A woman older than 65 has never been screened for osteoporosis and has no history of a fragility fracture. Which recommendation should the nurse provide?
1Start calcium now and postpone testing unless a low-trauma fracture occurs
2Schedule annual spine radiographs instead of a bone mineral density screening test
3Use a fracture risk questionnaire without obtaining a bone density measurement
4Arrange central dual-energy x-ray absorptiometry to screen for osteoporosis✓ Correct answer
Explanation
This client meets the age-based recommendation for osteoporosis screening. Central DXA measures bone mineral density and can identify osteoporosis before a fragility fracture, allowing evaluation and evidence-based fracture prevention.
Quick answer Arrange osteoporosis screening with central DXA. The client has crossed the universal screening age for women and has not previously been screened.
Why this is correct Osteoporosis often causes no symptoms until a fracture occurs. Central DXA measures bone mineral density at clinically useful sites, allowing the care team to identify low bone mass and discuss fracture prevention before an injury reveals the disease.
Easy analogy or mental picture Screening is like checking the strength of a bridge before a heavy load exposes a weak point. DXA estimates bone strength before a fracture, but the image does not replace clinical risk assessment or evaluation of secondary causes.
Memory hook Age threshold reached plus no prior screening means measure bone density before the first fragility fracture.
NCLEX decision rule For an asymptomatic woman above the routine screening threshold, choose central DXA rather than waiting for pain or fracture. Younger postmenopausal clients require risk assessment first, and secondary osteoporosis needs individualized evaluation.
Why the other choices are wrong Calcium intake is part of bone health but does not replace indicated screening. Routine spine radiographs are not the preferred screening test, and a risk questionnaire alone does not substitute for DXA when universal age-based screening applies.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing