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A client has a bone density score of 2.8. What action by the nurse is best?
- A. Asking the client to keep a food diary
- B. Planning to teach about bisphosphonates
- C. Scheduling another scan in 2 years
- D. Scheduling another scan in 2 months
Correct Answer: B
Rationale: A T-score of 2.5 or lower indicates osteoporosis. The nurse should plan to teach about medications used to treat this disease, such as bisphosphonates. A food diary may help assess calcium and vitamin D intake, but dietary changes alone are insufficient at this stage. Scheduling another scan does not address immediate treatment needs.
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A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
- A. Allow the client to rest in a position of comfort
- B. Assess the client's cardiac and respiratory systems
- C. Assist the client with ambulating and position changes
- D. Position the client on one side propped with pillows
Correct Answer: B
Rationale: A 65-degree spinal curve in scoliosis can impair cardiac and respiratory function due to chest deformity. Assessing these systems is the priority to ensure the client's safety. Comfort, ambulation, and positioning are important but secondary.
A nurse is assessing an older client and discovers back pain with tenderness along L2 and L3. What action by the nurse is best?
- A. Consult the provider about an X-ray
- B. Encourage the client to use ibuprofen (Motrin)
- C. Have the client perform hip range of motion
- D. Apply a cervical collar
Correct Answer: A
Rationale: Back pain with tenderness at L2 and L3 suggests a spinal compression fracture, common in osteoporosis. Consulting the provider for an X-ray is the priority to confirm the diagnosis. Ibuprofen may be considered post-diagnosis, and hip range of motion is unrelated. A cervical collar is inappropriate for lumbar issues.
The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)
- A. Draining sinus tracts
- B. Presence of sequestra
- C. High fever
- D. Presence of foot ulcers
- E. Swelling and redness
Correct Answer: A,B,D
Rationale: Chronic osteomyelitis is characterized by draining sinus tracts, sequestra (dead bone), and foot ulcers. High fever and swelling/redness are more typical of acute osteomyelitis.
The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.)
- A. Corticosteroids
- B. Anticonvulsants
- C. Loop diuretics
- D. Proton pump inhibitors
- E. Selective serotonin reuptake inhibitors
Correct Answer: A,B,D,E
Rationale: Corticosteroids, anticonvulsants, proton pump inhibitors, and SSRIs are associated with bone loss and osteoporosis risk. Antibiotics are not typically linked to this condition.
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?
- A. Client with diabetes who has a serum creatinine of 0.8 mg/dL
- B. Client who recently fell and has vertebral compression fractures
- C. Hypertensive client who takes calcium channel blockers
- D. Client with a spinal cord injury who cannot tolerate sitting up
Correct Answer: D
Rationale: Bisphosphonates require the client to sit upright for 30"?60 minutes after administration to prevent esophageal irritation. A client with a spinal cord injury who cannot tolerate sitting up is not a good candidate. A serum creatinine of 0.8 mg/dL is normal, and neither vertebral fractures nor calcium channel blockers contraindicate bisphosphonates.