Chapter 39: Osteoporosis Treatment

Chapter 39: Osteoporosis Treatment

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A 55-year-old woman who experienced menopause at age 50 years undergoes central dual-energy x-ray absorptiometry and has a T-score greater than 2.5. The patient weighs 130 lb and has a body mass index of 22. She sits at a computer all day at work. The primary care nurse practitioner (NP) caring for this patient should:

ANS:  C

The NP should counsel the patient about diet and exercise. Women who are at least 5 years postmenopausal or who have several risk factors should have bone density testing. Osteoporosis is defined as a T-score of less than 2.5, and treatment is indicated for women with T-scores that are 2 or more standard deviations below the normal premenopausal level. It is not necessary to initiate treatment at this time.

DIF:    Cognitive Level: Applying (Application)                           REF:   435

2. A 50-year-old white woman who is experiencing menopause asks the primary care NP what she can do to prevent osteoporosis. She has a negative family history and no risk factors. The NP should counsel her to:

ANS:  D

Postmenopausal women should consume 1200 mg of calcium and at least 1000 U of vitamin D each day. Bisphosphonate therapy should be considered for persons with known risk factors. Bone density testing is indicated for women with risk factors and then routinely after age 65. Patients should be encouraged to engage in high-impact sports if possible to improve bone density.

DIF:    Cognitive Level: Applying (Application)                           REF:   433

3. A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-score of 1.9. A health history reveals no risk factors for osteoporosis. The primary care NP should:

ANS:  A

This woman’s T-score is less than 2.5 and indicates osteoporosis. She should begin treatment with a bisphosphonate. Increasing physical activity and taking supplemental calcium and vitamin D are indicated as well but only as part of a medication regimen. Calcitonin is not a first-line medication.

DIF:    Cognitive Level: Applying (Application)                           REF:   433

4. A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax) and calcium for 6 months. The primary care NP orders a urine NTx level, which is 42. The NP should discontinue the alendronate and prescribe:

ANS:  B

Teriparatide is used in patients with a high fracture risk or in whom bisphosphonate therapy has failed. Raloxifene and ibandronate are second-line treatments for patients with usual fracture risks. Calcitonin is a last-line treatment.

DIF:    Cognitive Level: Applying (Application)                           REF:   436