M.S., a 72-year-old white woman, comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because "I don't like doctors." Her only complaint today is "pain in my upper back."
She describes the pain as sharp and knifelike. The pain began approximately 3 weeks ago
when she was getting out of bed in the morning and hasn't changed at all. M.S. rates her pain as 6 on a
0- to 10-point pain scale and says the pain decreases to 3 or 4 after taking "a couple of ibuprofen." She
denies recent falls or trauma.
M.S. admits she needs to quit smoking and start exercising but states, "I don't have the energy to
exercise, and besides, I've always been thin." She has smoked one to two packs of cigarettes per day since
she was 17 years old. Her last blood work was 11 years ago, and she can't remember the results. She went
through menopause at the age of 47 and has never taken hormone replacement therapy. The physical
examination findings are unremarkable other than moderate tenderness to deep palpation over the spinous
process at T7. No masses or tenderness to the tissue surround the tender spot. No visible masses,
skin changes, or erythema are noted. Her neurologic findings are intact, and no muscle wasting is noted.
An x-ray examination of the thoracic spine reveals a collapsed vertebra at T7 and bone
density changes in the spine. What could this result indicate?
The physician suspects osteoporosis. List seven risk factors associated with osteoporosis.
Place a star or asterisk next to those risk factors specific to M.S.
These results could indicate osteoporosis, which is a decrease in bone density at a level that can be
diagnosed by conventional x-rays. In this case, the patient reports pain in the area at the bottom of
her shoulder blades; the pain is caused by the collapsed vertebra. Note that bone loss is not detected
by conventional x-rays until bone loss is in the 25% to 40% range. Many patients do not realize they
have osteoporosis until a bone fracture occurs.
The risk factors for osteoporosis are:
• Cigarette smoking
• Female gender
• White or Asian ethnicity
• Lack of adequate exercise
• Lifelong insufficient calcium and vitamin D intake
• Low body weight (less than 128 pounds)
• Postmenopausal status (estrogen deficiency)
• Alcoholism
• History of fractures in a first-degree relative
• Advanced age (65 years and older in women; older than age 75 in men)
• Long-term use of specific medications that can lead to loss of bone density, such as glucocorticoids
and certain antiepileptic drugs
Cigarette smoking, female gender, low body weight, white or Asian ethnicity, lack of adequate
exercise, postmenopausal status, advanced age
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The nurse knows that the dehydration associated with diabetic ketoacidosis results from
a. increased serum osmolality and urea. b. decreased serum osmolality and hyperglycemia. c. ketones and potassium shifts. d. acute renal failure.
Parents of a 5-year-old child diagnosed as cognitively impaired have come to the nurse to discuss different approaches to the ongoing care of their child. The nurse should suggest focusing on what activity?
a. Acquiring job skills b. Making decisions c. Performing self-care activities d. Reading and doing simple math
The student learns the Medicare guidelines for preventive health and reimbursement policies. Which statement follows the guidelines? (Select all that apply.)
a. Medicare pays for an annual pneumococ-cal vaccination. b. Medicare covers annual influenza vacci-nations. c. Pap smears and pelvic exams are covered once every 2 years. d. Annual fecal occult blood tests are cov-ered for those who are from 50 to 85 years of age. e. A bone density scan is covered every 2 years (a co-payment is required).
Multiply the decimals using a calculator: 9.2 x 0.7 __________
Fill in the blank(s) with correct word