OP, OA, & RA

Which statements accurately describe the different medications available for the treatment of osteoporosis? Select all that apply. One, some, or all responses may be correct.

1. Individuals with an allergy to salmon can't take calcitonin. 2. Bisphosphonates inhibit osteoclast-mediated bone resorption. 3. Denosumab is a subcutaneous injection given once every 6 months. Individuals with an allergy to salmon cannot take calcitonin, which is salmon-based. Bisphosphonates work by inhibiting osteoclasts, which are responsible for breaking down and reabsorbing minerals such as calcium from the bone. Denosumab is a subcutaneous injection that is given once every 6 months; the client takes calcium and vitamin D daily. It is not true that denosumab acts by stimulating bone formation; it is a monoclonal antibody that blocks osteoclast activation and thus decreases the breakdown of bone. Teriparatide is not used for the prevention of postmenopausal osteoporosis; instead, it is generally reserved for the subset of clients at the highest risk—those who have suffered a previous fracture. It stimulates osteoblast function and increases gastrointestinal calcium absorption and renal tubular reabsorption of calcium.

Which coworker's statement indicates understanding of content taught by the nurse educator regarding the care of clients with osteoporosis?

1. "I should teach clients with osteoporosis to avoid milk." 2. "I should encourage the client to ambulate in the sunlight." Sunlight is a good source of vitamin D, which is required for calcium absorption; therefore ambulation of the client in the sun would be beneficial. Milk is rich in calcium and the nurse should provide milk for clients with bone disorders. Because immobilizing a joint may result in permanent immobility, this is not a current nursing practice for clients with osteoporosis. Weight-bearing exercises can improve the strength of muscles around week bones/joints as well as increase bone density to reduce the risk of fractures and should be encouraged.

A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin would the nurse recommend?

Vitamin D All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C helps maintain cartilage and connective tissue integrity but does not help prevent osteoporosis. Vitamins E and B do not help prevent osteoporosis.

When treating clients for osteoporosis, which medication has a side effect of atrial fibrillation when infused too quickly?

Zoledronic acid Zoledronic acid may cause atrial fibrillation when it is infused too quickly into the body. This medication has multiple uses and treats breast cancer, osteoporosis, Paget disease, hypercalcemia, and prostate cancer. Calcium-Vitamin D3-Vitamin K combination may cause hypercalcemia, cardiac dysrhythmias, and urinary stones. Raloxifene may increase the risk of liver disease and liver thromboembolism. Alendronate may cause esophagitis, esophageal ulcers, and gastric ulcers.

Which rationale explains why the nurse would advise a client to have a dental examination before beginning prescribed therapy with zoledronic acid?

To prevent maxillary osteonecrosis Zoledronic acid is a bisphosphonate used to treat osteoporosis that can cause maxillary osteonecrosis. The client should have a dental examination before starting the medication therapy to prevent maxillary osteonecrosis. The client's serum creatinine should be checked before and after administration of the medication to prevent kidney failure. To prevent atrial fibrillation, the medication should not be infused too quickly. The medication should not be given to a client who is sensitive to aspirin as it may cause bronchoconstriction.

A client with osteoporosis is encouraged to drink milk. The client refuses the milk, explaining that it causes gas and bloating. Which calcium-rich food would the nurse suggest for clients who do not tolerate milk?

yogurt

The nurse is assessing a client with arthritis. Which statement made by the client indicates a precipitating factor?

"I run for 30 minutes every day; this exercise increases my pain." A precipitating factor is an activity or factor that worsens the symptoms. If running for 30 minutes each day increases the client's pain, this action is a precipitating factor. By saying, "The pain is usually present in my fingers and knees," the client is providing information about the location. Swelling and redness are concomitant symptoms of pain. The quality factor indicates the description of the symptom; this is exemplified by the statement, "I feel the pain in each and every joint of my hands and legs."

A female client asks the nurse whether she should be tested for osteoporosis. Which statements reflect current advice regarding the prevention of osteoporosis? Select all that apply. One, some, or all responses may be correct.

1. "A bone mineral density test is the only way to diagnose osteoporosis." 2. "Postmenopausal women and all adults over the age of 65 should be tested for osteoporosis." A bone mineral density test is the only way to diagnose osteoporosis and determine the risk for future fractures. The U.S. Preventive Services Task Force and the National Osteoporosis Foundation recommend testing for all postmenopausal women and all adults over the age of 65. Everyone with osteoporosis will not necessarily be treated with bisphosphonates; many other treatments are available, including calcitonin, estrogens, estrogen agonist-antagonists, and parathyroid. Adults under the age of 50 require 1200 mg of calcium and 800 to 1000 IU of vitamin D. All postmenopausal women, regardless of age, should be evaluated clinically for risk of osteoporosis and need for bone mineral density testing.

The nurse is asking a client with arthritis questions to collect information. Which questions asked by the nurse are closed-ended questions? Select all that apply. One, some, or all responses may be correct.

1. "Are you having pain?" 2. "Do you think the medication is helping you get pain relief?" Closed-ended questions limit the answers to one or two words. These queries help identify specific problem areas and prompt additional questions. When the nurse asks, "Are you having pain?" the client can reply with either yes or no. Similarly, when the nurse asks the client, "Do you think the medication is helping you get pain relief?" the answer can be either yes or no. These two questions are closed-ended questions. Open ended-questions are client-centered and require a complete explanation.

A primary health care provider schedules a bone scan for a client with osteoporosis. Which nursing actions are beneficial for the client? Select all that apply. One, some, or all responses may be correct.

1. Placing the client in the supine position 2. Instructing the client to empty their bladder before the scan A bone scan is done to assess osteomyelitis, osteoporosis, primary and metastatic malignant lesions of bone, and certain fractures. The nurse has to place that client in the supine position for 1 hour for easy assessment while performing the bone scan. The nurse should instruct the client to empty the bladder before scanning. The client undergoing a computed tomography (CT) scan must be screened for a shellfish allergy to reduce the incidences of anaphylactic shock associated with the radiocontrast agent. Radio waves and a magnetic field are used during magnetic resonance imaging (MRI); therefore, the nurse should ensure that the client has no metal on the clothing before the procedure. The main risk of a myelogram is a spinal headache that usually resolves within 2 days of the procedure.

Which client is most at risk for osteoporosis?

A 66-year-old white woman, body mass index (BMI) 18, who is a paralegal A postmenopausal woman who is small-boned, underweight, and relatively sedentary is at risk for osteoporosis; other risk factors are family history and white or Asian ethnicity. A woman who is relatively heavy and does not smoke is at less risk for osteoporosis than is a thin postmenopausal woman. Postmenopausal women who are black are at lower risk for osteoporosis than are white and Asian women. A woman who takes a daily calcium supplement is at less risk for osteoporosis than a woman who does not take a calcium supplement.

A client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which inference will the nurse make?

Higher doses are needed to achieve pain relief. As the body adapts to the medication (tolerance), an increased dose is needed to produce the desired effect. The half-life of a medication does not change and is related to the time required for it to be absorbed, distributed, metabolized, and excreted from the body. Idiosyncratic reactions are unpredictable; these sporadic reactions are unrelated to dosage. The data are insufficient for the nurse to conclude that emotional or physiological dependence has developed.

Which definition would the nurse use to explain osteoporosis?

It involves a decrease in bone substance. Osteoporosis involves a defect in the bone matrix formation that weakens bones, making them unable to withstand usual functional stresses. Avascular necrosis is the death of bone tissue that results from reduced circulation to bone. Pathological fractures can result from osteoporosis. Hyperplasia of osteoblasts is not related to osteoporosis. This occurs during bone healing.

The nurse teaches a client who is premenopausal and obese about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective?

Joins a tennis league and practices every day High-impact exercises (e.g., tennis, running, aerobics, dancing) are best for building bone mass. Weight loss should be slow and reasonable; restricting calories promotes production of the hormone leptin, which stimulates bone loss. The recommended intake of vitamin D for adults younger than 50 years of age (premenopausal women) is 800 international units; 1200 mg is the recommended daily dose of calcium for adults older than 50 years of age (postmenopausal women). Signing up for a swimming class three times a week may promote overall health and vigor, but it will not increase the strength or mass of bone.

A health care provider prescribes teriparatide for a client with osteoporosis. Which statement about this medication would the nurse recognize as accurate?

Osteoblastic activity is stimulated more than osteoclastic activity. Teriparatide is a 34-amino acid polypeptide that represents the biologically active part of human parathyroid hormone; it enhances bone microarchitecture and increases bone mass and strength by stimulating activity by osteoblasts. Supplemental intake of vitamin A should not exceed recommended daily requirements; too much vitamin A has been associated with bone loss and an increased incidence of fractures. Alendronate sodium, a regulator of bone metabolism, not teriparatide, inhibits osteoclast-mediated bone resorption, minimizing bone destruction and loss of bone density. Sunscreen should be avoided to promote exposure to the sun so that vitamin D can be converted in the skin; vitamin D helps the body absorb calcium. Sunscreen should be used after 5 to 20 minutes of exposure to prevent the negative effects of prolonged exposure to ultraviolet rays.

Which information from the client's history would the nurse identify as a risk factor for developing osteoporosis?

Receives long-term steroid therapy Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight-bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Estrogen promotes deposition of calcium into bone which may prevent, not cause, osteoporosis.