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 C
Explanation
Choice A rationale
Motor weakness is a common symptom in both hemorrhagic and thrombotic strokes because both types of stroke disrupt blood flow to brain regions responsible for motor control. Ischemic damage or compression from hemorrhage within motor cortex or descending motor tracts can lead to similar presentations of contralateral hemiparesis or hemiplegia, making it non-specific for differentiation.
Choice B rationale
Sensory changes, such as paresthesia or numbness, can occur in both hemorrhagic and thrombotic strokes. This is due to damage to sensory pathways in the brain, including the thalamus or somatosensory cortex. The specific location and extent of brain injury determine the precise sensory deficits, which can be similar regardless of stroke etiology.
Choice C rationale
A sudden onset of severe headache is a hallmark symptom distinguishing hemorrhagic stroke. This intense headache, often described as "the worst headache of my life," results from the rapid increase in intracranial pressure and meningeal irritation caused by blood extravasation into the subarachnoid space or brain parenchyma, unlike thrombotic strokes.
Choice D rationale
A history of hypertension is a significant risk factor for both hemorrhagic and thrombotic strokes. Chronic uncontrolled hypertension damages arterial walls, predisposing them to rupture in hemorrhagic stroke or promoting atherosclerosis and thrombus formation in ischemic stroke. Therefore, its presence does not specifically differentiate between the two types.
Correct Answer is B
Explanation
Choice A rationale
An impacted fracture occurs when one bone fragment is driven into another, often due to significant axial compression forces. This mechanism results in a stable fracture but can be challenging to reduce due to the interdigitation of the bone ends, potentially causing localized pain and limited range of motion.
Choice B rationale
A greenstick fracture is an incomplete fracture typically seen in children, where one side of the bone cortex is broken and the other side is bent. This occurs because children's bones are more flexible and cartilaginous than adult bones, allowing them to bend rather than completely break under stress.
Choice C rationale
A compression fracture results from a compressive force that causes a bone to collapse, commonly observed in the vertebrae. This type of fracture often occurs in osteoporotic bone due to reduced bone mineral density, leading to loss of vertebral body height and potential neurological deficits if spinal cord compression ensues.
Choice D rationale
A compound fracture, also known as an open fracture, involves a break in the bone where the bone fragments pierce through the skin, exposing the bone to the external environment. This significantly increases the risk of infection and requires immediate surgical debridement and antibiotic therapy to prevent osteomyelitis.
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