Chapter 75: Drugs Affecting Calcium Levels and Bone Mineralization Test Bank
MULTIPLE CHOICE
1. A 55-year-old female patient asks a nurse about
... [Show More] calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient’s serum calcium level is 9.5 mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will recommend adding
daily and IU of vitamin D3 each day.
a. 1200 mg of calcium once; 10,000
b. 1500 mg of calcium twice; 1000
c. 600 mg of calcium once; 10,000
d. 600 mg of calcium twice; 2000
ANS: C
Women older than 50 years need 1200 mg of calcium per day. This patient is getting 600 mg/day. She should add 600 mg/day to compensate for what she does not get in her diet, because the amount of a supplement should be enough to make up the difference. Her vitamin D level is low, so she needs a vitamin D supplement. To treat deficiency, adults older than 19 years should get 10,000 IU/day. An additional intake of 1200 mg of calcium once daily is too much calcium. An additional intake of 1500 mg of calcium twice daily is too much calcium, and 1000 IU of vitamin D is not enough to treat deficiency. An additional intake of 600 mg of calcium twice daily is too much calcium, and 2000 IU of vitamin D is not sufficient to treat deficiency.
DIF: Cognitive Level: Application
REF: Calcium Physiology | Functions, Sources, and Daily Requirements | Dietary Sources | Daily Requirements | Vitamin D Deficiency TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A nurse is providing education to a patient who will begin taking alendronate (Fosamax). Which complication should the patient be instructed to report immediately?
a. Difficulty swallowing
b. Dizziness
c. Drowsiness
d. Pallor
ANS: A
Esophagitis is the most serious adverse effect of alendronate, sometimes resulting in ulceration. The nurse should instruct the patient to report difficulty swallowing immediately, because it can be a sign of esophageal injury. Dizziness is not an adverse effect of alendronate. Drowsiness is not a symptom associated with alendronate. Pallor is not a symptom associated with alendronate.
DIF: Cognitive Level: Application REF: Alendronate | Adverse Effects TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching?
a. “Chewable calcium tablets are not absorbed well and are not recommended.”
b. “I should not take more than 600 mg of calcium at one time.”
c. “I should take enough supplemental calcium to meet my daily requirements.”
d. “If I take calcium with green, leafy vegetables, it will increase absorption.”
ANS: B
To help ensure adequate absorption of calcium, no more than 600 mg should be consumed at one time. Chewable calcium tablets are recommended because of their more consistent bioavailability. The amount of supplemental calcium should be enough to compensate for what is not consumed in the diet and should not constitute the total amount needed per day. Green, leafy vegetables reduce the absorption of calcium.
DIF: Cognitive Level: Application
REF: Calcium Physiology | Functions, Sources, and Daily Requirements | Food Interactions | Preparations and Dosage TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
4. A nurse is preparing to administer IV calcium chloride to a patient with a low serum calcium level. Which drug on the patient’s medication record, administered concurrently, would require additional patient monitoring by the nurse?
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Lorazepam (Ativan)
d. Pantoprazole (Protonix)
ANS: A
Parenteral calcium may cause severe bradycardia in patients taking digoxin; therefore, the heart rate should be monitored closely. Concurrent administration of calcium chloride and pantoprazole, lorazepam, or furosemide is not known to lead to drug interactions.
DIF: Cognitive Level: Analysis REF: Parenteral Calcium Salts | Drug Interactions TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A nurse is discussing the role of vitamin D in calcium regulation with a nursing student. Which statement by the student indicates a need for further teaching?
a. “Adequate amounts of vitamin D occur naturally in the diet.”
b. “Vitamin D3 is preferred over vitamin D2.”
c. “Vitamin D can promote bone decalcification.”
d. “Vitamin D increases the absorption of calcium and phosphorus from the intestine.”
ANS: A
Vitamin D does not occur naturally in the diet. Adequate amounts are gained through fortified foods, supplements, and exposure to sunlight. Vitamin D3 is preferred. If calcium intake is not sufficient, vitamin D can promote bone decalcification. Vitamin D acts to increase the absorption of calcium and phosphorus from the intestine.
DIF: Cognitive Level: Application
REF: Vitamin D | Physiologic Actions | Sources and Daily Requirements | Sources | Preparations, Dosage, and Administration TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. A patient reports experiencing weakness, fatigue, nausea, vomiting, constipation, and nocturia. A dipstick urinalysis shows a positive result for protein. When questioned, the patient reports taking vitamin D and calcium supplements. The nurse will counsel the patient to:
a. reduce the amount of vitamin D and stop taking the calcium.
b. discuss taking calcitonin-salmon (Fortical) with the provider.
c. stop both supplements and discuss the use of a diuretic with the provider.
d. stop taking vitamin D, reduce the amount of calcium, and increase the fluid intake.
ANS: D
Vitamin D toxicity can occur, and early responses include the symptoms described. Patients should be counseled to stop taking vitamin D, reduce their calcium intake, and increase their fluid intake. It is not correct to reduce the vitamin D intake and the calcium intake. Calcitonin- salmon is not indicated. A diuretic is indicated when hypercalciuria is severe.
DIF: Cognitive Level: Application
REF: Toxicity (Hypervitaminosis D) | Clinical Presentation | Treatment TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. A patient has severe Paget’s disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider?
a. Alendronate (Fosamax)
b. Calcifediol (25-Hydroxy-D3)
c. Calcitonin-salmon (Miacalcin)
d. Long-acting NSAIDs
ANS: C
Salmon calcitonin is the drug of choice for rapid relief of pain associated with Paget’s disease. Alendronate, calcifediol, and NSAIDs are not indicated.
DIF: Cognitive Level: Analysis
REF: Calcitonin-Salmon | Therapeutic Uses | Paget’s Disease of the Bone TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
8. A patient who has developed postmenopausal osteoporosis will begin taking alendronate (Fosamax). The nurse will teach this patient to take the drug:
a. at bedtime to minimize adverse effects.
b. for a maximum of 1 to 2 years.
c. while sitting upright with plenty of water.
d. with coffee or orange juice to increase absorption.
ANS: C
Alendronate can cause esophagitis, and this risk can be minimized if the patient takes the drug with water while in an upright position. Taking the drug at bedtime is not indicated. The drug may be taken up to 5 years before re-evaluation is indicated. Coffee and orange juice reduce the absorption of alendronate and should be delayed for 30 minutes after taking the drug.
DIF: Cognitive Level: Application
REF: Alendronate | Adverse Effects | Esophagitis | Administration TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
9. A patient is taking alendronate (Fosamax) to treat Paget’s disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to:
a. reduce the likelihood of atrial fibrillation.
b. maximize bone resorption of calcium.
c. minimize the risk of esophageal cancer.
d. prevent hyperparathyroidism.
ANS: D
Alendronate can induce hyperparathyroidism in patients with Paget’s disease; calcium supplementation can prevent this effect. Giving calcium does not reduce the incidence of atrial fibrillation, maximize bone resorption of calcium, or minimize the risk of esophageal cancer.
DIF: Cognitive Level: Application
REF: Alendronate | Adverse Effects | Hyperparathyroidism TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
10. A patient taking risedronate IR (Actonel) for osteoporosis reports experiencing diarrhea and headaches. What will the nurse tell this patient?
a. These are common side effects of this drug.
b. These symptoms indicate serious toxicity.
c. The patient should discuss taking risedronate DR (Atelvia) with the provider.
d. The medication should be taken after a meal to reduce symptoms.
ANS: A
Diarrhea and headaches are common adverse effects of risedronate IR. These symptoms do not indicate toxicity. The side effects of Atelvia are similar to those of Actonel. Taking the medication after a meal will not reduce these effects.
DIF: Cognitive Level: Application REF: Risedronate | Adverse Effects TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
11. A nurse is providing teaching for a patient with osteoporosis who has just switched from alendronate (Fosamax) to zoledronate (Reclast). Which statement by the patient indicates a need for further teaching?
a. “I will need to have blood tests periodically while taking this drug.”
b. “I will only need a dose of this medication every 1 to 2 years.”
c. “This drug is less likely to cause osteonecrosis of the jaw.”
d. “This drug is only given intravenously.”
ANS: C
Zoledronate has an increased risk of osteonecrosis of the jaw, as does alendronate. The patient is correct to identify the need for periodic blood tests. Zoledronate is given only every 1 to 2 years and is given only intravenously.
DIF: Cognitive Level: Application
REF: Zoledronate | Actions and Uses | Adverse Effects | Preparations, Dosage, and Administration TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
12. A postmenopausal patient develops osteoporosis. The patient asks the nurse about medications to treat this condition. The nurse learns that the patient has a family history of breast cancer. The nurse will suggest discussing which medication with the provider?
a. Estrogen estradiol
b. Pamidronate (Aredia)
c. Raloxifene (Evista)
d. Teriparatide (Forteo)
ANS: C
Raloxifene is a selective estrogen receptor modulator (SERM) that has estrogenic effects in some tissues and antiestrogenic effects in others. It can preserve bone mineral density while protecting against breast and endometrial cancers. Estrogen promotes breast cancer and would not be indicated. Pamidronate and teriparatide are not protective against breast cancer.
DIF: Cognitive Level: Application
REF: Raloxifene | Therapeutic Uses | Postmenopausal Osteoporosis | Breast Cancer TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
13. A patient with severe glucocorticoid-induced osteoporosis will start therapy with teriparatide (Forteo). What will the nurse expect to administer?
a. 20 mcg once daily subQ
b. 20 mcg twice daily subQ
c. 10 mcg once daily subQ
d. 10 mcg twice daily subQ
ANS: A
The dose of teriparatide for all indications is 20 mcg once daily subQ.
DIF: Cognitive Level: Comprehension
REF: Teriparatide | Preparations, Dosage, and Administration TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
14. A postmenopausal patient is at high risk for developing osteoporosis. The patient’s prescriber orders raloxifene (Evista), and the nurse provides teaching about this drug. Which statement by the patient indicates understanding of the teaching?
a. “I may experience breast tenderness while taking this drug.”
b. “I may experience fewer hot flashes while taking this drug.”
c. “I should discontinue this drug several weeks before any surgery.”
d. “I should walk as much as possible during long airline flights.”
ANS: D
Like estrogen, raloxifene increases the risk of deep vein thrombosis. Patients taking this drug should be cautioned to take walks on long flights or whenever they must sit for long periods. The drug does not increase breast tenderness or decrease hot flashes. There is no need to discontinue this drug before surgery.
DIF: Cognitive Level: Application
REF: Raloxifene | Adverse Effects | Venous Thromboembolism | Table 75-6: Comparison of Estrogen and Raloxifene TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
15. A patient who takes teriparatide (Forteo) administers it subcutaneously with a prefilled pen injector. The patient asks why she must use a new pen every 28 days when there are doses left in the syringe. Which is the correct response by the nurse?
a. “Go ahead and use the remaining drug; I know it is so expensive.”
b. “The drug may not be stable after 28 days.”
c. “You are probably not giving the drug accurately.”
d. “You should be giving the drug more frequently.
ANS: B
Teriparatide is supplied in 3-mL injectors. The pen should be stored in the refrigerator and discarded after 28 days, even if some drug remains in the syringe. Although the drug is expensive, it is not correct to use what is in the syringe after 28 days. Drug may be left in the syringe even with correct dosing.
DIF: Cognitive Level: Application
REF: Teriparatide | Preparations, Dosage, and Administration TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
16. A patient with metastatic cancer has had several fractures secondary to bone metastases. The provider orders denosumab (Xgeva). What will the nurse teach this patient?
a. Denosumab may delay healing of these fractures.
b. Denosumab should be given subcutaneously every 12 months.
c. Denosumab will improve hypocalcemia.
d. Unlike bisphosphonates, denosumab does not increase osteonecrosis of the jaw (ONJ).
ANS: A
Because denosumab suppresses bone turnover, fracture healing may be delayed. Denosumab is given every 6 months. Denosumab can exacerbate hypocalcemia. Denosumab can increase the incidence of ONJ.
DIF: Cognitive Level: Application
REF: Denosumab | Adverse Effects | Preparations, Dosage, and Administration TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies [Show Less]