Which patient would be at greatest risk for developing osteoporosis?
An 84-year-old man who has recently been diagnosed with hypothyroidism and is prescribed levothyroxine (Synthroid).
A 55-year-old woman who recently had a hysterectomy with bilateral salpingo-oophorectomy and refuses estrogen therapy.
A 69-year-old woman who had a renal transplant 5 years ago and has been taking prednisone to prevent organ rejection.
A 73-year-old man who has 5 alcoholic drinks per week and limits sun exposure to prevent recurrence of skin cancer.
The Correct Answer is C
Choice A rationale
Hypothyroidism, particularly if untreated, can contribute to bone loss, but levothyroxine therapy typically normalizes thyroid function, mitigating this risk. While age is a risk factor, other choices present more significant and direct risks for accelerated bone demineralization and osteoporosis development.
Choice B rationale
Estrogen plays a crucial role in bone density maintenance by inhibiting osteoclast activity and promoting osteoblast activity. A bilateral salpingo-oophorectomy removes the primary source of estrogen, leading to premature menopause and rapid bone loss, significantly increasing osteoporosis risk if hormone therapy is refused.
Choice C rationale
Prednisone, a corticosteroid, is a potent cause of secondary osteoporosis. It directly inhibits osteoblast function, promotes osteoclast activity, and impairs calcium absorption, leading to significant bone density loss. Long-term use post-transplant makes this patient at exceptionally high risk.
Choice D rationale
Excessive alcohol intake (more than 2-3 drinks daily) is a risk factor for osteoporosis by impairing bone formation and nutrient absorption. Limiting sun exposure can cause vitamin D deficiency, also contributing to reduced bone density. However, this patient's alcohol intake is moderate, and vitamin D deficiency is more easily corrected.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Methotrexate does not have a significant interaction with vitamin K. Methotrexate's primary mechanism of action involves inhibiting dihydrofolate reductase, thereby interfering with folate metabolism and DNA synthesis. Vitamin K is crucial for blood clotting factors. There is no contraindication for vitamin K rich foods.
Choice B rationale
Methotrexate excretion is primarily renal, and adequate hydration is critical to prevent nephrotoxicity and facilitate drug elimination. Drinking at least 2 liters of water daily helps maintain good kidney function, ensuring that methotrexate and its metabolites are efficiently cleared from the body, thus minimizing the risk of drug accumulation and associated toxicities.
Choice C rationale
Methotrexate for rheumatoid arthritis is typically administered once weekly, not daily, to mitigate severe adverse effects such as bone marrow suppression, hepatotoxicity, and gastrointestinal complications. Daily dosing would lead to rapid accumulation and dangerously high systemic concentrations, overwhelming the body's detoxification pathways.
Choice D rationale
Alcohol-based mouthwashes should be avoided when taking methotrexate because alcohol can cause mucosal irritation and increase the risk of oral mucositis, a common side effect of methotrexate. Additionally, alcohol can exacerbate hepatotoxicity, a significant concern with methotrexate therapy, by increasing metabolic burden on the liver.
Correct Answer is B
Explanation
Choice A rationale
Quadriplegia, or tetraplegia, involves paralysis affecting all four limbs and the torso, typically occurring with spinal cord injuries at the cervical level (C1-C8). A T2-T3 injury is below the cervical spine, so it would not result in quadriplegia.
Choice B rationale
Paraplegia involves paralysis that affects the lower half of the body, including both legs, and typically results from spinal cord injuries at the thoracic (T1-T12) or lumbar (L1-L5) levels. A T2-T3 injury would spare upper limb function but impair sensation and movement in the trunk and lower extremities.
Choice C rationale
Paresthesia refers to abnormal sensations such as tingling, prickling, or numbness, without actual paralysis. While paresthesia can be present with a spinal cord injury, it describes a sensory disturbance, not the type of motor disability, which is the primary focus of this question.
Choice D rationale
Hemiplegia is paralysis affecting one side of the body and is typically associated with brain injuries like stroke, rather than spinal cord injuries. Spinal cord injuries generally cause bilateral deficits below the level of the lesion.
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