1. The RN has assigned a client with severe osteoporosis to an LPN. Which information about the care of the client is most important for the RN to provide the LPN?

a.            Provide passive range of motion (ROM) to all weight-bearing joints.

b.            Position the client upright to promote lung expansion.

c.             Place a pillow between the client’s knees when in the side-lying position.

d.            Use a lift sheet to reposition the client.

ANS: D

Severe osteoporosis causes such bone density loss that pathologic fractures can easily occur when lifting or pulling a client. Use of a lift sheet when positioning reduces this risk. Passive range of motion prevents contractures, but active weight-bearing exercise reduces bone resorption and is a better choice if possible. Positioning the client to promote lung expansion and positioning with a pillow for side-lying are important interventions for any client. The most important intervention for this client is to prevent bone fractures.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Accident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

2. Which instruction is most important for the RN to provide to the nursing assistant assigned to care for a client with primary osteoporosis?

a.            “Clean up clutter in the room.”

b.            “Encourage the client to bathe herself or himself.”

c.             “Monitor urinary output.”

d.            “Perform passive range-of-motion exercises.”

ANS: A

Clients with osteoporosis are at risk for fracture when they fall. Clutter in the room is a risk factor for falls. The other choices have nothing to do with prevention of bone fracture in a client with primary osteoporosis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Accident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

3. Which instruction does the nurse include in the discharge teaching plan of a client who has osteoporosis?

a.            “Avoid using scatter rugs.”

b.            “Avoid weight-bearing exercises.”

c.             “Use a cane when walking outside.”

d.            “Reduce the amount of protein in your diet.”

ANS: A

To avoid falls, the client should keep a hazard-free environment, including avoiding scatter rugs, cluttered rooms, and wet floor areas. Weight-bearing exercises help prevent bone resorption. A cane is not needed unless the client has a physical disability. A protein deficiency should be avoided because it might cause a reduction in bone density.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Accident/Injury Prevention) MSC: Integrated Process: Teaching/Learning

4. After the administration of each dose of zoledronic acid (Zometa), it is most important for the nurse to determine which finding?

a.            Capillary refill

b.            Pain relief

c.             Level of consciousness

d.            Urine output

ANS: D

Zoledronic acid is a bisphosphonate that helps protect bones and prevent fractures. Urine output and serum creatinine should be monitored because this drug can be toxic to the kidneys. Zometa does not relieve pain or affect capillary refill or level of consciousness.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiologic Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Assessment)

5. Which nursing intervention is most effective in preventing transfer of an organism from the wound of a client with osteomyelitis to other clients?

a.            Contact Precautions

b.            Restriction of visitors

c.             Irrigating the wound as needed

d.            Leaving the wound open to air

ANS: A

In the presence of wound drainage, Contact Precautions may be used to prevent the spread of the offending organism to other clients and health care personnel. Restricting visitors does not prevent transfer. One visitor could possibly transfer the bacteria to another surface. Irrigating the wound would not destroy the organism. The wound should be covered to prevent transfer of the organism.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Standard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

6. While caring for a client who has chronic osteomyelitis and wound drainage, which intervention is most important for the nurse to implement?

a.            Cover the wound with a dressing.

b.            Teach about the cause of the infection.

c.             Monitor the erythrocyte sedimentation rate (ESR).

d.            Prepare the client for hyperbaric oxygenation.

ANS: A

If an open wound is present in the hospital or long-term care setting, the client’s treatment usually includes Standard Precautions for limiting infection by covering the wound. Teaching about the cause of the infection could prevent further episodes of infection, but does not take care of the current problem. The ESR just tells the health care provider that an inflammatory process is going on. Hyperbaric oxygenation is used only for clients with chronic, unremitting osteomyelitis. Covering the wound would be the most important step for the nurse to take first.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Handling Hazardous and Infectious Materials)

MSC: Integrated Process: Nursing Process (Implementation)

7. Which exercise does the nurse recommend to a client at risk for osteoporosis?

a.            High-impact aerobics 45 minutes once weekly

b.            Walking 30 minutes three times weekly

c.             Jogging 30 minutes four times weekly

d.            Bowling for 1 hour twice weekly

ANS: B

Weight-bearing, nonjarring exercises have been proved to reduce or slow bone loss without causing vertebral compression. High-impact aerobics, jogging, and bowling are activities that actually could cause fracture in a client with osteoporosis. Walking would be the best choice as an exercise.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)

MSC: Integrated Process: Teaching/Learning

8. An adult client’s susceptibility to osteoporosis is caused by which aspect of his or her history?

a.            Fractured arm at age 16

b.            Active smoking

c.             Vitamin D supplements

d.            Weight lifting

ANS: B

A history of smoking has been identified as a risk factor for osteoporosis. A history of low-trauma fracture after the age of 50 has been identified as a risk factor. Vitamin D and weight lifting are measures that can be used to prevent this disease.

DIF: Cognitive Level: Comprehension/Understanding REF: Chart 53-1, p. 1120

TOP: Client Needs Category: Health Promotion and Maintenance (Lifestyle Choices)

MSC: Integrated Process: Nursing Process (Analysis)