NCLEX PN - Musculoskeletal Pharmacology

The nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide. During data collection, the nurse asks which question to determine if the medication is effective? 1. "Do you have any joint pain?" 2. "Are you having any diarrhea?" 3. "Do you have frequent headaches?" 4. "Are you experiencing heartburn?"

1. "Do you have any joint pain?" Rationale: Asking the client, "do you have any joint pain?" is the question to ask to determine if the medication is effective. Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other questions are unrelated to medication effectiveness.

The nurse has reinforced discharge instructions to a client with multiple sclerosis who is receiving baclofen. Which statement by the client indicates an understanding of the medication? 1. "I need to watch for urinary retention." 2. "I need to stop the medication if diarrhea occurs." 3. "If I develop fatigue, I need to notify the primary health care provider." 4. "I need to restrict my fluid intake while I take this medication."

1. "I need to watch for urinary retention." Rationale: Baclofen is a central nervous (CNS) depressant. It is not necessary to restrict fluids, but the client would be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary for the client to notify the primary health care provider. Constipation rather than diarrhea is an adverse effect of baclofen. Additionally, the client would be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents.

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder would alert the nurse to contact the primary health care provider (PHCP)? 1. A seizure disorder 2. Hyperthyroidism 3. Diabetes mellitus 4. Coronary artery disease

1. A seizure disorder Rationale: Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

The nurse notes that meloxicam is prescribed for a client. The nurse knows that what are the specific actions of this medication? Select all that apply. 1. Analgesic 2. Antipyretic 3. Antiemetic 4. Antibacterial 5. Antihypertensive 6. Anti-inflammatory

1. Analgesic 2. Antipyretic 6. Anti-inflammatory Rationale: Meloxicam is used for the treatment of osteoarthritis. It is a medication with some cyclooxygenase (COX-2) selectivity and has analgesic, anti-inflammatory, and antipyretic actions. The other actions are not properties of meloxicam.

The nurse is caring for a client with muscle spasticity characterized by heightened muscle tone, spasm, and loss of dexterity caused by multiple sclerosis. Which centrally acting skeletal muscle relaxants might be prescribed for this client? Select all that apply. 1. Baclofen 2. Diazepam 3. Ibuprofen 4. Dantrolene 5. Trazadone

1. Baclofen 2. Diazepam 4. Dantrolene Rationale: Baclofen, dantrolene, and diazepam may be prescribed for this client with muscle spasticity. Centrally acting skeletal muscle relaxants are prescribed as an adjunct to rest and physical therapy for relief of discomfort associated with acute, painful musculoskeletal disorders such as multiple sclerosis, cerebral palsy, spinal cord lesions, and CVA. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Trazadone is given for anxiety and depression.

Cyclobenzaprine is prescribed for a client for muscle spasms, and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the primary health care provider about the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hypothyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because cyclobenzaprine has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure. Cyclobenzaprine should be used only for a short time (2 to 3 weeks). The conditions in options 2, 3, and 4 are not a concern with this medication.

Cyclobenzaprine is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the primary health care provider (PHCP) regarding the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hyperthyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy. The disorders in options 2, 3, and 4 are not a concern when the client is taking cyclobenzaprine.

The nurse prepares to reinforce instructions to a client who is taking allopurinol. The nurse would include which instruction in the plan? 1. Instruct the client to drink 3000 mL of fluid per day. 2. Instruct the client to take the medication on an empty stomach. 3. Inform the client that the effect of the medication will occur immediately. 4. Instruct the client that if swelling of the lips occurs, this is a normal expected response.

1. Instruct the client to drink 3000 mL of fluid per day. Rationale: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. Allopurinol is an antigout medication used to decrease uric acid levels. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the primary health care provider because this may indicate hypersensitivity.

A client with multiple sclerosis is receiving baclofen. The nurse monitoring this client would look for which outcome to indicate a primary therapeutic response from the medication? 1. Decreased nausea 2. Decreased muscle spasms 3. Increased muscle tone and strength 4. Increased range of motion of all extremities

2. Decreased muscle spasms Rationale: A primary therapeutic response from baclofen is to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and multiple sclerosis. Baclofen is a skeletal muscle relaxant and acts at the spinal cord level. Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication. Decreased nausea is incorrect.

During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show Non progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given. 6. A low-grade temperature when rising in the morning that remains throughout the day

1. Symptom control during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show Non progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data? 1. The white blood cell and platelet counts 2. A metallic taste in the mouth, with a loss of appetite 3. Whether the client is experiencing fatigue and joint pain 4. Whether the client is experiencing itching and edema at the injection site

1. The white blood cell and platelet counts Rationale: Infection and suppression can occur as a result of etanercept. Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell and platelet counts can alert the nurse to a potentially life-threatening infection or potential bleeding. Injection site itching and edema are common occurrences following administration. A metallic taste and loss of appetite are not associated with this medication. Fatigue and joint pain occur with rheumatoid arthritis.

A client has been started on cyclobenzaprine for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. The nurse interprets these signs/symptoms as which response? 1. These are the common side effects of this medication. 2. These effects represent an allergic reaction to the medication. 3. These effects are related to the problem with the cervical spine. 4. These effects are dose-related; the client should cut the medication dose in half.

1. These are the common side effects of this medication. Rationale: Drowsiness, dizziness, and dry mouth are the most common side effects of cyclobenzaprine. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm that accompanies a variety of conditions. The other responses are incorrect.

The nurse has given medication instructions to a client beginning therapy with carisoprodol. The nurse determines that the client understands the effects of the medication if the client makes which statement? 1. "I can expect muscle spasticity as a side effect." 2. "I need to avoid alcohol while taking this medication." 3. "I can drive on city streets, but would avoid highway driving." 4. "I can take a missed dose when remembered, regardless of when the next dose is due."

2. "I need to avoid alcohol while taking this medication." Rationale: Carisoprodol, a centrally acting skeletal muscle relaxant, may cause central nervous system (CNS) side effects of drowsiness and dizziness. For this reason, the client avoids other CNS depressants, such as alcohol, while taking this medication. Driving or other activities requiring mental alertness are also avoided until the client's reaction to the medication is known. The medication is used to reduce muscle spasticity and pain. Missed doses would be taken if remembered within 1 hour.

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication? 1. Depresses spinal reflexes 2. Acts directly on the skeletal muscle to relieve spasticity 3. Acts within the spinal cord to suppress hyperactive reflexes 4. Acts on the central nervous system (CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticity Rationale: Dantrolene acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. Options 1, 3, and 4 are not actions of the medication.

The nurse is reinforcing discharge instructions to a client receiving baclofen. Which would the nurse include in the instructions? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the primary health care provider (PHCP) if fatigue occurs.

2. Avoid the use of alcohol. Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Constipation rather than diarrhea is an adverse effect of baclofen. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the PHCP if fatigue occurs.

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction would be included in the teaching plan? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the primary health care provider (PHCP) if fatigue occurs.

2. Avoid the use of alcohol. Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the PHCP about fatigue.

A client has been prescribed allopurinol. The nurse reinforces which information concerning the administration of the medication? 1. Take the medication 1 hour before eating. 2. Drink at least 8 glasses of fluid every day. 3. Put ice on the upper and lower lips if they swell. 4. Use an antihistamine lotion if an itchy rash develops.

2. Drink at least 8 glasses of fluid every day. Rationale: Clients taking allopurinol are encouraged to drink 2000 to 3000 mL of fluid a day to prevent the formation of crystals in the urine. Allopurinol is to be given with milk or immediately following meals. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, the primary health care provider should be notified because this may indicate hypersensitivity.

A client with a history of spinal cord injury is receiving baclofen for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences which sign/symptom? 1. Muscle pain 2. Drowsiness 3. Hypertension 4. Photosensitivity

2. Drowsiness Rationale: Baclofen is a centrally acting skeletal muscle relaxant. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. The other signs/symptoms are incorrect.

A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which data would indicate that the client is experiencing a side effect related to this medication? 1. Headache 2. Drowsiness 3. Urinary retention 4. Increased salivation

2. Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication. The other side effects are incorrect.

The nurse is caring for a client who just been prescribed alendronate. Which conditions contraindicate this medication being given to the client? Select all that apply. 1. Liver failure 2. Hypocalcemia 3. Cardiac disease 4. Poor renal function 5. Irritable bowel syndrome (IBS) 6. Gastroesophageal reflux disease (GERD)

2. Hypocalcemia 4. Poor renal function 6. Gastroesophageal reflux disease (GERD) Rationale: A client with hypocalcemia, poor renal function, and gastroesophageal reflux disease (GERD) should not take alendronate. Alendronate is a bisphosphonate. The other conditions do not prevent a client from taking alendronate.

A client is receiving diazepam for its skeletal muscle relaxant effects. The nurse would monitor this client for which side effect of this medication? 1. Headache 2. Incoordination 3. Urinary retention 4. Increased salivation

2. Incoordination Rationale: Diazepam is a centrally acting skeletal muscle relaxant. Incoordination and drowsiness are common side effects resulting from this medication. The other side effects of diazepam are incorrect.

A client with multiple sclerosis is receiving diazepam, and the home care nurse reinforces instructions to the client regarding the side effects of the medication. The nurse tells the client that which is a side effect of this medication? 1. Insomnia 2. Incoordination 3. Inability to urinate 4. Increased salivation

2. Incoordination Rationale: Incoordination and drowsiness are common side effects resulting from this medication. Insomnia, inability to urinate and increased salivation are unrelated to the use of this medication.

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication? 1. Creatinine 2. Liver function tests 3. Blood urea nitrogen 4. Hematological function tests

2. Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. Options 1 and 3 are tests that assess kidney function.

Auranofin has been prescribed for a client with rheumatoid arthritis. The nurse who is collecting data 2 weeks later interprets that the client may be experiencing the signs of medication toxicity based on what data collection findings? Select all that apply. 1. Reports loss of appetite 2. Observes several mouth lesions 3. Notes a rash on trunk and neck 4. Reports a metallic taste in the mouth 5. Notes purplish blotches on the skin

2. Observes several mouth lesions 3. Notes a rash on trunk and neck 4. Reports a metallic taste in the mouth 5. Notes purplish blotches on the skin Rationale: Auranofin is the one gold preparation that is given orally rather than by injection. Gastrointestinal side effects, including diarrhea, abdominal pain, nausea, and loss of appetite, are common early in therapy but usually subside in the first 3 months. Early symptoms of toxic effects include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? 1. Myxedema 2. Renal failure 3. Hypothyroidism 4. Diabetes mellitus

2. Renal failure Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic, or cardiac disorders, or those with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication would be used with caution in clients with impaired hepatic function, older clients, and debilitated clients.

The nurse is caring for a client with gout who is taking colchicine. The client has been instructed to restrict the diet to low-purine foods. Which food would the nurse instruct the client to avoid while taking this medication? 1. Spinach 2. Scallops 3. Potatoes 4. Ice cream

2. Scallops Rationale: High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. Colchicine is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake.

A primary health care provider instructs a client with rheumatoid arthritis to take ibuprofen. The nurse reinforces the instructions, knowing that the normal adult dose for this client is which? 1. 100 mg orally twice a day 2. 200 mg orally twice a day 3. 400 mg orally 3 times a day 4. 1000 mg orally 4 times a day

3. 400 mg orally 3 times a day Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg 3 or 4 times daily.

The client has been on treatment for rheumatoid arthritis for 3 weeks. Which is most important for the nurse to check during the administration of etanercept? 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. A metallic taste in the mouth and a loss of appetite 4. Whether the client is experiencing fatigue and joint pain

2. The white blood cell counts and platelet counts Rationale: When the client is taking etanercept, it is most important for the nurse to check the client's white blood cell count. Infection and pancytopenia are adverse effects of etanercept. Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.

Carisoprodol is been prescribed for a client to relieve muscle spasms. The client is being discharged and the nurse is instructing the client and family about the medication. What comment by the client indicates a need for further teaching? 1. "I will avoid alcohol." 2. "I know this medication is only used for short periods, such as 2 to 3 wks." 3. "I'm glad there are no withdrawal problems when I stop taking this medication." 4. "I must avoid tasks that require alertness and movement skills until my response to the medication is okay."

3. "I'm glad there are no withdrawal problems when I stop taking this medication." Rationale: There is a need for further teaching when the client states, "I'm glad there are no withdrawal problems when I stop taking this medication." There is a risk for withdrawal problems when carisoprodol is stopped. The client needs to be taught to report withdrawal symptoms such as syncope, tachyarrhythmia, excessive fatigue or unusual mental status changes. The client needs to avoid tasks that require alertness and motor skills until response to the medication is established, and also avoid alcohol. Carisoprodol would only be used for short periods of time (2 to 3 weeks).

A client receives a prescription for methocarbamol, and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further teaching? 1. "My urine may turn brown or green." 2. "This medication is prescribed to help relieve my muscle spasms." 3. "If my vision becomes blurred, I don't need to be concerned about it." 4. "I need to call my doctor if I experience nasal congestion from this medication."

3. "If my vision becomes blurred, I don't need to be concerned about it." Rationale: There is a need for further teaching when the client says, "If my vision becomes blurred, I don't need to be concerned." The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that if these adverse effects occur, the primary health care provider needs to be notified. The medication is used to relieve muscle spasms.

A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction would the nurse reinforce to the client? 1. "Crush the tablets and mix them with food." 2. "Open the tablet and mix the contents with food." 3. "Swallow the tablets with large amounts of water or milk." 4. "Notify the primary health care provider for a medication change."

3. "Swallow the tablets with large amounts of water or milk." Rationale: The initial instruction the nurse would reinforce to the client is to swallow the tablets with large amounts of water or milk. Taking the medication with a large amount of water or milk should be tried before contacting the primary health care provider. Diflunisal may be given with water, milk, or meals. The tablets would not be crushed or broken open.

A client is receiving a maintenance dose of oral dantrolene sodium for the treatment of spasticity. The nurse reviews the medication record, expecting which dose to be prescribed? 1. 50 mg daily 2. 100 mg daily 3. 100 mg twice daily 4. 200 mg four times daily

3. 100 mg twice daily Rationale: For treatment of spasticity, dantrolene is administered orally. The initial dosage in adults is 25 mg once daily. The usual maintenance dosage is 100 mg 2 to 4 times daily. If beneficial effects do not develop within 45 days, dantrolene therapy should be discontinued.

The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect would the nurse monitor? 1. Tachycardia 2. Rapid pulse 3. Bradycardia 4. Hypertension

3. Bradycardia Rationale: Intravenous administration of methocarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these adverse effects. Options 1, 2, and 4 are not effects with administration of this medication.

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which would indicate that the client is experiencing a side effect? 1. Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

3. Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

A client diagnosed with rheumatoid arthritis (RA) has been started on medication therapy with hydroxychloroquine. The nurse reinforces teaching with this client regarding the most serious adverse effect of this medication? 1. Liver disease 2. Kidney failure 3. Retinal damage 4. Esophageal irritation and necrosis

3. Retinal damage Rationale: The most serious adverse effect of hydroxychloroquine is retinal damage. This drug slows the progression of mild rheumatoid disease before it worsens. The nurse needs to teach the client to report blurred vision or headache. Remind clients to have an eye examination before taking the drug and every 6 months to detect changes in the cornea, lens, or retina. If this rare complication occurs, the primary health care provider discontinues the drug.

An adult client with severe muscle spasticity is receiving intrathecal baclofen (ITB). The nurse knows that what adverse effects may occur if the medication is suddenly withdrawn. Select all that apply. 1. Fatigue 2. Sedation 3. Seizures 4. Dizziness 5. Hallucinations

3. Seizures 5. Hallucinations Rationale: Seizures and hallucinations may occur if ITB is suddenly withdrawn. Other centrally-acting skeletal muscular relaxants, such as tizanidine, may cause severe drowsiness and sedation in most clients and may not be effective in reducing spasticity. As an alternative to other centrally-acting skeletal muscular relaxants, intrathecal baclofen (ITB) therapy may be prescribed. This drug is administered through a programmable, implantable infusion pump and intrathecal catheter directly into the cerebrospinal fluid. The pump is surgically placed in a subcutaneous pouch in the lower abdomen. Common adverse effects include sedation, fatigue, dizziness, and possible changes in mental status.

A client is receiving baclofen for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which is a side effect of this medication? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

3. Slurred speech Rationale: Slurred speech is a one of the side effects of baclofen. Other side effects include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. The other side effects are not related to this medication.

The nurse is reinforcing dietary instructions to a client who is currently prescribed probenecid. Which food would the nurse encourage the client to continue to eat? 1. Liver 2. Shrimp 3. Spinach 4. Scallops

3. Spinach Rationale: Probenecid inhibits the reabsorption of uric acid by the kidneys and promotes excretion of uric acid in the urine. Clients taking this medication are instructed to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. Spinach is not a high-purine food.

A client newly diagnosed with gout has been prescribed allopurinol. The nurse would question the primary health care provider if the dose for which medication already prescribed has not changed? 1. Digoxin 2. Adenosine 3. Warfarin sodium 4. Ergonovine maleate

3. Warfarin sodium Rationale: Allopurinol is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium is an anticoagulant, and if this medication was prescribed for the client, the nurse should verify the prescription. The dose of warfarin sodium may need to be decreased. Adenosine is an antidysrhythmic. Digoxin is a cardiac glycoside. Ergonovine maleate is an antimigraine medication.

The nurse is providing instructions to a client with a diagnosis of rheumatoid arthritis (RA) who is receiving acetylsalicylic acid 5 g orally daily. Which statement by the client would indicate an understanding of the instructions? 1. "A slow pulse might indicate a reaction to the medication." 2. "If I have joint pain, I need to notify the primary health care provider." 3. "If I have discomfort with exercise, I need to stop the medication." 4. "I should notify the primary health care provider if I get any ringing in my ears."

4. "I should notify the primary health care provider if I get any ringing in my ears." Rationale: Aspirin is a nonsteroidal anti-inflammatory medication. Adverse reactions include gastrointestinal bleeding and/or gastric mucosal lesions, ringing in the ears (tinnitus), and generalized pruritus. Headache, dizziness, flushing, tachycardia, hyperventilation, sweating, and thirst also are adverse reactions. The other comments are incorrect client statements.

The nurse is teaching a client with osteoporosis who is being discharged with a prescription for a bisphosphonate. What comment by the client shows a need for further teaching? 1. "I will call my dentist for an oral exam before beginning the medication." 2. "I know I shouldn't take the medication if I get gastroesophageal reflux disease (GERD)." 3. "If I get any chest pain, I'll stop the medication and contact my primary health care provider." 4. "I'll take it before supper with 8 ounces of water and stay in an upright position for 30 to 60 minutes."

4. "I'll take it before supper with 8 ounces of water and stay in an upright position for 30 to 60 minutes." Rationale: There is a need for further teaching when the client states," I'll take the medication before supper with 8 ounces of water and stay in an upright position for 30 to 60 minutes." Bisphosphonates (BPs) must be taken early in the morning and not as just described. Bisphosphonates (BPs) slow bone resorption by binding with crystal elements in bone, especially spongy, trabecular bone tissue. The nurse needs to teach the client to have an oral assessment and preventive dentistry before beginning any bisphosphonate therapy and to inform any dentist who is planning invasive treatment, such as a tooth extraction or implant, that they are taking a BP drug.

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse would make which appropriate response to the client? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

4. "Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

A client with multiple sclerosis is receiving dantrolene for relief of muscle spasticity. When would this medication be discontinued if there is no relief of spasticity? 1. 10 days 2. 2 weeks 3. 5 weeks 4. 2 months

4. 2 months Rationale: Dantrolene is discontinued if no relief of spasticity is achieved in 6 to 8 weeks.

Allopurinol has been prescribed for a client with chronic tophaceous gout. The nurse explains to the client that what condition can occur during the first few months of treatment? 1. Leukemia 2. Myeloid metaplasia 3. Polycythemia vera 4. Acute gouty arthritis

4. Acute gouty arthritis Rationale: Allopurinol is an antigout medication. It decreases uric acid production by inhibiting the enzyme xanthine oxidase and reduces uric acid concentrations in serum and urine. During the initial months of treatment, allopurinol may increase the incidence of acute gouty arthritis. The risk of an attack can be reduced by concurrent treatment with colchicine or a nonsteroidal anti-inflammatory drug (NSAID).

A licensed practical nurse (LPN) is reviewing the medical record of a newly assigned client and notes that the client is receiving cyclobenzaprine hydrochloride for the treatment of muscle spasms. The LPN questions the prescription if which disorder is noted in the admission history? 1. Hypothyroidism 2. Chronic bronchitis 3. Recurrent pneumonia 4. Angle-closure glaucoma

4. Angle-closure glaucoma Rationale: Cyclobenzaprine hydrochloride is a skeletal muscle relaxant. Because cyclobenzaprine hydrochloride has anticholinergic effects, it should be used cautiously in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. It is intended for short-term (2- to 3-week) therapy. The other disorders are not contraindications or concerns for the client receiving cyclobenzaprine hydrochloride.

A primary health care provider prescribes auranofin for a client with rheumatoid arthritis. Which data would indicate to the nurse that the client is experiencing toxicity related to the medication? 1. Joint pain 2. Constipation 3. Ringing in the ears 4. Complaints of a metallic taste in the mouth

4. Complaints of a metallic taste in the mouth Rationale: Early symptoms of toxicity of auranofin include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth. Auranofin is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy, but these usually subside in the first 3 months of therapy.

The nurse tells a client with leukemia that allopurinol has been added to the medication list. The client is currently receiving busulfan. When the client asks the purpose of the new medication, the nurse responds that allopurinol is intended to prevent which complication? 1. Arthritis 2. Alopecia 3. Diabetes 4. Hyperuricemia

4. Hyperuricemia Rationale: Busulfan is an antineoplastic agent used in the treatment of acute myelocytic leukemia and in the palliative treatment of chronic myelogenous leukemia. This therapy can cause blood dyscrasias, and with massive cell death the release of uric acid resulting in hyperuricemia. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute kidney injury. Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil therapy to prevent stomatitis. Allopurinol is not used to prevent alopecia or diabetes. It is used to treat gouty arthritis, but this is the case with its use with chemotherapy.

The nurse is reviewing medications with the client receiving colchicine for the treatment of gout. The nurse determines that the medication is effective if the client reports a decrease in which? 1. Headaches 2. Blood glucose 3. Blood pressure 4. Joint inflammation

4. Joint inflammation Rationale: Colchicine is effective if the client has a decrease in joint inflammation. This medication is classified as an antigout agent. It interferes with the ability of the white blood cells to initiate and maintain an inflammatory response to monosodium urate crystals. The client would also report a decrease in pain as well as inflammation in the affected joints. There will also be a decrease in the number of gout attacks. Colchicine has no effect on the client's blood glucose or blood pressure and is not used to treat a headache.

A licensed practical nurse (LPN) is reviewing laboratory results for a client taking dantrolene sodium. The LPN would suggest that the registered nurse notify the primary health care provider if which finding is noted on the laboratory report sheet? 1. Creatinine 0.6 mg/dL 2. Platelet count 290,000 mm 3. Blood urea nitrogen 9 mg/dL 4. Lactate dehydrogenase (LDH) 600 units/L

4. Lactate dehydrogenase (LDH) 600 units/L Rationale: Dantrolene sodium is a skeletal muscle relaxant. Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, tests of liver function would be performed before treatment and throughout the treatment interval. It is administered in the lowest effective dosage for the shortest time necessary. The LDH level reported is high. The other laboratory results are considered normal.

Baclofen is prescribed for a client with a spinal cord injury who is experiencing muscle spasms, and the nurse prepares a list of the associated side effects of the medication and reviews the list with the client. Which side effect identified by the client indicates a need for further teaching? 1. Tremors 2. Slurred speech 3. Nasal congestion 4. Photosensitivity

4. Photosensitivity Rationale: There is a need for further teaching when the client identifies photosensitivity as a side effect of baclofen. Photosensitivity is not a side effect of this medication. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur along with slurred speech, tremor, dry mouth, nocturia, and impotence.

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions for the administration of the medication. Which instruction would the nurse reinforce? 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal side/adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

A client has been prescribed cyclobenzaprine in the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse would withhold the medication and question the prescription if the client had which concurrent prescriptions to take? 1. Ibuprofen 2. Furosemide 3. Valproic acid 4. Tranylcypromine

4. Tranylcypromine Rationale: The client would not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors (MAOIs) such as tranylcypromine or phenelzine within the past 14 days. Otherwise, the client could experience hyperpyretic crisis, seizures, or death.