When caring for a patient with Paget's disease, the nurse should prioritize which intervention?
Encouraging high-impact exercises to strengthen bones
Monitoring serum calcium levels regularly
Assisting with range-of-motion exercises to maintain joint mobility
Administering corticosteroids to reduce inflammation
The Correct Answer is B
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.
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Correct Answer is D
Explanation
The typical pattern of bone involvement in Paget's disease is characterized by patchy areas of increased bone density (osteosclerosis) and disorganized bone formation. These areas of abnormal bone remodeling result in structurally weak and misshapen bones.
a. Uniform increase in bone density throughout the skeleton: This pattern of bone density is not characteristic of Paget's disease. The condition involves localized areas of increased density rather than uniform changes.
b. Focal areas of bone demineralization scattered throughout the skeleton: This pattern of bone demineralization is more characteristic of osteoporosis, not Paget's disease.
c. Diffuse increase in bone density with areas of focal bone loss: This pattern is not typical of Paget's disease. The condition primarily involves areas of increased bone density and disordered bone remodeling.
Correct Answer is C
Explanation
Osteoclasts are the primary cell type responsible for bone resorption in Paget's disease. These cells become overactive, leading to excessive bone breakdown, which is a hallmark of the condition.
a. Osteocytes: Osteocytes are mature bone cells embedded in the bone matrix. While they play a role in maintaining bone health, they are not directly responsible for bone resorption.
b. Osteoblasts: Osteoblasts are bone-forming cells. In Paget's disease, they attempt to repair the resorbed bone but their activity is disordered, leading to structurally abnormal bone formation.
d. Osteoprogenitor cells: Osteoprogenitor cells are undifferentiated cells that can differentiate into osteoblasts. They are not directly involved in the increased bone resorption seen in Paget's disease.
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