids decrease the absorption of calcium and place the client at risk for the development of osteoporosis. Potassium, sodium, and phosphorus levels are within normal range.

Calcium participates in many metabolic processes, including the regulation of which of the following? Choose all that apply. a. Cell membrane permeability and function b. Nerve-cell excitability and transmission of impulses c. Contraction of cardiac, skeletal, and smooth muscle d. Essential component of deoxyribonucleic acid e. Combines with fatty acids to form phospholipids

a. Cell membrane permeability and function b. Nerve-cell excitability and transmission of impulses c. Contraction of cardiac, skeletal, and smooth muscle Calcium participates in many metabolic processes, including the regulation of cell membrane permeability and function; nerve-cell excitability and transmission of impulses (e.g., required for release of neurotransmitters at synapses); and contraction of cardiac, skeletal, and smooth muscle. Phosphorus is an essential component of DNA and also forms phospholipids.

The nurse is caring for a 77-year-old client and understands that calcium deficiency commonly occurs in the elderly because of what factors? (Select all that apply.) a. Impaired absorption of calcium from the intestine b. Excessive exposure to ultraviolet rays c. Lack of exposure to sunlight d. Impaired liver or kidney metabolism of vitamin D e. Excessive intake of sodium

a. Impaired absorption of calcium from the intestine c. Lack of exposure to sunlight d. Impaired liver or kidney metabolism of vitamin D Calcium deficiency commonly occurs in the elderly because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack of exposure to sunlight, and impaired liver or kidney metabolism of vitamin D to its active form. It is not connected to sodium intake.

The nurse is caring for a client with a possible calcium deficiency and reads the client's history to see if the client has experienced which common reasons for calcium deficiency? (Select all that apply.) a. Long-term dietary deficiencies of calcium and vitamin D b. Impaired absorption of calcium from the intestine c. Lack of exposure to sunlight d. Overexposure to ultraviolet rays e. Chronic use of ampicillin

a. Long-term dietary deficiencies of calcium and vitamin D b. Impaired absorption of calcium from the intestine c. Lack of exposure to sunlight Calcium deficiency commonly occurs because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack of exposure to sunlight, and impaired liver or kidney metabolism of vitamin D to its active form. It is not associated with chronic use of ampicillin.

Which information about medication administration and meals should the nurse include in teaching a client prescribed calcium orally? a. Take with or after meals. b. Take 2 hours before a meal. c. Take early in the morning. d. Take as recommended by the pharmacist.

a. Take with or after meals. Oral preparations of calcium can be administered with or after meals to increase absorption. If used with an antacid, administer the calcium after a meal. The client does not need to take calcium 2 hours before a meal or early in the morning. The nurse should provide the administration recommendations while teaching about the need for the medication.

What is the body's physiological response when blood levels of calcium are excessive? a. The parathyroid glands stop making parathyroid hormone. b. The thyroid stops making parathyroid hormone. c. The parathyroid stops absorbing calcium. d. The parathyroid begins absorbing calcium.

a. The parathyroid glands stop making parathyroid hormone. When blood calcium levels increase above a certain point, calcium-sensing receptors in the parathyroid gland are activated to decrease hormone production. The thyroid gland does not produce parathyroid hormone. Calcium is absorbed in the intestines, not in the parathyroid gland.

Which of the following are appropriate goals to set with your patient who is suffering from an alteration in calcium levels? Choose all that apply. a. The patient will achieve and maintain normal serum levels of calcium. b. The patient will comply with instructions for safe drug use. c. The patient will decrease dietary intake of calcium-containing foods to prevent or treat osteoporosis. d. The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia.

a. The patient will achieve and maintain normal serum levels of calcium. b. The patient will comply with instructions for safe drug use. d. The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia. All are correct except the patient will want to increase dietary intake of calcium-containing foods to prevent and treat osteoporosis.

A home health registered nurse has a client who cannot afford medications. The health care provider has ordered a calcium supplement for the client. What would the nurse recommend for the client? a. Tums (5 per day) b. Alendronate (Fosamax) c. Ibandronate (Boniva) d. Risedronate (Actonel)

a. Tums (5 per day) If taking a calcium supplement, calcium carbonate 500 milligrams twice daily is often recommended. This can be obtained through the inexpensive over-the-counter antacid Tums, which contains 200 milligrams of calcium per tablet.

Which statement best summarizes the negative feedback loop of the hormones that regulate calcium and bone metabolism? a. When serum calcium levels are decreased, hormonal mechanisms increase them. b. When serum calcium levels are increased, hormonal mechanisms increase them. c. When hormonal levels are decreased, serum calcium levels are secreted. d. When hormonal levels are increased, serum calcium levels are inhibited.

a. When serum calcium levels are decreased, hormonal mechanisms increase them. Three hormones regulate calcium and bone metabolism: parathyroid hormone, calcitonin, and vitamin D. They all act to maintain normal serum levels of calcium. When serum calcium levels are decreased, hormonal mechanisms raise them. When the serum calcium levels are increased, hormonal mechanisms lower them. Overall, the hormones alter absorption of the dietary calcium from the gastrointestinal tract, movement of calcium from bone to serum, and excretion of calcium through the kidneys.

When is calcitonin released by the body? a. When serum calcium levels rise b. When serum calcium levels fall c. When PTH secretion mobilizes calcium d. When PTH secretion immobilizes calcium

a. When serum calcium levels rise The release of calcitonin is not controlled by the hypothalamic-pituitary axis, but is regulated locally at the cellular level. Calcitonin is released when serum calcium levels rise.

Bisphosphonates are drugs that bind to bone and inhibit calcium resorption from bone. These drugs are used to treat hypercalcemia. Which of the following are bisphosphonates? Choose all that apply. a. alendronate (Fosamax) b. ibandronate (Boniva) c. risedronate (Actonel) d. raloxifene (Evista) e. teriparatide (Forteo)

a. alendronate (Fosamax) b. ibandronate (Boniva) c. risedronate (Actonel) Fosamax, Boniva, and Actonel are all examples of bisphosphonates. Raloxifene is a selective estrogen receptor modulator; teriparatide is a parathyroid hormone.

Which of the following clinical manifestations are indicative of hypercalcemia? Choose all that apply. a. calcium serum level > 10.5 mg/dL b. coma c. lethargy d. convulsions e. tetany

a. calcium serum level > 10.5 mg/dL b. coma c. lethargy Severe hypercalcemia may produce lethargy, syncope, disorientation, hallucinations, coma, and death. Clinical manifestations of hypocalcemia are characterized by increased neuromuscular irritability, which may progress to tetany. Tetany is characterized by numbness and tingling of the lips, fingers, and toes; twitching of facial muscles; spasms of skeletal muscle; carpopedal spasm; laryngospasm; and convulsions.

The nurse knows that raloxifene achieves a therapeutic effect by altering the function of what hormone? a. estrogen b. thyroid-stimulating hormone (TSH) c. prolactin d. insulin

a. estrogen Raloxifene is a selective estrogen receptor modulator that is used to prevent or treat postmenopausal osteoporosis. It acts like estrogen in some body tissues and prevents the action of estrogen in other body tissues. It has estrogenic effects in bone tissue, thereby decreasing bone breakdown and increasing bone mass density. The drug is unrelated to TSH, prolactin, or insulin.

In addition to calcium, what electrolyte affects parathyroid hormone (PTH) secretion? a. magnesium b. sodium c. potassium d. zinc

a. magnesium Another electrolyte—magnesium—also affects PTH secretion by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal. Sodium, potassium, and zinc do not affect PTH function.

What organ provides the control over the amount of calcium in the blood? a. parathyroid glands b. thyroid gland c. pituitary d. kidneys

a. parathyroid glands Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an increase in the serum level of calcium. Parathyroid chief cells constitute one of the few cell types of the body that regulate intracellular calcium levels as a consequence of extracellular (or serum) changes in calcium concentration. The thyroid controls how quickly the body burns energy and makes proteins, and how sensitive the body should be to other hormones. The pituitary releases ACTH (adrenocorticotropic hormone), which in turn tells the adrenal cortex to release cortisol and aldosterone into the blood. The kidneys are complicated organs that have numerous biological roles. Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.

Serum calcium levels are directly related to what blood components? a. protein b. potassium c. glucose d. sodium

a. protein Circulating calcium is in the free, ionized form (Ca2+) or bound to blood proteins such as serum albumin. Low serum albumin decreases the total serum level of calcium by decreasing the amount of calcium that is bound to protein. Serum calcium levels are not dependent on sodium, potassium, or glucose levels.

Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to: a. stand or sit upright for at least 30 minutes after taking alendronate. b. avoid drinking water with the drug. c. lift weights in the gym at least five times a week. d. take calcium and vitamin D supplements.

a. stand or sit upright for at least 30 minutes after taking alendronate. To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress.

The nurse is caring for a child who needs replacement of the parathyroid hormone. A student nurse asks the nurse what the most common cause of hypoparathyroidism is. What would be the best correct response? a. Radiation injury b. Accidental removal of glands c. Destruction by iodine d. Accidental resection of thyroid

b. Accidental removal of glands The absence of PTH results in a low calcium level (hypocalcemia) and a relatively rare condition called hypoparathyroidism. This is most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery.

The health care provider has ordered oral calcium for a client. The nurse understands that this medication is used to treat or manage which conditions? (Select all that apply.) a. Poor digestion b. Bone loss c. Fractures d. Chronic nonemergent hypercalcemia e. Heartburn

b. Bone loss c. Fractures e. Heartburn Calcium is used to decrease stomach acid and reduce heartburn. It also is used in the treatment of chronic nonemergent hypocalcemia. It decreases bone loss and assists in reducing fractures in women.

The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)? a. Potassium b. Calcium c. Glucose d. Magnesium

b. Calcium When bisphosphonates are administered, serum calcium levels are monitored before, during, and after therapy.

A client who is taking tetracycline has been prescribed a calcium supplement. What guidance should the nurse include in medication teaching? a. Calcium enhances the effectiveness of tetracycline. b. Calcium should be taken at least 2 hours before or after taking tetracycline. c. Calcium presents no considerations associated with tetracycline therapy. c. Calcium and tetracycline should be taken 4 to 6 hours after meals to prevent toxicity.

b. Calcium should be taken at least 2 hours before or after taking tetracycline. Oral calcium preparations decrease the effects of oral tetracycline drugs by combining with the antibiotic and preventing its absorption. The two medications should be taken at least 2 hours apart.

The nurse is caring for a client who would like to increase her phosphorus intake. The nurse instructs the client to increase the amount of what foods that are high in phosphorus? a. Apples b. Dairy products c. Tomatoes d. Potatoes

b. Dairy products Dairy products are high in phosphorus.

Teriparatide (Forteo) is a recombinant DNA version of parathyroid hormone (PTH). How is this drug different than others that are used in the treatment of osteoporosis? Choose all that apply. a. Slows bone loss b. Increases bone formation c. Does not accumulate in bone or other tissues d. Does not require dose adjustment with renal or hepatic impairment e. Increases serum levels of calcium and calcitriol

b. Increases bone formation c. Does not accumulate in bone or other tissues d. Does not require dose adjustment with renal or hepatic impairment e. Increases serum levels of calcium and calcitriol Other drugs for osteoporosis slow bone loss, whereas teriparatide increases bone formation by increasing the number of bone-building cells (osteoblasts). Teriparatide also increases serum levels of calcium and calcitriol. It is not expected to accumulate in bone or other tissues, to interact significantly with other drugs, or to require dosage adjustment with renal or hepatic impairment.

A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate? a. Height in the lowest quartile of the population and a history of joint pain b. Low bone density and a family history of osteoporosis c. Reports of cold intolerance, recurrent constipation, and evidence of diverticular disease d. Labile moods and short-term memory deficits

b. Low bone density and a family history of osteoporosis Bisphosphonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women, and in managing Paget disease. Low bone density and a family history of osteoporosis would consequently indicate a potential benefit. Impaired growth, cold intolerance, and cognitive deficits are not indications for the use of bisphosphonates.

A patient asks the nurse to explain the physiological actions of phosphorous. The nurse knows which of these statements regarding phosphorous is correct? a. Most phosphorous is free in the circulatory system. b. Milk is the best source of phosphorous. c. Vitamin D is essential for phosphorous absorption. d. Phosphorous deficiency is a common disorder.

b. Milk is the best source of phosphorous. Most phosphorous is bound to calcium in bones and teeth. Milk contains equal amounts of phosphorous and calcium, which promotes absorption of phosphorous. Vitamin D enhances but is not essential for phosphorous absorption. Phosphorous is found in many foods, especially dairy products, meats, eggs, and nuts; thus, deficiency is rare.

A nurse is reviewing the laboratory values of a client being treated for a diagnosis of hypocalcemia. The current serum calcium level is 8.1 mg/dL. What intervention does the nurse expect the prescriber to order? a. Redraw the serum level of calcium. b. Order an additional calcium supplement. c. Prescribe potassium chloride infusion. d. The prescriber will not order any intervention.

b. Order an additional calcium supplement. Normal serum calcium levels are in the range of 8.5 to 10.5 mg/dL. The nurse would anticipate that the level is below the therapeutic range and the prescriber should order another calcium supplement. Once the hypocalcemia is stabilized, finding the underlying cause of recurrence is priority. Measurement of serum magnesium levels should also be completed to correct the hypocalcemia. The potassium chloride infusion is not associated with calcium.

The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect? a. Infertility b. Osteoporosis c. Hypertension d. Paget's disease

b. Osteoporosis Both men and women who take corticosteroids are at risk for osteoporosis.

A client is to receive teriparatide. The nurse would instruct the client in: a. Oral administration b. Subcutaneous injection c. Intranasal spray administration d. Transdermal application

b. Subcutaneous injection Teriparatide is administered subcutaneously.

The nurse is providing education to a client who has been newly diagnosed with osteoporosis. How should the nurse describe the role of the parathyroid on the development of the disorder? a. When there is too much parathyroid hormone, the bones retain calcium at a rate that is too high, resulting in bones that have too little calcium. b. When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. c. When there is too much parathyroid hormone, the thyroid releases calcium into the blood at a rate that is too high, resulting in bones that have too little calcium. d. When there is too much thyroid hormone, the parathyroid releases calcium into the blood at a rate that is too high, resulting in bones that have too little calcium.

b. When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone acts directly on the bones to remove calcium from the bones.

The nurse is providing education to a client who is taking calcium for the treatment of osteopenia. What is the rationale for the nurse suggesting that the client limit whole grains in the diet? a. Whole grains contain insufficient amounts of needed calcium. b. Whole grains are known to interfere with calcium absorption. c. Whole grains interact with calcium and increase serum phosphate levels. d. Whole grains increase the client's risks of adverse effects when taking calcium supplements.

b. Whole grains are known to interfere with calcium absorption. Clients should be taught to avoid whole grain cereals in the meal before taking calcium because they interfere with calcium absorption. The restriction is not related to serum phosphate levels, adverse effects, or the nutritional content of the grain products.

The nurse is reviewing the medication history of a client who reports taking a calcium supplement. What medication, if taken with calcium, presents the risk of drug toxicity? a. fluoroquinolones b. digoxin c. atenolol d. phenytoin

b. digoxin Calcium preparations and digoxin have similar effects on the myocardium. Therefore, if calcium is given to a client taking digoxin, the risks of digitalis toxicity and cardiac dysrhythmias are increased. This combination must be used very cautiously. Calcium decreases the effects of multiple drugs—including phenytoin, atenolol, and fluoroquinolones—so calcium should be taken separately.

The nurse is caring for a pediatric client with a new onset of hypercalcemia. What condition would be most likely to cause this altered serum calcium level? a. radiation injury b. malignancy c. liver failure d. hypothyroidism

b. malignancy Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland, and it would not be caused by liver failure or hypothyroidism.

The nurse is caring for a client who is prescribed raloxifene to treat postmenopausal osteoporosis. The nurse will question the health care provider about this medication when noticing what information in the medical record? a. history of total hip replacement b. treatment for coronary heart disease c. medicated for type 2 diabetes d. treatment for a small bowel obstruction 3 months ago

b. treatment for coronary heart disease Raloxifene is a selective estrogen receptor modulator that is used to prevent or treat postmenopausal osteoporosis. It acts like estrogen in some body tissues and prevents the action of estrogen in other tissues. Raloxifene increases the risk of deep vein thrombosis or pulmonary emboli, and the risk of death due to stroke may be increased in clients with coronary heart disease. Because of these risks, the nurse should question providing the medication to the client with coronary heart disease. Raloxifene is not contraindicated for a history of joint replacements, treatment for type 2 diabetes, or a previous small bowel obstruction.

A nurse is discussing nutrition with a group of older adults at a community senior center. The nurse informs the group that the recommended daily calcium intake is: a. 1500-2000 mg b. 750-1250 mg c. 1000-1500 mg d. 2000-2500 mg

c. 1000-1500 mg For most adults, the calcium requirement is 1000 mg daily. For postmenopausal women do not take replacement estrogens, it is 1500 mg daily.

The nurse elicits a positive Chvostek sign when tapping on the facial nerve. What action by the nurse is a priority after this assessment is complete? a. Assess the client's level of thyroid hormone. b. Assess the client's sodium level for hyponatremia. c. Assess the client's calcium level for hypocalcemia. d. Assess the client's potassium level for hypokalemia.

c. Assess the client's calcium level for hypocalcemia. Hypocalcemia is indicated by a positive Chvostek sign and the nurse should assess the calcium level for the deficit and prepare to administer calcium. Low levels of potassium, thyroid hormone, and sodium do not elicit the response of tetany.

What is the best position for the client after the administration of a bisphosphonate medication? a. Supine b. Prone c. High Fowler's d. Lateral recumbent

c. High Fowler's The client should be instructed to remain upright (avoid lying down - supine, prone, or lateral recumbent) for at least 30 minutes after taking bisphosphonate drugs. Therefore, the best position is high Fowler's.

Several nursing students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state that which of the following is a risk factor? a. Excess caffeine intake b. Prolonged corticosteroid use c. Hypothyroidism d. Sedentary lifestyle

c. Hypothyroidism Among the many risk factors for osteoporosis are sedentary lifestyle, excessive intake of caffeine or alcohol, chronic use of certain medications (e.g., corticosteroids), hyperthyroidism, advanced age, white or Asian race, and family history of the disease.

Prevention of osteoporosis includes which of the following measures? a. Placing items within reach of the client. b. Installing grab bars in the bathroom to prevent falls. c. Maintaining adequate calcium and vitamin D intake. d. Using a professional alert system in the home in case a fall occurs when the client is alone.

c. Maintaining adequate calcium and vitamin D intake. Measures that can reduce the risk of developing osteoporosis include maintaining adequate dietary intake of calcium and vitamin D. The other options describe measures that can reduce the risk of injury related to the disease.

A client is prescribed ibandronate. The nurse instructs the client to take the drug at which frequency? a. Once a week b. Once every 2 weeks c. Once a month d. Once every 3 months

c. Once a month Ibandronate is taken once a month on the same day each month.

Which statement reflects the relationship between calcium and phosphate? a. There is no relationship with calcium and phosphate. b. When there is an increase in calcium, the phosphate is elevated. c. When there is an increase in calcium, the phosphate is decreased. d. When there is a decrease in calcium, the phosphate is decreased.

c. When there is an increase in calcium, the phosphate is decreased. An inverse relationship exists between calcium and phosphate. When serum calcium levels increase, serum phosphate levels decrease. When the serum calcium level decreases, serum phosphate levels increase. Calcium and phosphorus are learned together as they are closely related. These mineral nutrients occur in the same food, and absorbed together.

A client diagnosed with excessive parathyroid production is prone to develop: a. Alzheimer's disease. b. hypertension. c. osteopenia. d. heart disease.

c. osteopenia. Most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptoms are fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. However, these symptoms are improved after intervention. Thus, although it may contribute to an existing diagnosis of Alzheimer's, it is not the cause. Hypertension is not commonly associated with this disorder. Excess parathyroid hormone acts directly on the bones to remove calcium from the bones. The calcium levels may cause abnormalities in heart function, but they do not cause heart disease.

The nurse is caring for a client who takes alendronate. What laboratory result best demonstrates successful treatment? a. serum iodine 515 nmol/L (65.3 µg/L) b. free thyroxine 22 pmol/L (1.7 ng/dL) c. serum calcium 2.45 mmol/L (9.8 mg/dL) d. thyrotropin 3.1 mIU/L (3.1 mIU/L)

c. serum calcium 2.45 mmol/L (9.8 mg/dL) Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. All of the listed components are within their respective reference ranges, but calcium levels are the focus of this client's treatment.

The nurse is preparing a teaching tool on the action of calcium preparations. The nurse will identify that calcium is absorbed through which body area? a. mouth b. stomach c. small intestine d. large intestine

c. small intestine The absorption of calcium occurs in the small intestines. Approximately one third of the amount of calcium consumed is actually absorbed. Calcium is not absorbed through the mouth, the stomach, or the large intestines.

A patient is receiving calcitonin by IM injection. The nurse would expect the drug's effects to last how long? a. less than 1 hour b. approximately 2 hours c. approximately 3 to 4 hours d. approximately 6 to 8 hours

d. approximately 6 to 8 hours Calcitonin by IM injection decreases serum calcium levels in approximately 2 hours; its effects last approximately 6 to 8 hours.

A patient with osteoporosis has bones that become progressively porous, brittle, and especially prone to fracture. This increased susceptibility to fracture manifests most commonly as: a. spiral fracture of the tibia. b. dislocation of the shoulder. c. boxer's fracture. d. compression fracture of the vertebrae.

d. compression fracture of the vertebrae. Although all bones in the affected patient are more prone to fracture, common fracture sites are the vertebrae of the lower dorsal and lumbar spines, wrists, and hips.

A preschool age child who weighs 33 lb (15 kg) is prescribed to receive 4 mg/kg of intravenous calcium chloride every 6 hours. How many milligrams of the medication will the client receive in one day? Record the answer as a whole number.

240 To calculate a single dose of calcium chloride, multiply the client's weight in kg by 4 mg/kg: 15 kg × 4 mg/kg = 60 mg. Then, because 1 dose every 6 hours means that 4 doses will be given in a single day, multiply the individual dose by 4: 60 mg/dose × 4 doses = 240 mg.

A female client presents to the health care provider's office for a routine physical examination. The nurse assesses her current over-the-counter drug history and discovers that she takes vitamin D 600 international units daily. The nurse recognizes that the client is at risk for what condition? a. Paget's disease b. Hypocalcemia c. Hypocalciuria d. Hypercalcemia

d. Hypercalcemia Clients diagnosed with osteoporosis require adequate calcium and vitamin D (at least the recommended dietary allowance), whether obtained from the diet or from supplements. Calcium 600 mg and vitamin D 200 international units once or twice daily are often recommended for postmenopausal women with osteoporosis, and pharmacologic doses of vitamin D are sometimes used to treat clients with serious osteoporosis. If such doses are used, caution should be exercised, because excessive amounts of vitamin D can cause (?)

The nurse knows that phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia. Hypophosphatemia is assumed when the serum phosphorus is less than what level? a. Less than 5 mg/dL b. Less than 10 mg/dL c. Less than 4 mg/dL d. Less than 3 mg/dL

d. Less than 3 mg/dL Phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia (serum phosphorus less than 3 mg/dL) and renal function is normal, to minimize the risk of soft tissue calcification.

After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example? a. Teriparatide b. Calcitonin-salmon c. Dihydrotachysterol d. Pamidronate

d. Pamidronate Pamidronate is an example of a bisphosphonate. Teriparatide and dihydrotachysterol are antihypocalcemic agents. Calcitonin-salmon is a calcitonin used to treat hypercalcemia.

The nurse is caring for four clients. Which client is at the highest risk for osteoporosis? a. The client receiving diuretic therapy b. The client with a diagnosis of renal hypertension c. The client with frequent falls d. The female client aged 76

d. The female client aged 76 Postmenopausal women are at high risk for osteoporosis.

Which would the nurse expect to assess in a patient who is to start therapy with bisphosphonates? a. Muscle weakness b. Hyperactive reflexes c. Tetany d. Paresthesias

a. Muscle weakness Muscle weakness is a sign of hypercalcemia for which bisphosphonate, an antihypercalcemic agent, would be used. Hyperactive reflexes suggest hypocalcemia for which an antihypocalcemic agent would be used. Tetany suggests hypocalcemia for which an antihypocalcemic agent would be used. Paresthesias suggest hypocalcemia for which an antihypocalcemic agent would be used.

A patient will be treated for postmenopausal osteoporosis. The nurse knows that which drug for osteoporosis is an estrogen-receptor modulator? a. Raloxifene (Evista) b. Alendronate (Fosamax) c. Calcitonin-salmon (Miacalcin) d. Denosumab (Prolia)

a. Raloxifene (Evista) Raloxifene interacts with specific estrogen receptors. In bone it has agonist activity, which inhibits bone resorption. In the breasts and uterus, it is an estrogen-receptor blocker. Alendronate is a bisphosphonate binding directly to bone. Calcitonin-salmon and denosumab decrease bone resorption via actions that do not involve estrogen receptors.

Alendronate (Fosamax) is prescribed for a patient. Which statement made by the patient will indicate to the nurse that further instruction is needed? a. "I can go back to bed as soon as I take this drug." b. "I must wait at least 30 minutes after taking this drug before eating or drinking anything." c. "I will take this drug with a full glass of water." d. "I will immediately report any upper abdominal pain or heartburn."

a. "I can go back to bed as soon as I take this drug." The patient must remain upright (sitting or standing) for at least 30 minutes after taking alendronate with a full glass of water. Nothing should be taken by mouth for at least 30 minutes. Upper abdominal pain or heartburn may indicate that alendronate is causing esophageal irritation or damage.

A female client presents to the emergency department with symptoms and laboratory values indicative of hypercalcemia. What IV solutions would the health care provider order to treat the hypercalcemia? a. Sodium chloride (0.9%) b. D5 1/2 normal saline c. D5 1/4 normal saline d. Lactated Ringer's solution

a. Sodium chloride (0.9%) Sodium chloride (0.9%) injection (normal saline) is an IV solution that contains water, sodium, and chloride. It is included here because it is the treatment of choice for hypercalcemia and is usually effective. The sodium contained in the solution inhibits the reabsorption of calcium in renal tubules and thereby increases urinary excretion of calcium.

A patient is receiving teriparatide. The nurse would expect to administer this drug by which route? a. Subcutaneous b. Oral c. Intramuscular d. Intravenous

a. Subcutaneous Teriparatide is administered by subcutaneous injection.

A patient is diagnosed with hypocalcemia. The nurse knows that which statement regarding hypocalcemia is correct? a. Hypocalcemia is a calcium blood level of 10.5 mg/dL. b. Hypocalcemia is characterized by a decrease in muscle tone. c. Hypocalcemia can be accompanied by hyperphosphatemia. d. Hypocalcemia often occurs with breast cancer and multiple myeloma.

c. Hypocalcemia can be accompanied by hyperphosphatemia. Normal blood levels of calcium are 8.5 to 10.5 mg/dL. Calcium blood levels below 8.5 mg/dL are hypocalcemia. This imbalance is characterized by increased muscle tone that can progress to tetany. Phosphorus levels are increased when calcium levels fall; thus, hypocalcemia is often accompanied by hyperphosphatemia. Several malignancies, including breast cancer and multiple myeloma, enhance decalcification of bone, leading to hypercalcemia.