Bisphosphonates, Calcium Preparations, Vitamin D, and Estrogen Receptor Modulators

Every question here, with the answer

1. A client is starting weekly alendronate. Which instruction is correct?

   1. Take it together with your calcium supplement.
   2. Take it with 6–8 ounces of water and stay upright for 30 minutes.
   3. Take it at bedtime and lie down right away.
   4. Take it with breakfast and a glass of orange juice.

   Answer: Take it with 6–8 ounces of water and stay upright for 30 minutes.

   Bisphosphonates are taken with at least 6–8 ounces of water, and the client stays standing or sitting upright for 30 minutes to reduce esophageal irritation. They should not be taken with other medications or supplements, and orange juice is avoided for 2 hours.

2. A client who takes alendronate says she is scheduled for a tooth extraction next week. What should the nurse do?

   1. Notify the health care provider, because invasive dental procedures should not be done during bisphosphonate therapy.
   2. Tell her the extraction is safe with this drug.
   3. Advise her to take calcium right after the extraction.
   4. Tell her to double her dose before the procedure.

   Answer: Notify the health care provider, because invasive dental procedures should not be done during bisphosphonate therapy.

   Osteonecrosis of the jaw is a major adverse effect and occurs more often with invasive dental procedures, which should not be done while receiving bisphosphonates. The other responses ignore this risk.

3. In which clients should the nurse question an order for an oral bisphosphonate? Select all that apply.

   1. A client with severe renal insufficiency
   2. A client who walks 30 minutes most days
   3. A postmenopausal client with osteoporosis
   4. A client with an esophageal abnormality that delays stomach emptying
   5. A client who cannot sit up for 30 minutes after a dose

   Answer: A client with severe renal insufficiency, A client with an esophageal abnormality that delays stomach emptying, A client who cannot sit up for 30 minutes after a dose

   Bisphosphonates are contraindicated with esophageal abnormalities that delay emptying, inability to stay upright for 30 minutes, and severe renal insufficiency. Postmenopausal osteoporosis is the indication, and walking is recommended.

4. A client takes levothyroxine every morning and has started a calcium supplement. What should the nurse teach?

   1. Take both at the same time to make it easier.
   2. Take calcium with a high-fat meal.
   3. Stop levothyroxine while taking calcium.
   4. Take levothyroxine at least 30 minutes before or 2 hours after the calcium.

   Answer: Take levothyroxine at least 30 minutes before or 2 hours after the calcium.

   Calcium can reduce absorption of other drugs, so levothyroxine is taken at least 30 minutes before or 2 hours after calcium. A high-fat meal reduces calcium absorption, and stopping levothyroxine is not advised.

5. A client is prescribed raloxifene for osteoporosis. Which findings in her history are reasons for concern? Select all that apply.

   1. History of pulmonary embolism
   2. History of deep vein thrombosis
   3. Documented coronary heart disease
   4. Current smoking
   5. Previous low calcium intake

   Answer: History of pulmonary embolism, History of deep vein thrombosis, Documented coronary heart disease, Current smoking

   Raloxifene carries a risk of clots and a boxed warning for venous thromboembolism and stroke death in clients with prior thrombosis or coronary heart disease; smoking also raises clot risk. Low calcium intake is managed by adding supplements.

6. A client taking calcium supplements reports fatigue, weakness, and urinating much more than usual. What should the nurse suspect?

   1. Osteonecrosis of the jaw
   2. Hypocalcemia
   3. Hypercalcemia
   4. Vitamin D deficiency

   Answer: Hypercalcemia

   Hypercalcemia can lead to poor muscle tone, renal insufficiency, weight loss, fatigue, polyuria and arrhythmias. The other conditions do not match this pattern in the section.