The public health nurse reviews osteoporosis screening plans. Which plans require follow-up? Highlight the plans that do not match current screening guidance.
Highlight in Table
Choose your responses, then check the answer.
Explanation
Skipping screening in eligible women, omitting risk assessment before age 65, substituting heel ultrasound for DXA, and applying average-risk guidance to chronic glucocorticoid use require follow-up.
Quick answer Highlight skipping DXA for an asymptomatic woman age 66, delaying risk assessment for a postmenopausal smoker age 61, replacing central DXA with heel ultrasound, and treating chronic glucocorticoid use as average risk.
Why this is correct Current guidance recommends DXA screening for women age 65 or older even without symptoms. A younger postmenopausal woman with a risk factor should first receive clinical risk assessment and then DXA if risk is increased. The recommendation does not establish routine screening for men and does not apply unchanged to secondary osteoporosis or chronic bone-loss medication exposure.[2]
Easy analogy or mental picture Think of two doors. Age 65 opens the screening door for women; before that age, menopause plus risk assessment can open it. A separate side door is needed for secondary causes. The doors organize eligibility but do not replace clinical judgment.
Memory hook Women 65 and older: DXA; younger after menopause: risk first, then DXA if increased.
NCLEX decision rule When reviewing osteoporosis prevention, check age, menopause status, risk factors, and secondary causes before choosing a test. Use central DXA for screening, and do not turn insufficient evidence for men into a universal yes or no.
Why the other choices are wrong Scheduling DXA for an older woman, using risk assessment for a younger postmenopausal woman, avoiding routine screening in a healthy premenopausal adult, individualizing decisions for men, and clinically evaluating a prior fragility fracture are appropriate plans.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
USPSTF: Osteoporosis Screening Clinician SummaryU.S. Preventive Services Task Force