Deck 75: Drugs Affecting Calcium Levels and Bone Mineralization

Question 1

A nurse is providing teaching for a patient with osteoporosis who has just switched from alendronate [Fosamax] to zoledronate [Reclast]. Which statement by the patient indicates a need for further teaching?

A) "I will need to have blood tests periodically while taking this drug."
B) "I will only need a dose of this medication every 1 to 2 years."
C) "This drug is less likely to cause osteonecrosis of the jaw."
D) "This drug is only given intravenously."

Answer 1

"This drug is less likely to cause osteonecrosis of the jaw."

Question 2

A patient has severe Paget's disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider?

A) Alendronate [Fosamax]
B) Calcifediol [25-Hydroxy-D3]
C) Calcitonin-salmon [Miacalcin]
D) Long-acting NSAIDs

Answer 2

Calcitonin-salmon [Miacalcin]

Question 3

A patient who has developed postmenopausal osteoporosis will begin taking alendronate [Fosamax]. The nurse will teach this patient to take the drug:

A) at bedtime to minimize adverse effects.
B) for a maximum of 1 to 2 years.
C) while sitting upright with plenty of water.
D) with coffee or orange juice to increase absorption.

Answer 3

while sitting upright with plenty of water.

Question 4

A postmenopausal patient develops osteoporosis. The patient asks the nurse about medications to treat this condition. The nurse learns that the patient has a family history of breast cancer. The nurse will suggest discussing which medication with the provider?

A) Estrogen estradiol
B) Pamidronate [Aredia]
C) Raloxifene [Evista]
D) Teriparatide [Forteo]

Question 5

Which drugs are approved for treating osteoporosis in men?

A) Alendronate [Fosamax]
B) Calcitonin
C) Raloxifene [Evista]
D) Teriparatide [Forteo]
E) Zoledronate [Reclast]

Question 6

A patient taking risedronate IR [Actonel] for osteoporosis reports experiencing diarrhea and headaches. What will the nurse tell this patient?

A) These are common side effects of this drug.
B) These symptoms indicate serious toxicity.
C) The patient should discuss taking risedronate DR [Atelvia] with the provider.
D) The medication should be taken after a meal to reduce symptoms.

Question 7

A 65-year-old female patient tells a nurse that she has begun taking calcium supplements. The nurse learns that the patient consumes two servings of dairy products and takes 1200 mg in calcium supplements each day. The patient's serum calcium level is 11.1 mg/dL. What will the nurse tell this patient?

A) She should increase her dietary calcium in addition to the supplements
B) The amount of calcium she takes increases her risk for heart attack and stroke
C) To continue taking 1200 mg of calcium supplement since she is over age 50
D) To supplement her calcium with 10,000 units of vitamin D each day

Question 8

A patient with metastatic cancer has had several fractures secondary to bone metastases. The provider orders denosumab [Xgeva]. What will the nurse teach this patient?

A) Denosumab may delay healing of these fractures.
B) Denosumab should be given subcutaneously every 12 months.
C) Denosumab will improve hypocalcemia.
D) Unlike bisphosphonates, denosumab does not increase osteonecrosis of the jaw (ONJ).

Question 9

A patient with severe glucocorticoid-induced osteoporosis will start therapy with teriparatide [Forteo]. What will the nurse expect to administer?

A) 20 mcg once daily subQ
B) 20 mcg twice daily subQ
C) 10 mcg once daily subQ
D) 10 mcg twice daily subQ

Question 10

A nurse is preparing to administer IV calcium chloride to a patient with a low serum calcium level. Which drug on the patient's medication record, administered concurrently, would require additional patient monitoring by the nurse?

A) Digoxin [Lanoxin]
B) Furosemide [Lasix]
C) Lorazepam [Ativan]
D) Pantoprazole [Protonix]

Question 11

A nurse is discussing the role of vitamin D in calcium regulation with a nursing student. Which statement by the student indicates a need for further teaching?

A) "Adequate amounts of vitamin D occur naturally in the diet."
B) "Vitamin D₃ is preferred over vitamin D₂."
C) "Vitamin D can promote bone decalcification."
D) "Vitamin D increases the absorption of calcium and phosphorus from the intestine."

Question 12

A patient reports experiencing weakness, fatigue, nausea, vomiting, constipation, and nocturia. Total serum calcium is 10.5 mg/dL. A dipstick urinalysis shows a positive result for protein. When questioned, the patient reports taking vitamin D and calcium supplements. The nurse will counsel the patient to:

A) reduce the amount of vitamin D and stop taking the calcium.
B) discuss taking calcitonin-salmon [Fortical] with the provider.
C) stop both supplements and discuss the use of a diuretic with the provider.
D) stop taking vitamin D, reduce the amount of calcium, and increase the fluid intake.

Question 13

A patient is taking alendronate [Fosamax] to treat Paget's disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to:

A) reduce the likelihood of atrial fibrillation.
B) maximize bone resorption of calcium.
C) minimize the risk of esophageal cancer.
D) prevent hyperparathyroidism.

Question 14

A 55-year-old female patient asks a nurse about calcium supplements. The nurse learns that the patient consumes two servings of dairy products each day. The patient's serum calcium level is 9.5 mg/dL. The serum vitamin D level is 18 ng/mL. The nurse will recommend adding ____ daily and ____ IU of vitamin D? each day.

A) 1200 mg of calcium once; 10,000
B) 1500 mg of calcium twice; 1000
C) 600 mg of calcium once; 10,000
D) 600 mg of calcium twice; 2000

Question 15

A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching?

A) "Chewable calcium tablets are not absorbed well and are not recommended."
B) "I should not take more than 600 mg of calcium at one time."
C) "I should take enough supplemental calcium to provide my total daily requirements."
D) "If I take calcium with green, leafy vegetables, it will increase absorption."

Question 16

A postmenopausal patient is at high risk for developing osteoporosis. The patient's prescriber orders raloxifene [Evista], and the nurse provides teaching about this drug. Which statement by the patient indicates understanding of the teaching?

A) "I may experience breast tenderness while taking this drug."
B) "I may experience fewer hot flashes while taking this drug."
C) "I should discontinue this drug several weeks before any surgery."
D) "I should walk as much as possible during long airline flights."

Question 17

A nurse is providing education to a patient who will begin taking alendronate [Fosamax]. Which complication should the patient be instructed to report immediately?

A) Difficulty swallowing
B) Dizziness
C) Drowsiness
D) Pallor

Question 18

A patient who takes teriparatide [Forteo] administers it subcutaneously with a prefilled pen injector. The patient asks why she must use a new pen every 28 days when there are doses left in the syringe. Which is the correct response by the nurse?

A) "Go ahead and use the remaining drug; I know it is so expensive."
B) "The drug may not be stable after 28 days."
C) "You are probably not giving the drug accurately."
D) "You should be giving the drug more frequently.