10th- 45 Flashcards
A client has a bone density score of –2.8. What intervention would the nurse anticipate based on this assessment?
Asking the client to complete a food diary
Planning to teach about bisphosphonates
Scheduling another scan in 2 years
Scheduling another scan in 6 months
ANS: B
A T-score from a bone density scan at or lower than –2.5 indicates osteoporosis. The nurse would plan to teach about medications used to treat this disease, such as the bisphosphonates. A food diary is helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will not prevent the disease. Simply scheduling another scan will not help treat the disease either.
The nurse teaches assistive personnel (AP) about care of an older adult diagnosed with osteoporosis. What teaching would the nurse include?
“Teach the client to eat high-calcium foods in the diet.”
“Assist the client with activities of daily living.”
“Osteoporosis places the client is at risk for fractures.”
“The client should stay in bed to prevent falling.”
ANS: C
Anyone who has osteoporosis is at risk for fragility fractures even if he or she does not experience trauma like a fall. The client needs to keep active rather than stay in bed where more bone could be lost. High-calcium foods may not be helpful because bone loss is already severe. There is no indication that the client needs assistance with ADLs.
. A client has been advised to perform weight-bearing exercises to help slow bone loss, but has not followed this advice. What response by the nurse is appropriate at this time?
Ask the client about fear of falling.
Instruct the client to increase calcium.
Suggest other exercises the client can do.
Tell the client to try weight lifting.
ANS: A
Fear of falling can limit participation in activity. The nurse would first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.
The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?
Client with diabetes who has a serum creatinine of 0.8 mg/dL (61 mcmol/L).
Client who recently fell and has vertebral compression fractures.
Hypertensive client who takes calcium channel blockers.
Client with a spinal cord injury who cannot tolerate sitting up.
ANS: D
Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients poor candidates for this drug, but the client with a creatinine of 0.8 mg/dL (61 mcmol/L) is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.
A client has been prescribed denosumab. What health teaching about this drug is most appropriate for the nurse to include?
“Drink at least 8 ounces (240 mL) of water with it.”
“Make appointments to come get your injection.”
“Sit upright for 30 to 60 minutes after taking it.”
“Take the drug on an empty stomach.”
ANS: B
Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces (240 mL) of water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60 minutes after taking this medication, nor does the client need to take the drug on an empty stomach.
The nurse is performing an assessment of a client with possible plantar fasciitis in the right foot. What assessment finding would the nurse expect in the right foot?
Multiple toe deformities
Numbness and paresthesias
Severe pain in the arch of the foot
Redness and severe swelling
ANS: C
The most common assessment finding is the client’s report of severe pain in the arch of the foot, especially when walking. The other findings are not typical in clients with this health problem.
The nurse is caring for a young client who has been diagnosed with osteopenia. Which risk factor in the client’s history most likely contributed to the bone loss?
Osteoarthritis
Hypothyroidism
Addison disease
Rheumatoid arthritis
ANS: D
Rheumatoid arthritis often occurs in young female adults and can lead to osteoporosis as a common complication. Cushing disease (rather than Addison disease) and hyperthyroidism (rather than hypothyroidism) are also risk factors. Osteoarthritis is a joint disease.
An older client with diabetes is admitted with a heavily draining leg wound. The client’s white blood cell count is 38,000/mm3 (38 × 109/L) but the client is afebrile. Which nursing action is most appropriate at this time?
Administer acetaminophen as needed.
Educate the client on amputation.
Place the client on Contact Precautions.
Refer the client to the wound care nurse.
ANS: C
In the presence of a heavily draining wound, the nurse would place the client on Contact Precautions. If the client has discomfort, acetaminophen can be used, but this client has not reported pain and is afebrile. The client may or may not need an amputation in the future. The wound care nurse may be consulted but not as the most appropriate action.
A nurse is caring for four clients. After the hand-off report, which client would the nurse see first?
Client with osteoporosis and a white blood cell count of 27,000/mm3 (27 × 109/L)
Client with osteoporosis and a bone fracture who requests pain medication
Post-microvascular bone transfer client whose distal leg is cool and pale
Client with suspected bone tumor who just returned from having a spinal CT
ANS: C
This client is the priority because the assessment findings indicate a critical lack of perfusion. A high white blood cell count is an expected finding for the client with osteoporosis. The client requesting pain medication should be seen second. The client who just returned from a CT scan is stable and needs no specific postprocedure care.
A client has a metastatic bone tumor in the left leg. What action by the nurse is appropriate?
Administer pain medication as prescribed.
Elevate the extremity and apply moist heat.
Teach the client about amputation care.
Place the client on protective precautions.
ANS: A
Pain medication should be given to control metastatic bone pain. Elevation and heat may or may not be helpful. Protective precautions are not needed for this client.
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client’s psychosocial needs?
Assess the client’s coping skills and support systems.
Explain that the surgery leads to a longer life expectancy.
Refer the client to the social worker or hospital chaplain.
Reinforce physical therapy to aid with ambulating normally.
ANS: A
The first step in the nursing process is assessment. The nurse would assess coping skills and possible support systems that will be helpful in this client’s treatment. Explaining that a limb salvage procedure will extend life does not address the client’s psychosocial needs. Referrals may be necessary, but the nurse should assess first. Reinforcing physical therapy is also helpful but again does not address the psychosocial needs of the client.
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?
“The bones in your feet are hard to operate on.”
“The surrounding bones and tissue are damaged.”
“Your feet have less blood flow, so healing is slower.”
“Your feet bear weight so they never really heal.”
ANS: C
The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging the healing time after surgery. The other explanations are not correct.
. A nurse assesses clients in an osteoporosis clinic. Which client would the nurse assess first?
Client taking calcium with vitamin D who reports flank pain 2 weeks ago.
Client taking ibandronate who cannot remember when the last dose was.
Client taking raloxifene who reports unilateral calf swelling.
Client taking risedronate who reports occasional dyspepsia.
ANS: C
The client on raloxifene needs to be assessed first because of the potential for deep vein thrombosis, which is an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on risedronate may need to change medications.
What information does the nurse teach a women’s group about osteoporosis?
“Primary osteoporosis occurs in postmenopausal women due to lack of estrogen.”
“Men actually have higher rates of the disease but are underdiagnosed.”
“There is no way to prevent or slow osteoporosis after menopause.”
“Women and men have an equal chance of getting osteoporosis.”
ANS: A
Women are more at risk of developing primary osteoporosis after menopause due to the lack of estrogen. Men have a slower loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after menopause.
. A client with osteoporosis is going home where the client lives alone. What action by the nurse is best?
Refer the client to Meals on Wheels.
Arrange a home safety evaluation.
Ensure that the client has a walker at home.
Help the client look into assisted living.
ANS: B
This client has several risk factors that place him or her at a high risk for falling. The nurse should consult social work or home health care to conduct a home safety evaluation. The other options may or may not be needed based upon the client’s condition at discharge.
