The healthcare provider suspects a client may have Paget's disease based on clinical presentation. Which laboratory test should be ordered to aid in the diagnosis?
Serum calcium level
Erythrocyte sedimentation rate (ESR)
Alkaline phosphatase (ALP) level
Serum creatinine level
The Correct Answer is C
An elevated alkaline phosphatase (ALP) level is a common finding in patients with Paget's disease. ALP is an enzyme present in bone cells, and its increased activity is indicative of increased bone turnover and remodeling seen in Paget's disease.
a. Serum calcium level: Serum calcium levels may be affected in Paget's disease due to abnormal bone remodeling, but they are not specific enough to confirm the diagnosis on their own.
b. Erythrocyte sedimentation rate (ESR): The ESR is a marker of inflammation and is not specific to Paget's disease. While it may be elevated due to bone inflammation, it does not confirm the diagnosis.
d. Serum creatinine level: Serum creatinine levels are not directly related to the diagnosis of Paget's disease. They are typically assessed to evaluate kidney function.
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Correct Answer is B
Explanation
A. Encouraging high-impact exercises to strengthen bones:
High-impact exercises are contraindicated in patients with Paget's disease due to the risk of fractures and bone injury. Low-impact and weight-bearing exercises are safer to maintain bone health and improve mobility.
B. Monitoring serum calcium levels regularly: Paget's disease often requires treatment with bisphosphonates or calcitonin to regulate bone remodeling. These treatments can affect calcium levels, potentially leading to hypocalcemia. Regular monitoring is crucial to detect and manage these imbalances.
C. Assisting with range-of-motion exercises to maintain joint mobility: While maintaining joint mobility is important, this is not the priority intervention. ROM exercises can be part of the overall care plan but do not address the critical metabolic imbalances associated with Paget's disease.
D. Administering corticosteroids to reduce inflammation: Corticosteroids are not a standard treatment for Paget's disease. Instead, the focus is on medications like bisphosphonates or calcitonin to regulate bone turnover.
Correct Answer is D
Explanation
Bone pain is a common clinical manifestation of Paget's disease, but another hallmark of the condition is the development of bone deformities. The abnormal bone remodeling in Paget's disease can lead to enlarged, misshapen bones, particularly in weight-bearing areas such as the skull, pelvis, and long bones.
a. Muscle weakness: While bone pain can lead to discomfort and reduced mobility, muscle weakness is not a specific clinical manifestation of Paget's disease.
b. Hypercalcemia: Hypercalcemia (elevated blood calcium levels) is not typically associated with Paget's disease. Instead, the condition is characterized by disorganized bone remodeling.
c. Joint swelling: Joint swelling is not a primary clinical manifestation of Paget's disease. Bone deformities are more characteristic of the condition.
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