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A community health nurse is teaching a group of older adults about risk factors for a hip fracture.
What statements indicate a correct understanding of these risk factors? Select all that apply.

“Men are more at risk for hip fractures than women.”.

“A history of osteoporosis is a risk factor.”.

“An increase in estrogen will weaken my bones.”.

“I am prone to a hip fracture if I’ve fallen in the past.”.

“I am more at risk as I get older.”.

Answer and Explanation

Correct Answer : B,D,E

Choice A is wrong because women are more at risk for hip fractures than men.

This is partly because women lose bone density faster than men do, especially after menopause.

Choice C is wrong because an increase in estrogen will not weaken the bones. In fact, estrogen helps protect the bones from osteoporosis, which is a leading cause of hip fracture.

Some other risk factors for hip fracture include:

Excessive alcohol and caffeine consumption
Lack of physical activity
Low body weight
Tall stature
Vision problems
Dementia
Medications that cause bone loss
Cigarette smoking
Institutional living, such as an assisted-care facility
Increased risk for falls, related to conditions such as weakness, disability, or unsteady gait

Normal ranges for bone density vary by age and sex, but generally, a T-score of -1.0 or above is considered normal, while a T-score of -2.5 or below is considered osteoporotic. A T-score between -1.0 and -2.5 is considered osteopenic, which means low bone mass.

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Correct Answer is C

Explanation

The directive takes effect only if the client is incapable of personally making health care decisions. This statement demonstrates an understanding of health care proxy and care because it reflects the definition of a health care proxy as a person who can make health care decisions for the client only when the client is unable to communicate these themselves.

Choice A is wrong because the daughter does not have the authority to make all of the client’s health care decisions, only those that the client has not specified in advance or that are not covered by the living will.

Choice B is wrong because no extraordinary means, such as cardiopulmonary resuscitation, will be initiated only if the client has expressed this preference in a living will or a do-not-resuscitate order.

Choice D is wrong because the closest relative, such as the spouse, does not have to be consulted before the daughter in making health care decisions, unless the client has designated them as an alternate proxy.

A. Every morning at 08:00AM (0800). B. Halfway between next scheduled dose. C. Just prior to next scheduled dose. D. Two hours after a scheduled dose.

Correct Answer is C

Explanation

Just prior to the next scheduled dose. A trough level is the lowest concentration of a drug in the blood, and it is measured just before the next dose is due to be administered.

This helps to ensure that the drug level does not fall below the therapeutic range or rise above the toxic range.

Choice A is wrong because every morning at 08:00 AM (0800) is not a consistent time interval for a drug that is administered every twenty-four hours.

The trough level should be measured at the same time before each dose.

Choice B is wrong because halfway between next scheduled dose is not a trough level, but a midpoint level.

This does not reflect the lowest concentration of the drug in the blood.

Choice D is wrong because two hours after a scheduled dose is not a trough level, but a peak level. This is the highest concentration of the drug in the blood, and it is measured after the drug has been absorbed and distributed. Peak levels are no longer routinely recommended for vancomycin.

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A community health nurse is teaching a group of older adults about risk factors for a hip fracture. What statements indicate a correct understanding of these risk factors? Select all that apply.

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A client with terminal cancer is admitted to hospice care. The daughter is documented as the client’s health care proxy agent. Which statement made by the nurse demonstrates an understanding of health care proxy and care?

Correct Answer is C

Explanation

The health care provider orders a trough level of an antibiotic administered every twenty four hours. When should the nurse plan for a trough level to be drawn?

Correct Answer is C

Explanation

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A community health nurse is teaching a group of older adults about risk factors for a hip fracture.
What statements indicate a correct understanding of these risk factors? Select all that apply.