Pharm Exam 3- ATI Musculoskeletal

A nurse is teaching a client about ADR of etanercept. Which of the following statements by the client indicates understanding of the teaching?

"I will need to get my blood drawn periodically while on this medication" Rationale: Etanercept places the client at risk for systemic fungal infections and other opportunistic infections. Therefore, the client will need to have their CBC monitored periodically while on this medication.

A nurse is teaching a client who has a new rx for etanercept. Which of the following statements should the nurse make?

"You should report signs of infections to your provider immediately" rationale: The nurse should teach the client that they are susceptible to infections when taking DMARD II medications such as etanercept. The client should report symptoms of infection, such as fever, cough, malaise, weight loss, and dyspnea, to the provider immediately to prevent further complications.

A nurse is caring for a client who has a new rx for etanercept. Which of the following actions should the nurse take?

Administer a tuberculin skin test prior to starting the medication rationale: Etanercept is contraindicated for administration to clients who have a history of exposure to tuberculosis. Therefore, the nurse should administer a tuberculin skin test prior to starting the medication.

A nurse should identify that a client who has diabetes mellitus and is taking etanercept is at an increased risk for which of the following ADR?

Infection rationale: Etanercept increases the risk of developing a serious infection. Providers should not prescribe etanercept for clients who have an existing infection and should use it cautiously with clients who have diabetes mellitus because the disease itself already causes an increased risk for infection.

Which of the following is the tx action of raloxifene?

Mimic the effects of estrogen on bone tissue Raloxifene mimics the effects of estrogen on bone tissue, minimizing or stopping bone loss.

A nurse is caring for a client who is taking etanercept for RA. THe nurse should monitor the client for which of the following indications of a serious ADR to the drug?

Shortness of breath rationale: Etanercept can cause heart failure, manifesting as shortness of breath, cough, elevated blood pressure and heart rate, and pink-tinged sputum.

A nurse is teaching a client who is taking etanercept for RA. The nurse should instruct the client to monitor for which of the following indication of an ADR?

Skin rash rationale: Etanercept can cause serious skin infections. Clients should immediately report any skin rashes or blisters, because an infection can cause a serious reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

A nurse is caring for a client who is currently taking methotrexate for RA. The nurse should identify that which of the following is an ADR of this medication?

Thrombocytopenia rationale: Methotrexate has many adverse effects that affect the central nervous, respiratory, dermatologic, and hematology systems, such as anemia, leukopenia, and thrombocytopenia.

A nurse is teaching about self-administering methotrexate to a client who has RA. Which of the following statements should the nurse make?

"Drink a minimum of 2 liters of water per day to promote the drug's excretion" Methotrexate can cause kidney damage. Adequate hydration optimizes drug excretion and helps prevent kidney damage. Clients can also take sodium bicarbonate tablets to increase urine alkalinity and reduce the drug precipitation that can lead to kidney damage.

A nurse is teaching a client about methotrexate tx for RA. Which of the following statements by the client indicates understanding of the teaching?

"I will take a birth control pill every day" rationale: Methotrexate is teratogenic to a fetus and is contraindicated during pregnancy. Therefore, a client of childbearing age should use birth control while on this medication.

A nurse is teaching a client about methotrexate tx for RA. Which of the following information should the nurse include? (select all that apply)

-Avoid being near people who are sick with a communicable illness is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Clients taking the drug should avoid contact with large crowds or people who are sick with a communicable illness. -Periodic laboratory tests are required is correct. Periodic laboratory tests help the provider monitor for kidney and liver damage. It is important to assess for jaundice and abdominal pain because these findings can indicate liver damage. -Report bruising or petechiae is correct. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae, because these findings indicate a low platelet count. The nurse should monitor the client's laboratory values for a decrease in platelets and red and white blood cells. -Avoid drinking alcohol is correct. Alcohol ingestion can increase the risk of liver damage. Clients who are taking methotrexate should avoid drinking alcohol.

A nurse is teaching a client about raloxifene. Which of the following information should the nurse include? (Select all that apply)

-Increase physical activity by taking walks is correct. Clients who take raloxifene should avoid long periods of inactivity to prevent deep-vein thrombosis. Furthermore, walking, and other weight-bearing exercises, can help increase bone density -Use a contraceptive if there is any possibility of pregnancy is correct. Raloxifene is a pregnancy category X drug and can cause severe fetal harm. Women who are pregnant, breastfeeding, or might become pregnant should not take the drug. -Increase intake of calcium and vitamin D is correct. An increased intake of calcium and vitamin D helps improve the effectiveness of raloxifene and increases bone mass.

A nurse should instruct a client who is taking alendronate to monitor for which of the following ADR? (select all that apply)

-Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, and clients who develop it should report it to the provider. -Blurred vision is correct. Alendronate can cause ocular inflammation. The client should report any eye pain or blurred vision to the provider. -Muscle pain is correct. Alendronate can cause musculoskeletal pain. If analgesics do not help, the client might have to stop taking alendronate.

A nurse is teaching a client about raloxifene tx to prevent osteoporosis. The nurse should instruct the client to monitor for which of the following indication of an ADR?

Calf pain rationale: Raloxifene can increase the risk of deep-vein thrombosis, which can lead to a pulmonary embolism or cerebrovascular accident. Clients should avoid long periods of inactivity and report any pain, redness, or swelling in the calf.

A nurse is caring for a client who is taking alendronate to treat postmenopausal osteoporosis. The nurse should explain to the client that alendronate increases bone mass by which of the following actions?

Decrease activity of osteoclasts rationale: Osteoclasts are cells that cause bone resorption or bone loss. Alendronate reduces the activity of osteoclasts, reducing bone loss and increasing bone mass.

A nurse is caring for a client who has a rx for methotrexate. Which of the following drugs would likely be prescribed in conjunction during the initial tx for RA?

Ibuprofen rationale: NSAID analgesics, such as ibuprofen, are often prescribed along with methotrexate during the initial course of treatment for rheumatoid arthritis. It can take weeks for DMARDs to reach therapeutic levels and begin relieving joint inflammation and pain, so ibuprofen can be administered concurrently to help make the client more comfortable while waiting for methotrexate's therapeutic effects.

alendronate is contraindicated for administration to clients who have which of the following conditions?

Inability to sit upright rationale: Alendronate is contraindicated for administration to a client who cannot sit upright or stand for 30 min. Clients should drink 240 mL (8 oz) of water after taking the drug and sit upright or stand for at least 30 min to prevent esophagitis.

A nurse is caring for a client who has a rx for etanercept. The nurse should identify that etanercept treats RA by which of the following actions?

Inactivation of tumor necrosis factor rationale: Etanercept directly binds to the tumor necrosis factor (TNF), preventing the attachment of TNF onto the cell's surface. This prevents the autoimmune response and subsequent inflammation of the joints.

A nurse is preparing to administer alendronate to a client who has osteoporosis. The nurse should recognize which of the following as an adverse effect of alendronate?

Joint Paint Rationale: Alendronate can cause joint and muscle pain. Clients can treat joint pain with analgesics. Other adverse effects of this drug include nausea, visual disturbances, and esophagitis.

A nurse is planning care for a client who has a new rx for methotrexate. The nurse should plan to monitor the client for which of the following adverse effects

Bone marrow depression The nurse should monitor the client for bone marrow depression, which is an adverse effect of folic acid analogs such as methotrexate.

A nurse is teaching a client about methotrexate. The nurse should inform the client to monitor for which of the following as ADR?

Black, tarry stools rationale: Methotrexate can cause gastric intestinal ulceration, which can lead to perforation and bleeding. The client should monitor for blood in stools or emesis and report either to the provider immediately.