What would the nurse include in the teaching plan for the patient with SLE?

Choice A reason: A bone scan detects bone metabolism or abnormalities like tumors, not precise bone mass. DEXA is the gold standard for osteoporosis evaluation, measuring bone mineral density (BMD). Misidentifying bone scans risks inaccurate diagnosis, delaying osteoporosis treatment like bisphosphonates, increasing fracture risk in vulnerable populations like postmenopausal women.

Choice B reason: DEXA provides fast, precise bone mass measurement of the spine, femur, forearm, and total body, using low-dose x-rays to assess bone mineral density. It’s the gold standard for diagnosing osteoporosis, guiding treatment with medications or lifestyle changes to prevent fractures, critical in older adults with reduced bone density.

Choice C reason: Densitogram is not a recognized medical term or test for osteoporosis. Bone density is measured by DEXA or, less commonly, QUS. Assuming densitogram exists misguides diagnosis, risking inappropriate testing or delayed intervention, leaving patients vulnerable to fractures from undiagnosed or untreated osteoporosis.

Choice D reason: Quantitative ultrasound (QUS) measures bone density, typically at peripheral sites like the heel, but is less precise than DEXA for spine, femur, or total body. It’s used for screening, not primary diagnosis. Expecting QUS misaligns with osteoporosis evaluation standards, potentially underestimating fracture risk and delaying treatment.

Choice A reason: Checking capillary refill is the priority to assess neurovascular status in a client with a casted tibia fracture. Impaired circulation, indicated by delayed refill (>2 seconds), suggests complications like compartment syndrome or vascular compromise. Early detection prevents tissue ischemia, nerve damage, or limb loss, as casts can compress vessels, especially in the initial post-casting period. This assessment ensures adequate blood flow, critical for healing and preventing irreversible damage.

Choice B reason: Discussing cast care, such as keeping it dry or avoiding weight-bearing, is important for long-term management but not the first priority. Education prevents complications like infection or cast breakdown but does not address immediate risks like vascular compromise. Neurovascular assessment takes precedence to ensure limb viability before focusing on patient education about cast maintenance and care.

Choice C reason: Performing range of motion exercises helps maintain joint mobility and prevent stiffness but is not the initial priority. Moving a casted limb prematurely may exacerbate swelling or disrupt fracture alignment. Neurovascular status must be confirmed first to ensure circulation is intact, as compromised blood flow could worsen with movement, risking further tissue damage.

Choice D reason: Managing pain is important, as pain may indicate complications like swelling or pressure within the cast. However, pain assessment is secondary to checking capillary refill, which directly evaluates circulation. Unaddressed vascular compromise could lead to ischemia, making neurovascular assessment the priority to rule out life-threatening conditions before addressing pain with medication or other interventions.