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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A rationale

Avoiding warm water for facial washing is generally unrelated to cranial nerve IX (glossopharyngeal) or X (vagus) impairment. These nerves primarily affect swallowing, gag reflex, and vocal cord function, not facial sensation or hygiene temperature responses. Facial sensation is predominantly mediated by the trigeminal nerve (CN V), and facial motor control by the facial nerve (CN VII).

Choice B rationale

Applying an eye patch to the right eye is indicated for impairment of the facial nerve (CN VII) or trigeminal nerve (CN V), which can lead to lagophthalmos or corneal abrasions due to incomplete eyelid closure or decreased sensation. Acoustic neuroma primarily affects CN VIII, but its growth can sometimes impinge on adjacent nerves, including CNs V and VII. However, the question specifically mentions CN IX and X impairment.

Choice C rationale

Impairment of cranial nerves IX (glossopharyngeal) and X (vagus) significantly affects the gag reflex and swallowing mechanisms, increasing the risk of aspiration. The glossopharyngeal nerve is crucial for the afferent limb of the gag reflex and initiates swallowing, while the vagus nerve controls pharyngeal and laryngeal muscles. Therefore, having suction equipment readily available is a critical safety measure to manage potential aspiration events and maintain airway patency.

Choice D rationale

Providing range-of-motion exercises to the client's neck and shoulders addresses musculoskeletal concerns and is not directly related to the physiological deficits caused by impairment of cranial nerves IX and X. These nerves are involved in functions like speech, swallowing, and parasympathetic regulation, not in the motor control of the neck and shoulder musculature, which is primarily managed by cervical spinal nerves and the accessory nerve (CN XI).

A. Dopamine and acetylcholine. B. An autosomal dominant genetic defect. C. Atherosclerosis and lack of blood supply. D. Estrogen and progesterone.

Correct Answer is A

Explanation

Choice A rationale

Idiopathic Parkinsonism is characterized by the degeneration of dopaminergic neurons in the substantia nigra, leading to a deficiency of dopamine in the basal ganglia. This creates an imbalance with acetylcholine, an excitatory neurotransmitter. Benztropine, an anticholinergic, helps restore this balance by blocking acetylcholine receptors, reducing tremors and rigidity.

Choice B rationale

While some forms of Parkinson's disease have genetic links, idiopathic Parkinsonism is not primarily defined by an autosomal dominant genetic defect. It is multifactorial, involving a complex interplay of genetic predispositions and environmental factors, with no single dominant gene responsible for the vast majority of cases.

Choice C rationale

Atherosclerosis and lack of blood supply are associated with vascular Parkinsonism, which is distinct from idiopathic Parkinsonism. Vascular Parkinsonism results from cerebrovascular disease leading to neuronal damage, while idiopathic Parkinsonism involves neurodegeneration of dopamine-producing neurons, not primarily ischemic injury.

Choice D rationale

Estrogen and progesterone are sex hormones and are not directly involved in the primary pathophysiological imbalance of neurotransmitters in idiopathic Parkinsonism. While hormonal fluctuations can influence neurological conditions, the core defect in Parkinsonism involves dopamine and acetylcholine dysregulation in the basal ganglia.

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Which patient would be at greatest risk for developing osteoporosis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has right-sided acoustic neuroma resulting in impairment of cranial nerves IX and X. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A client has idiopathic parkinsonism. Her physician prescribed benztropine mesylate (Cogentin) 1 mg po daily. The nurse explains to her that the pathophysiological defect is an imbalance between:

Correct Answer is A

Explanation

A client with subacute back pain asks the nurse about strategies to help keep the low back pain from becoming chronic. Which of the following responses is appropriate for the nurse to make at this time?

Identify the telemetry strip below.

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