infection and inflammation of the bone or bone marrow
Osteopenia is present when the T-score is ...
< −1 but above −2.5
Osteoporosis is diagnosed in a person who has a T-score at or lower than ...
−2.5
Medicare reimburses for BMD (Bone Mineral Density) testing every 2 years in people age 65 years and older who:
Are estrogen deficient
Receive long-term steroid therapy
Have hyperparathyroidism
Are being monitored while on osteoporosis drug therapy
Although estrogen does not build bone, it ...
helps prevent bone loss
Primary osteoporosis is more common and occurs in ...
postmenopausal women and in men in their seventh or eighth decade of life.
Secondary osteoporosis may result from other medical conditions, such as ...
hyperparathyroidism
long-term drug therapy, such as with corticosteroids
prolonged immobility, such as that seen with spinal cord injury
Regional osteoporosis, an example of secondary disease, occurs when ...
a limb is immobilized related to a fracture, injury, or paralysis. Immobility for longer than 8 to 12 weeks can result in this type of osteoporosis.
The focus of osteoporosis prevention is to decrease modifiable risk factors ...
Ensure adequate calcium intake.
Avoid sedentary lifestyle.
Continue program of weight-bearing exercises.
Tool for measuring bone mineral density (BMD) ...
dual x-ray absorptiometry (DXA). The spine and hip are most often assessed.
Quantitative computed tomography (QCT) can also measure bone density. This procedure analyzes trabecular and cortical bone separately and is especially sensitive to changes in the vertebral column. The test is more expensive than the DXA scan and exposes the patient to more radiation.
Qualitative ultrasound (QUS) of the heel is an effective and low-cost screening tool that can detect osteoporosis and predict risk for hip fracture. The test requires no special preparation, is quick, and has no radiation exposure or specific follow-up care
Nutrition needed for bone formation
Adequate amounts of protein
magnesium
vitamin K
trace minerals
Calcium
vitamin D
Intake of calcium alone is not a AAA for osteoporosis, but calcium is an important part of a BBB program to promote bone health.
A) treatment
B) prevention
Estrogen replacement therapy (ERT) and hormone replacement therapy (estrogen and progesterone) (HRT) have previously been used as ...
primary prevention strategies for reducing bone loss in the postmenopausal woman.
AAA slow bone resorption by binding with crystal elements in bone, especially spongy, trabecular bone tissue.
Bisphosphonates (BPs)
The selective estrogen receptor modulators (SERMs) are a class of drugs designed to mimic estrogen in some parts of the body while blocking its effect elsewhere. AAA is currently the only approved drug in this class and is used for prevention and treatment of osteoporosis in postmenopausal women.
A) Raloxifene (Evista)
Raloxifene (a AAA) increases BBB, reduces bone resorption, and reduces the incidence of osteoporotic vertebral fractures. The drug should notbe given to women who have a history of CCC.
A) selective estrogen receptor modulators (SERMs)
B) bone mineral density (BMD)
C) thromboembolism
Calcitonin is a thyroid hormone that inhibits osteoclastic activity, thus decreasing bone loss. It is used for the AAA of osteoporosis, Paget's disease, and hypercalcemia associated with cancer.
A) treatment
AAA is the injection of bone cement into the vertebral body to reduce a fracture or fill the space created by osteoporosis.
Vertebroplasty
AAA includes the use of a balloon in the vertebral body to contain the bone cement. These procedures greatly reduce pain and increase function in patients with back pain related to osteoporosis.
Kyphoplasty
AAA is loss of bone related to a BBB deficiency. It causes softening of the bone caused by inadequate deposits of calcium and phosphorus in the bone matrix. Normal remodeling of the bone is disrupted, and calcification does not occur. AAA is the adult equivalent of CCC, or BBB deficiency, in children.
A) Osteomalacia
B) vitamin D
C) rickets
The minimum recommended daily allowance (RDA) of vitamin D is AAA international units. Because older adults are at risk for bone demineralization from aging, as well as for osteomalacia, they may need as much as BBB international units daily.
A) 400
B) 800
The major treatment for osteomalacia is ...
vitamin D
Paget’s disease, or AAA, is a chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) and re-formed (osteoblastic activity). The result is bone that is structurally disorganized, causing bones to be weak with increased risk for bowing of long bones and fractures.
A) osteitis deformans
When performing a musculoskeletal assessment in a patient with Paget's disease, pay particular attention to the ...
size and shape of the skull, which is typically soft, thick, and enlarged.
In Paget's pts. pressure from an enlarged temporal bone may lead to ...
deafness and vertigo (dizziness).
Basilar (in the occipital area) complications in AAA can compress any of the cranial nerves and result in neurologic problems. Assess the patient for changes in BBB.
A) Paget's pts.
B) vision, swallowing, and speech
AAA, or basilar invagination, causes BBB that threatens life in CCC.
A) Platybasia
B) brainstem (vital sign center) damage
C) Paget's pts.
In some cases, Paget’s causes bony enlargement of the skull which blocks AAA, resulting in BBB.
A) cerebrospinal fluid (CSF)
B) hydrocephalus
Radionuclide bone scan may be most sensitive in detecting Paget's disease. A radiolabeled AAA is injected IV and shows pagetic bone in areas of high bone turnover activity.
A) bisphosphonate
When the calcium level is more than twice the normal value and the disease [Paget's] is widespread, the health care provider usually prescribes more potent drugs, such as selected ...
bisphosphonates
Administration of all bisphosphonates for AAA or BBB is CCC.
A) osteoporosis
B) Paget's disease
C) Empty stomach, first thing in morning, full glass of water, 30 minutes before food, drink or other drugs, and remain upright (sitting/standing) for 30 minutes after taking.
Six bisphosphonates are approved for use in the United States for treatment of Paget's disease. AAA and BBB are most commonly used. CCC and DDD are prescribed less often. These four drugs are oral preparations and require the same nursing considerations during administration as described in osteoporosis use.
A) Alendronate (Fosamax)
B) risedronate (Actonel)
C) Etidronate (Didronel)
D) tiludronate (Skelid)
Two newer drugs have been approved for the treatment of Paget's disease when the oral agents are not effective. AAA and BBB are administered IV. Aredia is given once every 3 months, and Reclast is given once a year as a single IV dose.
A) Pamidronate (Aredia)
B) zoledronic acid (Reclast)
AAA is a hormone that seems to reduce bone resorption and, subsequently, relieve pain. The drug often causes a dramatic decrease in the alkaline phosphatase level in a few weeks.
A) Calcitonin
AAA is a potent chemotherapeutic agent with many side effects. It is reserved for patients with severe disease and neurologic compromise or marked hypercalcemia. Plicamycin is thought to block the effects of parathyroid hormone on osteoclasts.
A) Plicamycin (Mithracin)
Paget’s Disease: Surgical Management
Tibial osteotomy
Partial or total joint replacement
Surgical decompression and stabilization of the spine
Bone pain is described as AAA.
a constant, localized, pulsating sensation that worsens with movement.
Acute osteomyelitis often has a fever over 101F(38C) but older adults may not have an extreme temperature elevation because of ...
lower core body temperature and compromised immune system that occur with normal aging.
In addition to systemic drug therapy for osteomyelitis, the wound ...
may be irrigated, either continuously or intermittently, with one or more antibiotic solutions.
A treatment to increase tissue perfusion for patients with chronic, unremitting osteomyelitis is the use of a AAA therapy.
A) hyperbaric chamber or portable device to administer hyperbaric oxygen (HBO)
Because bone cannot heal in the presence of necrotic tissue caused by osteomyelitis, a AAA may be performed to débride the necrotic bone and allow revascularization of tissue.
A) sequestrectomy
With chronic osteomyelitis, fever may be AAA and BBB.
A) low grade
B) occur in the afternoon or evening
Perform gentle ROM to joints ...
above and below the affected part
After a sequestrectomy performed to débride the necrotic bone resulting from osteomyelitis check for signs of neurovascular compromise, including AAA thru EEE. If any of these findings occur, report them immediately to the surgeon.
pain that cannot be controlled
paresis or paralysis (weakness or inability to move)
paresthesias (abnormal, tingling sensation)
pallor
pulselessness
The major classifications of benign bone tumors include AAA, BBB and CCC.
A) chondrogenic tumors (from cartilage)
B) osteogenic tumors (from bone)
C) fibrogenic tumors (from fibrous tissue and found most often in children).
The AAA, is a lesion of mature hyaline cartilage affecting primarily the hands and the feet. This giant cell tumor is aggressive and although classified as benign, it can BBB.
A) chondroma, or endochondroma
B) metastasize to the lung
Benign bone tumor interventions:
Nondrug pain-relief measures
Drug therapy (analgesics, NSAIDs)
Surgical therapy (curettage, joint replacement, and less often arthrodesis - fused)
AAA, is the most common type of primary malignant bone tumor.
Osteosarcoma, or osteogenic sarcoma
Primary tumors of the AAA thru EEE are called bone-seeking cancers because they spread to the bone more often than other primary tumors. The FFF thru III are the bone sites commonly affected.
A) prostate
B) breast
C) kidney
D) thyroid
E) lung
F) vertebrae
G) pelvis
H) femur
I ribs
Pathologic fractures caused by metastatic bone are a major concern in patient care management. The most commonly affected areas for fracture are the AAA and BBB.
A) acetabulum
B) the proximal femur
Chemotherapy seems to work best for AAA and may be administered BBB surgery.
A) small, metastatic tumors
B) before or after
AAA is removal of the lesion surrounded by an intact cuff of normal tissue and leads to cure of BBB. A radical resection includes removal of the lesion, the entire muscle, bone, and other tissues directly involved. It is the procedure used for CCC.
A) Wide excision
B) low-grade (bone) tumors only
C) high-grade tumors
AAA used when large bone defects from tumor removal result, can be taken from the iliac crest, rib, or fibula with adjacent tendons and ligaments. These are harvested from cadavers and can be frozen or freeze-dried for a prolonged period.
Allografts
With allografts weight bearing is prohibited until there is evidence that the graft is ...
incorporated into the adjacent bone tissue
AAA, or deformity, is a slowly progressive thickening of the palmar fascia, resulting in flexion contracture of the fourth (ring) and fifth (little) fingers of the hand. The third or middle finger is occasionally affected. Although AAA is a common problem, the cause is unknown. It usually occurs in older Euro-American men, tends to occur in families, and can be bilateral.
Dupuytren's contracture
A AAA is a round, benign cyst, often found on a wrist or foot joint or tendon.
ganglion
The AAA deformity is a common foot problem in which the great toe drifts laterally at the first metatarsophalangeal
hallux valgus
AAA, or plantar digital neuritis, a small tumor grows in a digital nerve of the foot.
Morton's neuroma
AAA is most common in the BBB lateral thoracic area. Curvature of greater than CCC degrees results in an CCC, and curvature of greater than DDD degrees in the thoracic spine results in DDD.
A) Scoliosis
B) right
C) 50 - unstable spine
D) 60 - compromise of cardiopulmonary function
Exact cause of scoliosis is not well understood. The process may result from some problem in the AAA
balance mechanism located in the central nervous system
Methods of managing adult scoliosis differ from those used for children. The adult spinal column is less flexible and therefore less likely to respond to exercises, weight reduction, bracing, and casting for correction of the deformity. In the adult, the disorder is progressive and can result in an additional AAA.
one degree of deviation each year
The patient is diagnosed with possible osteoporosis. Which diagnostic tests do you anticipate will be ordered? (Select all that apply.)
A. Sodium
B. Phosphorus
C. Serum calcium
D. Electrocardiogram
E. Thyroid function tests
F. 24-hour urine collection
G. Dual x-ray absorptiometry (DXA)
B, C, E, F, G
All tests listed, except for ECG and sodium, are tests used to gather information about the bones, or in the case of thyroid function tests, to check for hyperthyroidism.
The patient is diagnosed with osteoporosis. Which intervention would be appropriate?
C. Recommend walking for 30 minutes 3 to 5 times a week.
The single most effective exercise for osteoporosis is walking 30 minutes 3 to 5 times a week. Patients should include increased vitamin D along with calcium in the diet. Smoking should be avoided as should high-impact exercises, which may cause vertebral compression fractures.
Which patient statement about self-care indicates a need for further teaching by the nurse?
A. “Joining a bowling team will help me exercise.”
Bowling should be avoided for patients with osteoporosis because it can contribute to compression fractures. Swimming, eating yogurt, and eliminating throw rugs in the house are all appropriate things to consider for the patient with osteoporosis.
1.The provider orders calcium 1.5 g orally twice a day (1 g in the morning and 500 mg at bedtime). The patient asks why she must drink extra fluids with this medication. What is your best response?
2.The patient also asks why she can’t just take the calcium once a day. What is your best response?
1.Increased fluid intake helps prevent the formation of calcium-based urinary stones.
2.A third of the daily dose should be given at bedtime because calcium is most readily utilized by the body when the patient is fasting and immobile.
What are the odds of a woman over the age of 50 breaking a bone because of osteoporosis?
B. 1 out of 2
One in two women over the age of 50 will break a bone because of osteoporosis. A woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian, and uterine cancer combined. Women have lighter, thinner bones than men. Many women also lose bone quickly after menopause. Up to one in four men over the age of 50 will break a bone because of osteoporosis. A man older than age 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer.
The patient who is taking alendronate (Fosamax) is at high risk for developing which disorder?
B. Inflammation of the esophagus
Esophagitis and esophageal ulcers have been reported with use of all of the bisphosphonates. The other answer selections apply to hormone replacement therapy.
A patient with Paget’s disease is at greatest risk for developing:
D. Pathologic bone fractures
Pathologic fractures may be the presenting clinical manifestation of the disorder. The femur and the tibia are most often affected, and fracture of these bones can result from minimal trauma. Patients with Paget’s disease frequently are fatigued and, although less common, may develop renal stones, gout, and heart failure.
An expected outcome of an older patient with acute osteomyelitis is:
B. Low-grade fever
Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte count, fatigue, and general malaise. However, older adults may not have an extreme temperature elevation because of lower core body temperature and compromised immune system that occur with normal aging.
A client is placed on risedronate (Actonel) 35 mg for management of Paget’s disease of the bone. Which statement by the client indicates a need for further teaching?
C. “I have to take this pill faithfully every week.”
For Paget’s disease, Actonel is usually prescribed daily (but at 30mg qday, not 35) for 2 months and then possibly repeated, depending on the results of laboratory values.
B is incorrect. The medication does slow the rate of bone resorption and new bone formation.
C is incorrect. The patient should have an oral assessment and preventive dentistry before beginning bisphosphonates therapy. In addition, the patient should alert the dentist regarding use of bisphosphonates before tooth extraction, implant, or other invasive procedures.
D is incorrect. Medication should be taken in the morning with 6 to 8 ounces of water at least 30 minutes before eating. Warn against lying down after taking the medication to prevent severe heartburn or reflux.
What is the priority nursing diagnosis for the older adult diagnosed with bone cancer that has metastasized from the lungs?
D. Chronic Pain related to tumor invasion and nerve involvement
As with many forms of cancer, the priority diagnosis will focus on Acute Pain and Chronic Pain related to physical injury (direct tumor invasion into soft tissue and nerves). The patient, if possible, is expected to direct actions focused on pain management. The patient is instructed to identify onset of pain, recognize alleviating factors such as repositioning, use analgesics appropriately, and partake in alternatives to medication such as relaxation techniques, music therapy, meditation, and biofeedback. If the patient is unable to direct the care, family members need to be educated in methods to alleviate pain.
During the assessment of a 67 year-old female w/ osteoporosis, the nurse discovers that the patient does not take estrogen. What are contraindications or precautions if the physician decides to place her on estrogen replacement therapy?
Thromboembolic disease, tumors, hypertension, or liver or gallbladder disease
The 67 year-old female patient w/ osteoporosis says that she does not like milk and rarely drinks it. How could she increase her calcium intake?
Encourage increased calcium intake through the following sources: natural calcium sources, such as oyster shells; over-the-counter calcium sources, such as TUMS; calcium citrate; foods rich in calcium, such as dairy products (cheese) and dark green leafy vegetables
The health care provider suspects osteoporosis. What test is most likely to be ordered and what should the nurse tell the patient about the test?
The most commonly used screening and diagnostic tool for measuring bone mineral density (BMD) is dual x-ray absorptiometry (DXA). The spine and hip are most often assessed. Many physicians recommend that women in their 40s have a baseline DXA scan so that later bone changes can be detected and compared. DXA is a painless scan that emits less radiation than a chest x-ray. It is the best tool currently available for a definite diagnosis of osteoporosis.
The patient (67 year-old female patient w/ osteoporosis) is given a prescription for alendronate (Fosamax). What should the nurse tell her before she begins therapy with this drug?
Contraindications include reduced renal function, hypocalcemia, and gastrointestinal reflux disease (GERD). This drug needs to be taken early in the morning with 8 ounces of water, but she should wait 30 minutes before eating. It is important to remain upright during this 30-minute period before eating to prevent esophageal irritation. If chest pain, a sign of esophageal irritation, occurs, the patient should discontinue the drug and notify her health care provider.
Situation: Your patient is a 57-year-old man with metastatic bone cancer. It has been determined that the primary site of the cancer was his prostate. He is beginning chemotherapy. You are the nurse providing the education for him. He asks how chemotherapy works. Which of these statements will you include? Select all that apply.
A. Chemotherapy is useful because its effects are systemic.
B. The physician may prescribe chemotherapy alone or in combination with radiation or surgery.
C. Chemotherapy has some selectivity for killing cancer cells over normal cells.
D. Normal cells that divide rapidly are those most affected by chemotherapy.
A, B, C and D
Normal cells most affected are those that divide rapidly, including skin, hair, intestinal tissue, spermatocytes, and blood-forming cells.
Situation: Your patient is a 57-year-old man with metastatic bone cancer. It has been determined that the primary site of the cancer was his prostate. He is beginning chemotherapy. You are the nurse providing the education for him. The chemotherapy drug is selected based on what criteria? Select all that apply.
A. Based on universally accepted protocols
B. Based on known tumor sensitivity
C. Based on the primary source
D. Based on the degree of side effects expected
B, C and D
At present, there are no universally accepted protocols. Drugs are selected, in part, based on primary source; for example, treatment for breast cancer metastasis may include estrogen. Selection is based on sensitivity and degree of side effects; for example, most chemotherapy drugs suppress bone marrow and immune function, with some agents having a greater effect than others.
Situation: Your patient is a 57-year-old man with metastatic bone cancer. It has been determined that the primary site of the cancer was his prostate. He is beginning chemotherapy. You are the nurse providing the education for him. How is pain managed in the patient with metastatic bone disease? Select all that apply.
A. Use of analgesics
B. Recognition of pain onset
C. Use of nonanalgesics
D. Chemotherapy to cause tumor regression
All
In addition to analgesics used for pain, chemotherapy and radiation are often administered to cause tumor regression.
Situation: Drugs such as Os-Cal are some of the most cost-effective supplement formulas. Calcium citrate, available OTC as Citracal, is often recommended for those who experience gastric upset when taking a calcium supplement. What patient teaching should you do to ensure that she is taking this supplement correctly? Select all that apply.
A. Take the medication with food and 6 to 8 ounces of water.
B. Citracal should be taken at bedtime.
C. It is best to divide the daily dose, with one third of the daily dose taken at bedtime.
D. The medication should not be taken with food because it blocks absorption.
A, B and C
Teach patients to take calcium supplements with food and 6 to 8 ounces of water, although Citracal can be taken anytime. It is best to divide the daily dose, with at least one third of the daily dose being taken in the evening.
Situation: Your patient is a 56-year-old female diagnosed with osteoporosis. She has not experienced bone fractures but wants to get a "head start" on warding off bone problems. She has been taking the most cost-effective calcium supplement. After her bone density test, the physician has decided to place her on Boniva. What information should the patient receive to ensure that she takes this medication appropriately? Select all that apply.
A. Take the medication on the same day each week.
B. Take the medication on an empty stomach.
C. Remain upright for 1 hour after administration.
D. Take the medication with a full glass of water first thing in the morning.
B, C and D
Take on the same day each month. Take on an empty stomach, first thing in the morning with a full glass of water. Take 60 minutes before food, drink, or other medications. Remain upright for 1 hour after administration.
Most types of MD are multi-system disorders with manifestations in body systems including the ...
heart
gastrointestinal system
nervous system
endocrine glands
eyes
brain
Of these patients, which should the RN assess first?
B. The patient with osteoporosis and compression fractures of the lumbar spine who has not voided for 14 hours
This patient may be experiencing decreased neurologic function related to lumbar compression of the spinal cord and should be assessed immediately to avoid possible permanent spinal cord or urinary tract injury. The other patients should be assessed as soon as possible but are not the first priority.
Which members primarily make up the health care team caring for the client with musculoskeletal problems? (Select all that apply.)
A. Speech therapist
B. Nutritionist
C. Occupational therapist
D. Case manager
E. Physical therapist
F. Nurse
G. Chaplain
C, E, F and G
Which community resource is the best for the client with osteoporosis?
A. Hospital support group
Large hospitals often have osteoporosis specialty clinics and support groups for patients with osteoporosis.
Which are nonsurgical treatment options for cancerous bone tumors? (Select all that apply.)
A. Chemotherapy
B. Analgesics
C. Total joint replacement
D. Cordotomy
E. Radiation therapy
A and E
nonsurgical treatment options
Analgesics are used to treat pain related to cancerous bone tumors. They are administered together with nonsurgical procedures, i.e. these smart asses are saying that treating the pain caused by a thing is not treating the thing. So be it.
Which method helps prevent the incidence of osteomyelitis?
A. Brushing teeth after every meal
B. Maintaining clean dressing change technique for long-term IV catheters
C. Use of clean technique for clients undergoing hemodialysis
D. Use of standard precautions for clients at risk for infection
A. Brushing teeth after every meal
Long-term IV catheters can be a primary source of infection, so dressing changes are done using steriletechnique. Ditto with hemodialysis.
Which is the best way to decrease the risk for osteoporosis?
C. Walk for 30 minutes three times a week.
Calcium loss occurs at a more rapid rate when phosphorus intake is high. People who drink large amounts of carbonated beverages each day (over 40 ounces) are at high risk for calcium loss and subsequent osteoporosis, regardless of age or gender.
Which statement about Paget's disease is true?
A. Paget's disease is the second to osteoporosis as the most commonly occurring bone disease.
Several genetic and immunologic (not hematologic) changes have been identified in families with the disease.
Paget's disease is seen more frequently in those aged 50 years and older.
Paget's disease is thought to have an autosomal dominant pattern.
Which drugs are prescribed to clients for the prevention of bone loss and to increase bone density? (Select all that apply.)
A. Carvedilol (Coreg)
B. Raloxifene (Evista)
C. Calcitonin (Calcimar)
D. Tamsulosin hydrochloride Incorrect: Tamsulosin hydrochloride is an alpha-adrenergic blocker used for the treatment of benign prostatic hyperplasia.(Flomax)
E. Medroxyprogesterone (Prempro)
B, C and E
These three prevent bone loss and increase bone density.
High alcohol intake: risk factor for osteoporosis and/or osteomalacia?
both
History of smoking: risk factor for osteoporosis and/or osteomalacia?
osteoporosis only.
Inadequate exposure to sunlight: risk factor for osteoporosis and/or osteomalacia?
osteomalacia only
Homelessness: risk factor for osteoporosis and/or osteomalacia?
only osteomalacia
Which is a key feature of Paget's disease?
C. Enlarged thick skull
Progressive muscle weakness is a feature of muscular dystrophy.
Low body weight and thin build is a feature of osteoporosis.
Bone infection is a feature of osteomyelitis.
Which is a common feature of chronic osteomyelitis?
C. Ulceration of the skin
The others are features of acute osteomyelitis.
Which description best illustrates plantar fasciitis?
B. Severe pain in the arch of the foot, especially when getting out of bed.
Lateral deviation of the great toe; first metatarsal head becomes enlarged describes ...
a bunion of the foot.
Dorsiflexion of any metatarsophalangeal (MTP), with plantar flexion of the adjacent proximal interphalangeal (PIP) joint describes ...
a hallux valgus and hammertoe of the foot.
A small tumor in a digital nerve of the foot describes ...
Morton's neuroma of the foot.
Osteomalacia is loss of bone related to AAA. The major treatment for osteomalacia is BBB such as CCC.
A) vitamin D deficiency
B) vitamin D in an active form
C) ergocalciferol (calciferol)
The nurse is assessing a client with Ewing's sarcoma. Which finding will the nurse expect to observe?
C. Leukocytosis
Ewing's sarcoma is a malignant tumor, and the client may experience systemic manifestations including leukocytosis, anemia, and low-grade fever.
A mother is a carrier of muscular dystrophy (MD) and has a daughter. The client asks the nurse what the daughter's genetic risk is for having MD. What is the nurse's best response?
C. "There is a 50% chance that your daughter may carry the gene."
The nurse is assessing a client with osteomalacia. Which findings will the nurse expect to observe? Select all that apply.
A. Hyperparathyroidism
B. Hyperuricemia
C. Hypophosphatemia
D. Looser's lines or zones
E. Unsteady gait
C, D and E
Osteomalacia is loss of bone related to vitamin D deficiency, which can lead to bone softening and inadequate deposits of calcium and phosphorus in the bone matrix; this may cause hypophosphatemia.
Looser's lines or zones (radiolucent bands) represent stress fractures and are a classic diagnostic finding of osteomalacia.
Also, Muscle weakness in the lower extremities may cause waddling and an unsteady gait.
Hyperparathyroidism may be observed in Paget's disease as well as Hyperuricemia.
The nurse is caring for a client with prostate cancer who has bone metastasis. The nurse anticipates that the physician will prescribe which medication?
D. Pamidronate (Aredia)
Pamidronate (Aredia) is a bisphosphonate that is available intravenously and is approved for bone metastasis from the breast, lung, and prostate. Pamidronate protects bones and prevents fractures.
AAA is used for the treatment of postmenopausal osteoporosis, Paget's disease, and hypercalcemia associated with cancer.
A) Calcitonin (Calcimar)
Calcitonin (Calcimar) ...
is used for the treatment of postmenopausal osteoporosis, Paget's disease, and hypercalcemia associated with cancer.
AAA is indicated for treating menopausal symptoms and preventing osteoporosis.
A) Medroxyprogesterone (Prempro)
Medroxyprogesterone (Prempro) ...
is indicated for treating menopausal symptoms and preventing osteoporosis.
AAA is an alpha-adrenergic blocker used for the treatment of benign prostatic hyperplasia.
A) Tamsulosin hydrochloride (Flomax)
Tamsulosin hydrochloride (Flomax) ...
is an alpha-adrenergic blocker used for the treatment of benign prostatic hyperplasia.
The client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon?
C. Paresis of right lower extremity
Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon.
The client undergoing a sequestrectomy experiences increased swelling after the procedure. The affected extremity should be elevated to increase venous return and thus control swelling.
