# Situation: A nurse at the reproductive health clinic of a district hospital cares for adult men and women with gynecologic and reproductive tract problems. A 55-year-old woman reached menopause 3 years ago. She smokes, weighs 42 kg with a body mass index of 17 kg/m², and her mother had a hip fracture. After teaching about bone health, which statement shows that the teaching was effective?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629504  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse at the reproductive health clinic of a district hospital cares for adult men and women with gynecologic and reproductive tract problems.

A 55-year-old woman reached menopause 3 years ago. She smokes, weighs 42 kg with a body mass index of 17 kg/m², and her mother had a hip fracture. After teaching about bone health, which statement shows that the teaching was effective?

## 보기

1. "I will swim for 30 minutes daily, since it is gentle on my joints and bones."
2. "I will take my calcium carbonate tablet at bedtime on an empty stomach."
3. "I will walk briskly for 30 minutes on most days of the week." **✔ 정답**
4. "I can wait until I turn 65 to have my first bone density scan."

**정답: 3**

## 해설

Weight-bearing exercise such as brisk walking helps maintain bone density; swimming is good exercise but is not weight-bearing. Bone density testing is routine at 65, but a postmenopausal woman under 65 with risk factors such as smoking, low body weight, and a parent's hip fracture should be tested earlier. Calcium carbonate needs stomach acid to be absorbed, so it is taken with meals; she should also stop smoking and meet her calcium and vitamin D needs, preferably from food.

## 심화 해설

Core concept: bone health after menopause

This question tests whether you can apply osteoporosis risk assessment and nonpharmacologic prevention to a specific patient. The woman has several well-established risk factors: she is postmenopausal, currently smokes, has a low body weight with a BMI of 17 kg/m², and has a first-degree family history of hip fracture. These are not minor details; they change when and how aggressively bone health should be addressed.

The correct statement is “I will walk briskly for 30 minutes on most days of the week.” Brisk walking is a weight-bearing exercise. Mechanical loading through the long axis of the skeleton stimulates osteoblast activity and helps preserve bone mineral density. For a postmenopausal woman with multiple risk factors, this is an appropriate, evidence-aligned lifestyle measure.

Watch out! Swimming is excellent for cardiovascular fitness and joint-friendly movement, but it is not weight-bearing. Buoyancy removes the mechanical stress on bone that is needed to stimulate bone formation. Therefore, swimming alone does not provide the same skeletal benefit as walking, jogging, stair climbing, or resistance training.

The second option contains two errors. Calcium carbonate requires an acidic environment for optimal dissolution and absorption. Taking it on an empty stomach, especially at bedtime when gastric acid secretion is lower, reduces its bioavailability. Calcium carbonate should be taken with meals to take advantage of meal-stimulated gastric acid. In addition, the teaching should address smoking cessation and adequate intake of calcium and vitamin D, preferably from dietary sources.

The fourth option reflects a misunderstanding of screening guidelines. For average-risk women, bone density testing with dual-energy x-ray absorptiometry is routinely initiated at age 65 years. However, postmenopausal women younger than 65 years who have clinical risk factors should be screened earlier. This patient has at least four: smoking, low body weight, parental hip fracture, and postmenopausal status. Waiting until age 65 would delay identification of low bone mass and increase the window of vulnerability to fragility fracture.

| Risk factor in this patient | Why it matters for bone health |
| --- | --- |
| Postmenopausal (3 years) | Estrogen deficiency accelerates bone resorption through increased osteoclast activity |
| Current smoking | Nicotine and other tobacco components impair osteoblast function and reduce calcium absorption |
| BMI 17 kg/m² (low body weight) | Reduced mechanical loading on bone and often lower estrogen levels from diminished adipose tissue |
| Mother with hip fracture | Family history reflects genetic predisposition to low bone mass and fracture risk |

Key point! A fragility fracture in an adult aged 50 years or older is a sentinel event. It signals underlying bone fragility and predicts elevated risk for subsequent fractures, particularly in the year following the initial fracture. This is why early identification of high-risk patients, before the first fracture occurs, is a nursing priority.

The teaching goal for this patient is not simply to increase knowledge but to promote behaviors that reduce modifiable risk. Smoking cessation, adequate calcium and vitamin D intake, weight-bearing physical activity, and timely bone density assessment are all components of a comprehensive prevention plan. The statement about brisk walking shows that the patient understands the type of exercise that actually benefits bone, not just general physical activity.

## 임상 시나리오

Postmenopausal Bone Health CounselingWeight-bearing exercise and calcium intake for high-risk women
For a postmenopausal woman with smoking, low body weight (BMI 17 kg/m²), and a first-degree family history of hip fracture, recommend weight-bearing exercise such as brisk walking for 30 minutes on most days of the week. Mechanical loading stimulates osteoblast activity and helps preserve bone mineral density.

Swimming is not weight-bearing; buoyancy removes the mechanical stress on bone needed to stimulate bone formation. It is good for cardiovascular fitness but does not provide the same skeletal benefit as walking, jogging, stair climbing, or resistance training.

Calcium carbonate requires an acidic environment for optimal absorption. It should be taken with meals, not on an empty stomach or at bedtime when gastric acid secretion is lower. Encourage meeting calcium and vitamin D needs preferably from food sources and advise smoking cessation.

CautionRoutine bone density testing starts at 65, but a postmenopausal woman under 65 with risk factors such as smoking, low body weight, or a parent's hip fracture should be screened earlier. Do not delay assessment in high-risk patients.

## 핵심 개념

- **Weight-bearing exercise** — Physical activity performed on feet that works bones and muscles against gravity, such as walking, jogging, or stair climbing, which stimulates bone formation.
- **Osteoporosis risk factors** — Conditions that increase fracture risk including postmenopausal status, smoking, low body weight (BMI under 19), and family history of hip fracture.
- **Calcium carbonate absorption** — Requires an acidic gastric environment for optimal dissolution; should be taken with meals to maximize bioavailability.
- **Bone density screening** — Routine at age 65, but indicated earlier for postmenopausal women under 65 with clinical risk factors for osteoporosis.
- **Osteoblast stimulation** — Mechanical loading through weight-bearing activity activates bone-forming cells, helping preserve bone mineral density.

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