Osteoporosis 12-4
The nurse has completed the medication teaching for the patient prescribed a bisphosphonate for osteoporosis. Which patient statement indicates that further teaching is required? "I will keep a dietary log to track my intake of foods high in calcium, vitamin D, and phosphate." "I will make sure that I walk 30-40 minutes a day four times a week." "I will take my medication with my breakfast, so I do not get nauseated." "After I take my medication, I will wait for 1 hour before I take my calcium and vitamin D supplements."
"I will take my medication with my breakfast, so I do not get nauseated." The statement "I will take my medication with my breakfast, so I do not get nauseated" indicates that further teaching is required. Bisphosphonates should be taken on an empty stomach with water first thing in the morning. The patient should remain upright for 30 minutes and should not eat or drink anything else for 30 minutes to avoid esophagitis. A dietary log is helpful to the healthcare provider and the patient to ensure that adequate dietary calcium, vitamin D, and phosphate are consumed. Walking is a weight-bearing exercise that is important in the prevention of further complications of osteoporosis. Calcium and vitamin D supplements should be held 60 minutes or longer after taking the bisphosphonate.
The nurse is providing nutritional teaching for a newly diagnosed pregnant patient. Which dietary intervention should the nurse suggest in order for the growing fetus to obtain enough maternal dietary calcium without having to pull calcium from the maternal bones? "Increase your dietary intake of chicken." "Increase your dietary intake of beans." "Increase your dietary intake of beef." "Increase your dietary intake of wheat."
"Increase your dietary intake of beans." The newly diagnosed patient should be encouraged to increase their intake of beans. Beans not only contain fiber that will help with constipation that occurs during pregnancy, but more important, contain high levels of calcium necessary for the growing fetal skeleton. Other calcium-rich foods include dairy and vegetables. Beef, chicken, and wheat do not contain high amounts of calcium.
A pregnant woman asks, "Can you tell me about breastfeeding and bone loss? I read an article stating that I am at risk for bone loss if I breastfeed." Which response by the nurse demonstrates an understanding of breastfeeding and its effects on loss of maternal bone mass? "Loss of maternal bone mass does occur with breastfeeding but is restored after weaning." "Loss of maternal bone mass does not occur; the infant obtains calcium from your dietary intake." "Loss of maternal bone mass will not occur if you continue to take your prenatal vitamins while breastfeeding." "You will be supplemented with extra calcium and vitamin D while breastfeeding to prevent loss of maternal bone mass."
"Loss of maternal bone mass does occur with breastfeeding but is restored after weaning." Several studies indicate that breastfeeding affects maternal bones. Evidence suggests that some women may lose up to 5% of their bone mass while breastfeeding. Restoration occurs in several months once the infant is weaned from the breast. Taking prenatal vitamins, calcium, and vitamin D will not prevent bone loss but may decrease the amount of bone loss.
The nurse is providing care to a patient diagnosed with osteoporosis. Dual-energy x-ray absorptiometry (DEXA) has been ordered for the patient. Which explanation of this diagnostic procedure is appropriate for the nurse to give the patient? "The test detects osteopenia and identifies fractures." "The test is administered to the heel of the foot to measure bone density." "The test measures bone density in the lumbar spine or hip." "The test is used to evaluate bone mineral density and the degree of osteoporosis."
"The test measures bone density in the lumbar spine or hip." The DEXA measures bone density in the lumbar spine or hip. An ultrasound is administered to the heel of the foot to measure bone density. X-rays detect osteopenia and identify fractures. A quantitative ultrasound (QUS) is used to evaluate bone mineral density and the degree of osteoporosis.
A patient diagnosed with osteoporosis asks, "How can I prevent this disease from progressing?" Which response by the nurse provides the patient with important dietary information to prevent the osteoporosis from progressing? "To help prevent further progression of the disease, it is important for you to increase your calcium intake." "An increase in dietary intake of foods rich in vitamins A and E will help slow down the disease progression." "Increasing your dietary intake of animal protein will help slow the progression of your osteoporosis." "Foods high in dietary zinc and iron are a key factor in the prevention of disease progression."
"To help prevent further progression of the disease, it is important for you to increase your calcium intake." Calcium is an essential mineral in the process of bone formation and other significant body functions. When the intake of calcium through the diet is insufficient, the body compensates by removing calcium from the skeleton, weakening the bone tissue. The nurse should also remind the patient that vitamin D helps with calcium absorption. Foods high in vitamin A, iron, animal protein, and zinc are not effective in the prevention of the progression of osteoporosis.
A 65-year-old female patient has been recently diagnosed with osteoporosis. Which information should the nurse include in the teaching related to the patient's diagnosis? "Consume foods low in iron." "Increase dietary protein." "Walk 30-40 minutes per day." "Abstain from any caffeine intake."
"Walk 30-40 minutes per day." Walking is a weight-bearing exercise. The patient should be encouraged to walk 30-40 minutes per day, at least four times a week, to promote bone growth. It is not necessary to decrease dietary iron intake, increase dietary protein, or completely abstain from caffeine.
A patient is prescribed estrogen replacement therapy for treatment of osteoporosis. The patient states to the nurse, "I heard that estrogen is associated with an increased risk of uterine cancer." Which response made by the nurse provides the patient with accurate information? "Your provider will prescribe bisphosphonates to decrease the risk of cancer." "You will be prescribed progesterone with the estrogen to protect you from uterine cancer." "The dose of estrogen is too low to increase your risk of cancer." "The new research does not link estrogen replacement therapy to increased risk of cancer."
"You will be prescribed progesterone with the estrogen to protect you from uterine cancer." Estrogen therapy alone is associated with an increased risk of endometrial cancer, so it usually is prescribed in combination with progesterone; this is referred to as hormone replacement therapy. Bisphosphonates are not used to decrease the risk of cancer, they are used to inhibit bone reabsorption. There is no new research that disputes the risk factor of endometrial cancer associated with estrogen replacement therapy. The dose of estrogen is not too low in that there is no increase in the risk of cancer.
The nurse is providing teaching to a patient diagnosed with osteoporosis about how to slow the disease process. Which information is the most appropriate to provide? Decreasing fluid intake Encouraging use of prescribed pain medications Encouraging smoking cessation Discouraging further physical activity
Encouraging smoking cessation The information that is the most appropriate for the patient with osteoporosis to decrease the progression of the disease is to encourage smoking cessation. 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. Decreasing fluid intake, encouraging the regular use of pain medication, and discouraging further physical activity will not decrease the progression of the disease.
The nurse is caring for an older adult at risk for osteoporosis who frequently experiences a loss of balance. Which activity should the nurse encourage the patient to do to prevent osteoporosis? Tai chi Increasing calcium supplementation Walking when they feel stable Obtaining an assistive device, so the patient can walk
Tai chi The activity that the nurse can encourage the patient to do to prevent osteoporosis is tai chi. Tai chi is beneficial to the patient who has problems with balance. Increasing calcium supplementation will not provide the weight-bearing exercise necessary to increase the osteoblast growth and activity necessary to maintain strong bones. Having the patient walk when they "feel" stable may not provide consistent exercise that is necessary to maintain the health of the bones. An assistive device should be secured for the safety of a patient who is unstable.
The nurse working in a clinic is screening female adolescent patients for risk factors of osteoporosis. Which patient has the greatest risk for osteoporosis? The female adolescent that is on the golf team The female adolescent that is sedentary The female adolescent on a cross-country running team The female adolescent that is on a chess team
The female adolescent on a cross-country running team The female that is on the cross-country running team has the greatest risk factor for osteoporosis. Adolescent athletes who participate in sports that emphasize leanness, such as gymnastics or cross-country running, are at risk for osteoporosis. Golf does not pose a great risk factor. A sedentary lifestyle over a long period of time or sedentary activity such as chess increases the risk for osteoporosis in adults.
The nurse is providing care for a patient diagnosed with osteoporosis who is recovering from a wrist fracture. Which outcome should the nurse expect the patient to meet? The patient achieves adequate calcium and vitamin D intake. The patient incorporates weight-bearing exercises. The patient identifies and eliminates safety hazards. The patient maintains a healthy weight.
The patient identifies and eliminates safety hazards. A patient with a wrist fracture should be able to identify and eliminate safety hazards to prevent further injury. Achieving adequate calcium and vitamin D intake, incorporating weight-bearing exercises, and maintaining a healthy weight are not expected outcomes at this time.
During a home visit, the nurse is concerned that a patient recovering from an osteoporosis-related fracture is at risk for future fractures. Which assessment finding supports the nurse's conclusion? The patient is using a treadmill every day. The patient drinks an occasional glass of wine. The patient is consuming fresh fruits and vegetables every day. The patient is smoking cigarettes.
The patient is smoking cigarettes. For osteoporosis, the nurse can help the patient identify risk factors and encourage actions such as increasing activity, smoking cessation, healthy eating, and taking the recommended amount of calcium and vitamin D each day. Smoking cigarettes increases the patient's risk for a future osteoporosis-related fracture. 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. Although the patient should be discouraged from using alcohol, drinking an occasional glass of wine does not support that the patient is at an increased risk for future fractures. Using a treadmill for exercise and consuming fresh produce help reduce the risk of future osteoporosis-related fractures.
A patient with osteoporosis has been prescribed calcium citrate supplements. Which topic should the nurse include in the patient's medication teaching? Increased risk for depression Best taken with meals Decreasing overall caloric intake Necessity for additional iron supplementation
Best taken with meals Calcium citrate supplements may cause indigestion and should be taken with meals. Calcium supplements are not associated with depression, weight gain, or anemia.
The nurse is preparing to provide dietary teaching for the patient who is diagnosed with osteoporosis. Which food should the nurse recommend to provide dietary calcium? Wine Organ meats Canned sardines Brown rice
Canned sardines Patients who have osteoporosis or who are at risk for development of the disease later on benefit from choosing healthy menu items, particularly those high in calcium and vitamin D. Foods that are rich in calcium include canned sardines. Organ meats, brown rice, and wine are not high in calcium.
The nurse is providing medication teaching to a patient who has been prescribed alendronate sodium (Fosamax) for the treatment of osteoporosis. Which adverse effect should the nurse include? Sinusitis Dyspepsia Hot flashes Constipation
Dyspepsia Dyspepsia is a common adverse effect that occurs for patients taking alendronate sodium (Fosamax). Sinusitis and hot flashes are expected adverse effects that occur with raloxifene hydrochloride (Evista). Diarrhea, not constipation, is an adverse effect expected with the medication.
A 62-year-old female patient presents with a possible wrist fracture and reports no other health problems. This is the third such injury that the patient has had in the past year, and the nurse suspects osteoporosis. Which assessment finding in the patient's health history supports the diagnosis of osteoporosis? History of alcoholism Increased BMI Active lifestyle Daily vitamin D intake
History of alcoholism A history of alcoholism places this patient at risk for osteoporosis. An inactive lifestyle, not an active lifestyle, would place this patient at risk. Being underweight, not overweight, is a risk factor. A lack of vitamin D intake, not daily intake, is another risk factor for osteoporosis.
A 65-year-old man with a low testosterone and lifetime calcium level has had two bone fractures in the past 2 years. Which intervention should the nurse suggest to prevent or slow the development of osteoporosis? Implementing corticosteroid use Increasing calcium intake Implementing estrogen therapy Exercising less to avoid injury
Increasing calcium intake The nurse will recommend that the patient increase calcium intake as a way to slow the development of osteoporosis. The use of corticosteroids increases the risk factor for osteoporosis. Low estrogen levels are a cause of osteoporosis in women but not in men, so estrogen supplements would not be indicated for an older man. The patient should be advised to increase activity, not to decrease it.
An older adult female patient is diagnosed with osteoporosis. Which risk factor should the nurse recognize as a contributing to this disease? Lack of vitamin D Low testosterone Diet rich in calcium Aerobic exercise 3 times per week
Lack of vitamin D A patient with a history of decreased levels of vitamin D will be at a risk of developing osteoporosis. This is a modifiable risk factor for osteoporosis. Low testosterone in male patients, not female patients, increases the risk of osteoporosis. A diet rich in calcium and weight-bearing exercise both decrease the risk of osteoporosis.
The nurse is providing care for an older adult female patient who states, "I have been experiencing low back pain, which has been causing me to lose sleep." Which question will best help the nurse determine if the patient's pain is associated with osteoporosis? "Are you experiencing decreased range of motion?" "Do you have pain in your joints?" "Do you have a history of fractures?" "What position do you sleep in?"
"Do you have a history of fractures?" The question the nurse will ask the patient that is related to osteoporosis is, "Do you have a history of fractures?" A history of fractures and low back pain are risk factors for osteoporosis. Decreased range of motion, arthritis, and position of sleep are not directly related to osteoporosis.
The nurse who is caring for an older adult at risk for osteoporosis discusses the importance of weight-bearing activity. Which statement made by the patient requires further teaching? "I enjoy swimming, so I will try and swim at least 3 times a week." "I will attend a tai chi class at least 4 times a week." "I will join a gym and begin a weight-lifting program." "I used to be an avid golfer, and I will get back out on the course at least 4 times a week."
"I enjoy swimming, so I will try and swim at least 3 times a week." The patient statement, "I enjoy swimming, so I will try and swim at least 3 times a week," requires further teaching. Swimming is not a weight-bearing exercise. Weight-bearing exercises, such as tai chi, weight lifting, and walking on a golf course, influence bone metabolism in several ways. The stress of this type of exercise causes an increase in blood flow to bones, which brings growth-producing nutrients to the cells, resulting in increased osteoblast growth and activity.
The nurse is obtaining a health history on a patient diagnosed with osteoporosis. Which patient statement has the strongest association with osteoporosis? "I try to walk twice a week." "I am lactose intolerant and do not eat any dairy products." "I do not smoke and occasionally drink alcohol." "I follow a strict vegan diet."
"I try to walk twice a week." The statement made by the patient that has the strongest association with osteoporosis is, "I try to walk twice a week." Walking is a weight-bearing exercise, but it is recommended that the patient will participate in weight-bearing exercises for approximately 30 minutes a day at least four days a week. The statements regarding lactose intolerance, abstinence from smoking, occasional alcohol use, and consuming a vegan diet are not risk factors for osteoporosis.
The nurse is performing a yearly health screening on a patient at risk for osteoporosis. Which clinical assessment finding should the nurse associate with osteoporosis? An increase in weight over time Chronic episodes of vertebral pain A decrease in height over time Vertebral pain with substantial movement
A decrease in height over time A clinical assessment finding associated with osteoporosis is a decrease in height over time. An increase in weight is not associated with osteoporosis. Chronic episodes of vertebral pain or vertebral pain occurring with substantial movement are not associated with osteoporosis. Osteoporosis is characterized by acute, not chronic, episodes of vertebral pain.
A patient diagnosed with osteoporosis states to the nurse, "I don't understand how my bones can be so brittle and break easily." Before responding to the patient, the nurse should understand that which process is involved in the pathophysiology of osteoporosis? Osteoclasts are unable to produce new bone. Osteoblasts are not able to reabsorb bone. Excessive bone reabsorption has occurred. An imbalance between osteoblasts and osteoclasts has occurred.
An imbalance between osteoblasts and osteoclasts has occurred. Osteoporosis is a metabolic bone disorder characterized by loss of bone mass, increased bone fragility, and increased risk of fractures. Although the exact pathophysiology of osteoporosis is unclear, it is known to involve an imbalance in the activity of osteoblasts that form new bone and osteoclasts that reabsorb bone. Osteoclasts are responsible for reabsorption of bone and osteoblasts the formation of new bone.
The nurse caring for a patient with osteoporosis notes that the patient's height has significantly decreased each year over the past few years. Which further additional assessment finding should the nurse anticipate? Recumbent lordosis Dorsal kyphosis Cervical kyphosis Thoracic lordosis
Dorsal kyphosis Along with loss of height, characteristic dorsal kyphosis and cervical lordosis develop, accounting for the buffalo hump (sometimes referred to as a "dowager's hump") frequently associated with aging. Recumbent is a position, and cervical kyphosis and thoracic lordosis do not occur with osteoporosis.
The nurse is caring for a patient suspected of having osteoporosis. Which diagnostic test should the nurse anticipate to be ordered to specifically diagnose osteoporosis? Magnetic resonance imaging (MRI) Ultrasound Computerized tomography (CT) scan with contrast Dual-energy x-ray absorptiometry (DEXA)
Dual-energy x-ray absorptiometry (DEXA) DEXA is a bone mineral density test that measures bone density in the lumbar hip or spine. It differentiates osteoporosis from other bone-related disorders and is considered to be highly accurate. An MRI, ultrasound, and CT scan with contrast are not used to diagnose osteoporosis.
The nurse is teaching a postmenopausal woman how to reduce the risk factors associated with osteoporosis. Based on the patient's history, which activity should the patient be advised? Maintaining a vitamin D intake of 400 IU per day Maintaining calcium intake of 1000-1500 mg per day Maintaining a calcium intake of 1500-2000 mg per day Maintaining a vitamin D intake of 1500 IU per day
Maintaining calcium intake of 1000-1500 mg per day The postmenopausal patient should be encouraged to maintain a calcium intake of 1000-1500 mg daily, through either diet or a calcium supplement. The National Institutes of Health recommends a daily vitamin D intake of 800-1000 IU for those aged 50 and older.
The nurse is providing dietary teaching for a patient newly diagnosed with osteoporosis. Included in the teaching is the importance of dietary intake of calcium and vitamin D. Which foods that are high in vitamin D should the nurse recommend? Milk Beef Orange juice Beans
Milk Vitamin D is necessary for the body to absorb calcium. The food the nurse will recommend that is high in vitamin D is milk. Milk is also high in calcium, which is recommended in the prevention of further complications of osteoporosis. Beef does not contain high amounts of vitamin D. Orange juice and beans contain high amounts of calcium.
The nurse is caring for a patient diagnosed with osteoporosis. When planning the patient's care, which nursing diagnosis is most appropriate? Hypothermia Hyperthermia Mobility: Physical, Impaired Neurovascular Dysfunction: Peripheral, Risk for
Mobility: Physical, Impaired A nursing diagnosis that is most appropriate for a patient with osteoporosis is Mobility: Physical, Impaired. The patient may experience impaired mobility due to fractures and acute pain. The other diagnoses are not appropriate for a patient with osteoporosis. (NANDA-I © 2014)
The nurse is caring for an older adult who has advanced dementia, osteoporosis, and frequently gets out of bed throughout the night. Which nursing intervention is most appropriate for the nurse to include in the plan of care? Medicating the patient Providing the patient with an assistive device Obtaining an order for restraints Placing the bed in the lowest position
Placing the bed in the lowest position The safest nursing intervention to prevent injury to the patient with advanced dementia who frequently gets out of bed at night is to place the bed in the lowest position. Medicating the patient is a chemical restraint. Providing the patient with an assistive device is necessary if one is needed and the patient can use it safely. Restraints should be avoided, because they may actually increase the patient's risk for falling and the risk of injury associated with the fall.
The nurse is caring for a postmenopausal patient who reports difficulty sleeping and low back pain. Which testing procedure should the nurse anticipate being ordered to screen the patient for osteoporosis? Ultrasound Alkaline phosphatase Gla protein Dual-energy x-ray absorptiometry (DEXA)
Ultrasound The nurse can expect an ultrasound to be prescribed for the screening of osteoporosis. An ultrasound transmits painless sound waves through the heel of the foot to measure bone density and is accurate for screening purposes only. Alkaline phosphatase is elevated following a fracture. A dual-energy x-ray absorptiometry (DEXA) is used for diagnostic purposes and is not a screening tool for osteoporosis. Gla protein is used as a marker for osteoclastic activity and is an indicator of bone turnover. This test is most useful to evaluate the effects of treatment, rather than to indicate the severity of the disease.
