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M.S., a 72-year-old white woman, comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because “I don’t like doctors.” Her only complaint today is “pain in my upper back.” She describes the pain as sharp and knife like. The pain began approximately 3 weeks ago when she was getting out of bed in the morning and hasn’t changed at all. M.S. rates her pain as 6 on a 0- to 10-point pain scale and says the pain decreases to 3 or 4 after taking “a couple of ibuprofen.” She denies recent falls or trauma.

M.S. admits she needs to quit smoking and start exercising but states, “I don’t have the energy to exercise, and besides, I’ve always been thin.” She has smoked one to two packs of cigarettes per day since she was 17 years old. Her last blood work was 11 years ago, and she can’t remember the results. She went through menopause at the age of 47 and has never taken hormone replacement therapy. The physical examination findings are unremarkable other than moderate tenderness to deep palpation over the spinous process at T7. No masses or tenderness to the tissue surround the tender spot. No visible masses, skin changes, or erythema are noted. Her neurologic findings are intact, and no muscle wasting is noted.

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Questions:

1. How is osteoporosis diagnosed and which diagnostic test is most commonly used todiagnose osteoporosis?
2. M.S.’s diagnostic test revealed a bone density T-score of -2.7. How will the nurseinterpret this score?
3. M.S. receives a prescription for alendronate (Fosamax) 70 mg/week. Whichinstructions are appropriate as you provide patient teaching to M.S. about thisdrug?
4. M.S. asks whether she needs to take a calcium supplement. How doyou answer her?
5. What nonpharmacologic interventions will you teach M.S. to prevent further boneloss?
6. M.S. begins to cry and says “I cannot possibly stop smoking, change my diet, andexercise all at the same time”. How would the nurse respond to M.S.? Bespecific with education/instructions.
7. M.S. asks you about foods that contain calcium. “I’d rather eat than take all thesepills!” she states. You review food sources of calcium with her. Which foodsare considered good sources of dietary calcium?
8. Develop one nursing diagnosis and write a nursing care plan.

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