A Client with Rheumatoid Arthritis Pharm Questions

Which assessment data would the nurse expect for the client with rheumatoid arthritis who is taking sulfasalazine (Azulfidine), an antirheumatic medication? 1. Orange or yellowish discoloration of the urine. 2. Ulcers and irritation of the mouth. 3. Ecchymosis of the lower extremities. 4. A red, raised skin rash over the back.

1. Azulfidine may cause an orange or yellowish discoloration of urine and the skin; this is expected and is not significant.

Which instruction should the nurse discuss with the client diagnosed with rheumatoid arthritis who is prescribed methotrexate, a disease-modifying antirheumatic drug (DMARD)? 1. Use a soft-bristled toothbrush when brushing teeth. 2. Wear warm clothes when it is less than 40F. 3. Gargle with mouthwash at least four times a day. 4. Use a sunscreen with an SPF 15 or lower when outside.

1. Methotrexate causes bone marrow depression, which may lead to abnormal bleeding. Therefore, the client should use a soft-bristled toothbrush.

The client with rheumatoid arthritis is taking phenylbutazone (Butazolidin), a pyrazoline nonsteroidal anti-inflammatory drug (NSAID). Which statement would make the nurse question administering this medication? 1. "I have had a sore throat and fever the last few days." 2. "I have not had a bowel movement in more than 3 days." 3. "I can't believe I have gained 3 pounds in the last month." 4. "I have been having trouble sleeping at night."

1. The most dangerous adverse reaction to this classification of medication is blood dyscrasias, which are manifested in the client by flulike symptoms.

The client with rheumatoid arthritis is prescribed prednisone, a glucocorticoid, for an acute episode of pain. The client asks the nurse, "Why can't I be on this forever since it helps the pain so much?" Which statement would be the nurse's best response? 1. "The medication will cause you to have a buffalo hump or moon face." 2. "The medication has long-term side effects, such as osteoporosis." 3. "If you continue taking the medication, it may cause an Addisonian crisis." 4. "There are other medications that can be prescribed to help the pain."

2. Prednisone has serious long-term side effects that can lead to possible life threatening complications. Therefore, the client cannot take prednisone forever.

The client with rheumatoid arthritis has been taking methotrexate, a diseasemodifying antirheumatic drug (DMARD), for 2 weeks. Which laboratory data would warrant intervention by the nurse? 1. A serum creatinine level of 0.9 mg/dL. 2. A red blood cell count of 2.5 million/mm. 3. A white blood cell count of 9000 mm. 4. A hemoglobin of 14.5 g/dL and hematocrit of 43%.

2. This RBC count indicates thrombocytopenia, which would warrant intervention by the nurse. The normal RBC is 4.6 to 6.0 million/mm for men and 4.0 to 5.0 million/mm for women.

The client recently diagnosed with rheumatoid arthritis is prescribed 4 grams of aspirin daily. Which statement indicates the client needs more teaching concerning the medication? 1. "I will decrease my dose for a few days if my ears start ringing." 2. "I should take my aspirin with meals, food, milk, or antacids." 3. "I need to take the entire aspirin dose at night before going to bed." 4. "If I have any stomach upset, I will take enteric-coated aspirin."

3. The aspirin should be taken in divided doses (three to four 325-mg tablets four times a day). This statement indicates the client needs more teaching.

The client diagnosed with rheumatoid arthritis is taking the disease-modifying antirheumatic drug (DMARD) leflunomide (Arava). Which comment by the client would warrant intervention by the nurse? 1. "I have noticed that I am starting to lose my hair." 2. "I sometimes get dizzy and drowsy." 3. "My spouse and I are trying to start a family." 4. "I will not get any vaccines while taking this medication."

3. This medication is teratogenic. Women must undergo the drug-elimination procedure and men must take 8 grams of cholestyramine three times daily for 11 days to minimize any possible risk of harm to the fetus his partner is carrying.

The client with rheumatoid arthritis is taking etodolac (Lodine), a nonsteroidal antiinflammatory drug (NSAID). The client is complaining of a headache. Which action should the nurse implement? 1. Administer two aspirins to the client. 2. Administer an additional dose of Lodine. 3. Administer one oral narcotic analgesic. 4. Administer two acetaminophen (Tylenol).

4. Acetaminophen, a nonnarcotic analgesic, would be the most appropriate medication to give the client who is experiencing a headache and is taking an NSAID.

The client with rheumatoid arthritis is prescribed capsaicin (Zostrix), a topical analgesic. Which information should the nurse discuss with the client? 1. Apply the cream as needed for severe arthritic pain. 2. Notify the HCP if burning of the skin occurs after application. 3. It may take up to 3 months for the medication to become effective. 4. Rub the cream into skin until no cream is left on the surface.

4. The cream should be rubbed into the skin until little or no cream is left on the surface of the skin. The hands should be washed immediately after the cream is applied to the skin.

The client with rheumatoid arthritis is prescribed hydroxychloroquine sulfate (Plaquenil), a disease-modifying antirheumatic drug (DMARD). Which statement indicates the client needs more teaching concerning the medication? 1. "I will get my eyes checked every 6 months." 2. "I should not drink alcohol while taking this drug." 3. "It is important to take this medication with milk." 4. "I will call my HCP if the pain is not relieved in 2 weeks."

4. The medication takes 3-6 months to achieve the desired response, and many clients do not experience significant benefits.