The home health nurse is visiting a client with Paget's disease. An important part of preventive care for the client with Paget's disease is?

Appeared in: DHS 2018 shift 1st

Explanation

Paget's disease is characterized by disorganized bone remodeling, leading to bones that are structurally weak and brittle.
A major and serious complication of Paget's disease is pathologic fractures, which can occur with minimal trauma.
The question asks for an important part of preventive care. Preventing falls is the highest priority to avoid fractures in a patient with weakened bones.
Keeping the environment free of clutter is a direct and effective fall prevention strategy that a home health nurse would prioritize.

Option B: While dental care is relevant, especially for patients on bisphosphonates (a common treatment for Paget's) due to the risk of osteonecrosis of the jaw, it does not address the most immediate and life-altering risk of pathologic fractures from falls.
Option C: This is a general health maintenance recommendation for the population, particularly older adults. It is not a specific preventive measure related to the pathophysiology or primary risks of Paget's disease.
Option D: This advice is too general. While patients with Paget's disease need adequate calcium and Vitamin D, a 'daily multivitamin' may not be sufficient or the correct formulation. More importantly, nutritional strategies are long-term and do not mitigate the immediate environmental risk of falls.

Clinical Relevance

Nursing practice connection: Use the key finding related to Safety and preventive care for a client with Paget's disease to guide bedside assessment, documentation, and the next nursing action.
A key role of the home health nurse is assessing the patient's living environment for safety hazards. For patients with bone fragility, this is a critical intervention to prevent devastating injuries.
Patient and family education on fall prevention is paramount. This includes removing throw rugs, ensuring adequate lighting, installing grab bars, and wearing appropriate footwear.
What if? If the patient with Paget's disease reports new, severe pain in their thigh, the nurse must consider the possibility of an impending or actual pathologic fracture. This is a medical emergency requiring immediate evaluation, distinguishing it from the chronic, manageable pain of the disease.

How to Approach the Question

First, identify the core pathophysiology of the disease mentioned in the stem: Paget's disease causes weak, brittle bones.
Next, determine the most significant risk associated with this pathophysiology. For weak bones, the greatest risk is fracture.
Analyze the options to see which one most directly addresses this primary risk. The question asks for 'preventive care' in a 'home health' setting.
Option A (keeping the environment free of clutter) is a direct intervention to prevent falls, which cause fractures.
Compare this to the other options. Options B, C, and D are either secondary concerns, general health advice, or less specific. Therefore, the intervention that prevents falls is the highest priority and the correct answer.

Concept Tested & Keywords

Concept Tested: Safety and preventive care for a client with Paget's disease.
Stem keywords: home health nurse, Paget's disease, preventive care
Lead-in keywords: important part
Clinical cues: The setting is a home health visit, which emphasizes environmental safety.
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 2 p. 1218-1220

E6 Medicine Davidson Principles Practice 24e p. 1074-1076

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.