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Test 3 Review

Terms in this set (71)

A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following statements related to osteoporosis is most accurate?

Osteoporosis is categorized as a disease of the elderly.
A nonmodifiable risk factor for osteoporosis is a person's level of activity.
Secondary osteoporosis occurs in women after menopause.
Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier in life, when bone mass peaks and then begins to decline. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.
Which of the following are routes of administration for Calcitonin? Select all that apply.

Nasal spray
Subcutaneous
Intramuscular injection
Intravenous
Oral
Calcitonin is administered by nasal spray or by subcutaneous or intramuscular injections.
To confirm a diagnosis of low back pain, which of the following diagnostic procedures would be ordered to rule out the presence of a tumor?

Bone scan
Computed tomography
Magnetic resonance imaging
Electromyogram
A bone scan is the preferred diagnostic procedure to disclose tumors in a patient with low back pain.
What are some risk factors for osteoporosis?
Lifestyle risk factors for osteoporosis include lack of exposure to sunshine, a diet low in calcium and vitamin D, cigarette smoking, consumption of alcohol and/or caffeine, and lack of weight-bearing exercise. Lack of weight-bearing exercise, not aerobic exercise, is a lifestyle risk factor for osteoporosis. A diet low in calcium and vitamin D, not a low-protein, high-fat diet, is a lifestyle risk factor for osteoporosis. An estrogen deficiency or menopause is an individual risk factor for osteoporosis. Other individual risk factors include female gender, non-Hispanic white or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing coexisting medical conditions and medications.
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis?

Bisphosphonates
Calcitonin
Selective estrogen receptor modulators
Anabolic agents
Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.
A client has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care?
Constipation is a problem related to immobility and medications used to treat vertebral fractures. The client's risks of aspiration, dysphagia, and decreased cardiac output are not necessarily heightened.
A nurse practitioner was asked to explain to a patient the age-related process of bone loss that results in osteoporosis. Which of the following is the best statement the nurse should use?

Decreased estrogen inhibits bone breakdown.
Increased calcitonin enhances bone resorption.
Increased vitamin D use interferes with calcium use. Decreased parathyroid hormone increases bone resorption.
Osteoporosis is characterized by decreased estrogen, calcitonin, and vitamin D use; the parathyroid hormone increases with age, causing increased bone turnover and resorption.
A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply.

Vitamin B12
Potassium
Calcitonin
Calcium
Vitamin D
A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12 and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.
A physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care?

Administering the raloxifene in the evening
Holding the raloxifene and notifying the physician Administering the raloxifene with food or milk
Having the patient sit upright for 30-60 minutes following administration
Raloxifene is contraindicated in clients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene can be given without regard to food or time of day. Raloxifene is a selective estrogen receptor modulation medication. Sitting upright for 30-60 minutes is indicated with drugs classified as bisphosphonates.
A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply.

Pneumonia
Necrosis of the humerus
Skin breakdown
Sepsis
Delirium
Complications in clients with hip fractures are often related to the client's age. During the first 24 to 48 hours following surgery for hip fracture, atelectasis or pneumonia can develop as a result of the anesthesia. Thromboemboli are possible, as is sepsis. Elderly clients are also at risk for delirium in hospital settings because of the stress of the trauma, unfamiliar surroundings, sleep deprivation, and medications. An elderly client with decreased mobility is at risk for skin breakdown. Necrosis is a potential complication of the surgery, but the complication would be with the femur, not the humerus.
A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this client? Select all that apply.

Systemic infection
Complex regional pain syndrome
Deep vein thrombosis
Compartment syndrome
Fat embolism
Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and complex regional pain syndrome are later complications of fractures.
Which of the following type of fracture is associated with osteoporosis?

Compression
Stress
Oblique
Simple
Compression fractures are caused by compression of vertebrae and are associated frequently with osteoporosis. Stress fractures occur with repeated bone trauma from athletic activities, most frequently involving the tibia and metatarsals. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees. A simple fracture (closed fracture) is one that does not cause a break in the skin.
Emergency medical technicians transport a client to the emergency department. They tell the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." Which intervention by the nurse has the highest priority?

Assessing the left leg
Assessing the pupils
Placing the client in Trendelenburg's position
Assessing level of consciousness (LOC)
In this scenario, airway and breathing have been established, so the nurse's priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the left leg. Neurologic assessment of the pupils and LOC are secondary concerns to airway, breathing, and circulation. The nurse doesn't have enough data to warrant putting the client in Trendelenburg's position.
The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.)

Checking the urine for hematuria
Palpating peripheral pulses in both lower extremities
Testing the stool for occult blood
Assessing level of consciousness
Assessing pupillary response
In pelvic fracture, the nurse should palpate the peripheral pulses, especially the dorsalis pedis pulses of both lower extremities; absence of a pulse may indicate a tear in the iliac artery or one of its branches. To assess for urinary tract injury, the patient's urine is analyzed for blood.
The nurse is changing the dressing of a chronic wound. There is no sign of infection or heavy drainage. How long will the nurse leave the wound covered for?

6 to 12 hours
12 to 24 hours
24 to 36 hours
48 to 72 hours
The natural wound-healing process should not be disrupted. Unless the wound is infected or has a heavy discharge, it is common to leave chronic wounds covered for 48 to 72 hours and acute wounds for 24 hours.
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