Pharmacology Chapter 29: Skeletal Muscle, Bone, and Joint Disorder Drugs

A client is to receive allopurinol 300 mg orally for gout. The nurse has 100-mg tablets available. How many tablets would the nurse administer?

3 tablets Explanation: The given is 100 mg for every 1 tablet. The client is to receive 300 mg. So 300/100= 3 tablets.

What is a common side effect to the drug baclofen? Constipation Organ failure Tinnitus Itching

Constipation

A client who is menopausal is taking a calcium supplement to prevent osteoporosis. You instruct the client to watch for which of the following indications of hypercalcemia? Eye twitching Bleeding gums Tinnitus Nausea

Nausea Manifestations of hypercalcemia include anorexia, nausea, vomiting, and constipation.

Which lab results should a nurse observe for clients taking antigout Medication allopurinol? Blood pressure Body temperature Renal Function Pulse rate

Renal Function (allopurinol are used cautiously in clients with liver impairment.)

A primary care provider prescribes etanercept to treat a client's rheumatoid arthritis. Prior to beginning the treatment, the client requires testing for which of the following? Pancreatitis Hepatitis Tuberculosis Gastritis

Tuberculosis Primary care providers should test clients for tuberculosis prior and during to treatment with etanercept.

What is the brand name for the muscle relaxant diazepam? Dantrium Valium Zanaflex Ozobax

Valium

When administering a skeletal muscle relaxant, the nurse observes the client for the most common adverse reaction, which is _________. drowsiness GI bleeding vomiting constipation

drowsiness

What explanation will the registered nurse (RN) provide to the client who wants to take the full dose of calcium carbonate (1000 mg/day) in one dosing? "Taking the full dose of 1000 mg at one time will actually weaken rather than strengthen the bones." "I really don't know why the healthcare provider (HCP) instructed you to do this, but we must not argue with the HCP." " Taking a full dose of 1000 mg at one time will worsen the side-effects of constipation." " If you take the photos of 1000 mg at one time, the body will not be able to observe all the drug."

" If you take the photos of 1000 mg at one time, the body will not be able to observe all the drug." This drug is taken in divided doses with one dose less than 500 mg. A dose of 500 mg or more will not be absorbed completely.

A nurse is teaching about self-administering methotrexate to a client who has rheumatoid arthritis. Which of the following statements should the nurse make? "Use a nonsteroidal anti-inflammatory drug to reduce toxicity." "If you miss a dose, go ahead and take it with the next scheduled dose." "Drink a minimum of 2 liters of water per day to promote the drug's excretion." and reduce the drug precipitation that can lead to kidney damage. "Take it in the morning to prevent insomnia."

"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.

A nurse is teaching a client who has a new prescription for etanercept. Which of the following statements should the nurse make? "You will inject this medication once a week in your thigh muscle." "You should report signs of infection to your provider immediately." "You will need to avoid taking ibuprofen while on this medication." "You will need to receive a MM vaccine 1 month after starting this medication."

"You should report signs of infection to your provider immediately." 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.

While providing a nursing inservice about muscle relaxers, which common factor for all muscle relaxers will the registered nurse (RN) discuss? Select all that apply. "when taking any muscle relaxer, sedation and drowsiness occur" "when taking any muscle relaxer wine, can be drunk, but not beer" "when stopping any muscle relaxer, the drug must be tapered off" "when taking any muscle relaxer, minimal side-effects are expected" "when taking any muscle relaxer, the primary goal of the therapy is pain relief"

"when taking any muscle relaxer, sedation and drowsiness occur" "when stopping any muscle relaxer, the drug must be tapered off" All muscle relaxers cause sedation and drowsiness. It is important to not drink alcohol while taking muscle relaxers, as this will worsen the sedation. To prevent a rebound effect, muscle relaxers must be tapered off rather than discontinuing abruptly.

Prior to starting alendronate, the nurse should assess which of the following in the client? (Select all that apply.) Ability to swallow Baseline vision The client's ability to lay flat Absence of nasal dryness

Ability to swallow Baseline vision Alendronate is a contraindication in clients who have difficulty swallowing due to the risk of esophagitis. Alendronate can cause vision changes in some clients, so it would be important to know the client's baseline vision to assess for changes during drug therapy.

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? Decreases activity of osteoclasts Increases calcium excretion Promotes intestinal absorption of calcium and phosphorus Reduces action of osteoblasts

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

Define the term Dyspepsia. Fullness or epigastric discomfort Skeletal disorder characterized by porous bone, making weaker bone strength and greater risk of fracture of a bone. Metabolic disorder resulting in increased levels of uric acid and causing severe joint pain. Inflammatory changes in connective tissue

Fullness or epigastric discomfort

What are some of the adverse reactions of the drug Methotrexate. Select all that apply. Gastrointestinal (GI) upset) Mild pancytopenia Cough Alopecia Urinary frequency

Gastrointestinal (GI) upset) Mild pancytopenia Alopecia

A nurse is teaching a client about raloxifene. Which of the following information should the nurse include? (Select all that apply.) Perform a breast self-examination twice per month. Increase physical activity by taking walks. Use a contraceptive if there is any possibility of pregnancy. Take the drug on an empty stomach. Increase intake of calcium and vitamin D.

Increase physical activity by taking walks. Use a contraceptive if there is any possibility of pregnancy. Increase intake of calcium and vitamin D. 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. An increased intake of calcium and vitamin D helps improve the effectiveness of raloxifene and increases bone mass.

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 adverse effects? Kidney toxicity Infection Gout Deep- vein thrombosis

Infection 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.

Define rheumatoid arthritis. A response where antibodies are formed against one's own body. Fullness or epigastric discomfort. Inflammatory changes in connective tissue Abnormally high level of serum calcium

Inflammatory changes in connective tissue

A nurse should instruct a client who is taking alendronate to monitor for which of the following adverse effects? (Select all that apply.) jaw pain Drowsiness Blurred vision Tinnitus Muscle pain

Jaw pain Blurred vision Muscle pain

What are calcium supplements such as, Calcium Citrate, given for? Select all that apply. Osteoporosis Treat gout Bone health Treat hypothyroidism

Osteoporosis Bone health

What is the action of Disease- modifying anti rheumatic drugs (DMARDs)? Works by inhibiting bone reabsorption by reducing osteoclast activity in the bone. Enhances GABA in the brain which leads to relaxation of spazzed out muscles. Produce immunosuppression, which in turn decreases the body's autoimmune response. Interfere with protein synthesis in the bacterial cell.

Produce immunosuppression, which in turn decreases the body's autoimmune response.

Which adverse reaction should the nurse report to the HCP immediately for clients taking antigout medication Allopurinol? Rash Weight gain Nausea Diarrhea

Rash (Sign for serious hypersensitivity reaction such as Stevens-Johnson syndrome (SJS). )

When instructing the client about alendronate, which of the following information should the health care provider include? (Select all that apply.) Take the drug on an empty stomach Take the drug before bedtime. Take the drug with an antacid. Sit upright for 30 minutes following dosage. Take with a full glass of water.

Take the drug on an empty stomach Sit upright for 30 minutes following dosage. Take with a full glass of water. Alendronate should be taken in the morning on an empty stomach for optimal bioavailability. Alendronate should be taken first thing in the morning before breakfast. Clients should wait 30 minutes before taking calcium or an antacid that might reduce the absorption of alendronate. Following dosage, the client should sit or stand upright for at least 30 minutes to reduce the risk of esophagitis. Clients should wait 30 minutes before taking calcium or an antacid that may reduce absorption of alendronate. Alendronate should be taken with a full glass of water to reduce the risk of esophagitis.

When allopurinol (Zyloprim) is used for treating gout, the nurse _________. administers the drug with juice or milk administers the drug after the evening meal restricts fluids during evening hours encourages liberal fluid intake

encourages liberal fluid intake (Increase FLUID intake to excrete uric acid and prevent kidney stones.)

After completing a health history of a client who has an order to begin allopurinol, which medical condition identified will prompt the registered nurse (RN) to clarify the order with the healthcare provider? Select all that apply. hepatitis C peptic ulcer disease chronic bronchitis hyperlipidemia renal tumor

hepatitis C renal tumor This drug is contraindicated in individuals with kidney or liver disease. During the administration of this drug, liver enzymes and renal function levels are monitored.

Bisphosphonates work by _________. inhibiting calcium digestion inhibiting abnormal bone resorption eliminating more phosphorus prohibiting vitamin D absorption

inhibiting abnormal bone resorption

While obtaining a drug history from a client, the registered nurse (RN) identifies what purpose for the prescription alendronate? fibromyalgia psoriatic arthritis rheumatoid arthritis osteoarthritis

osteoarthritis The purpose for this drug is to treat osteoporosis.

The antigout drug allopurinol _________ while Colchicine ___________. treat acute gout attacks, prevent gout reduce pain, cure gout prevent gout, treat acute gout promote osteoblast, reduce osteoclast

prevent gout, treat acute gout

Which of the following statements if made by the client would indicate that they understand how to take a bone resorption medication properly? "If I get sleepy after taking my medication, it is okay to lie down." "If I get a pain in the stomach, it means the medicine is working." "Take this until you get diarrhea." "I can take a nice shower after taking the med, before I eat."

"I can take a nice shower after taking the med, before I eat." (You take bone resorption medications on an empty stomach.)

What statement made by a client prescribed carisoprodol for a muscle strain, indicates a need for further teaching by the registered nurse (RN)? "This drug will help relax the muscle in the area of the sprain." "This drug will help decrease muscle spasticity in the area of injury." "This drug can be taken for as long as I need it, even if it is 2 months." "This drug can cause drowsiness, so I need to get up slowly."

"This drug can be taken for as long as I need it, even if it is 2 months." This drug is for short-term treatment because it is addictive. It is recommended for no more than 3 weeks of treatment.

What explanation will the registered nurse (RN) provide to the client who asked why calcium carbonate was prescribed? "This drug will cure you of osteoarthritis" "This drug will help make your bones healthier." "This drug will prevent you from having a bone fracture." "This drug is what your healthcare provider wants you to take."

"This drug will help make your bones healthier."

When alendronate (Fosamax) is prescribed for osteoporosis, the nurse teaches the client to take the drug _________. with food or milk by injection 30 minutes before breakfast at bedtime

30 minutes before breakfast (Take on a empty stomach)

Which drugs are used to treat osteoporosis? Select all that apply. Alendronate Calcium Citrate Bisphosphonates NSAIDS Ibandronate Risedronate Fentanyl

Alendronate, Bisphosphonates, Ibandronate, Risedronate

A nurse is caring for a client who is taking etanercept for rheumatoid arthritis. The nurse should monitor the client for which of the following indications of a serious adverse reaction to the drug? Excessive salivation Increased thirst Blood in the urine Shortness of breath

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

A nurse is caring for a client who is currently taking methotrexate for rheumatoid arthritis. The nurse should identify that which of the following is an adverse effect of this medication? Hypertension Thrombocytopenia Glaucoma Edema

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

Which of the following should the nurse include in client teaching for the Disease-modifying anti rheumatic drug (DMARD), methotrexate? Sit up 30 minutes after taking medication Increase fluids and fibers Use a calendar or some other memory device to remember to take the drug on the same day each week. Limit physical activities

Use a calendar or some other memory device to remember to take the drug on the same day each week.

A nurse is caring for a client who was diagnosed with postmenopausal osteoporosis. Which of the following actions should the nurse take prior to administering calcitonin-salmon to the client for the first time? Check the client's urine for sedimentation. Assess the client's liver function. Use skin testing to check the client for allergies. Evaluate the client's breath sounds.

Use skin testing to check the client for allergies. Calcitonin-salmon is developed using salmon. The nurse should perform skin testing to check for an allergy to salmon or fish protein, and have epinephrine, antihistamines, and resuscitation equipment available.

Which supplement will the registered nurse (RN) instruct the client to take to improve the absorption of calcium carbonate? Select all that apply. Potassium Vitamin D Phosphate Magnesium Vitamin C

Vitamin D magnesium

A primary care provider prescribes calcitonin salmon for a post-menopausal client. Knowing the adverse effects of calcitonin, you instruct the client to increase fluid intake rise slowly from a reclining position. increase calcium and vitamin D intake. rest painful joints after exercise.

increase calcium and vitamin D intake Calcitonin can cause hypocalcemia due to increased excretion of calcium. The client should increase calcium and vitamin D intake and watch for indications of hypocalcemia, such as muscle cramps and numbness in the fingers or toes.

When administering a DMARD subcutaneously, the nurse should: use a 5-mL syringe. inject tissue close to the umbilicus. massage the area to increase blood flow to the muscles. rotate sites to minimize tissue irritation.

rotate sites to minimize tissue irritation.

The registered nurse (RN) identifies what primary reason the healthcare provider orders colchicine for a client? prevent the occurrence of gout prevent the occurrence of kidney stones treat an acute gout attack treat the occurrence of kidney stones

treat an acute gout attack This answer is correct because treating an acute gout attack is the primary reason for prescribing colchicine. Colchicine works by decreasing edema and decreasing the level of uric acid in the body. This drug does not directly relieve pain, but instead reduces uric acid, which will decrease the inflammation.

A client weighs 63 kg. If tocilizumab 4 mg/kg is prescribed, what is the total dosage of tocilizumab for this client?

252 mg Explanation: The dosage for this drug is 4 mg/kg. So every kg a person weighs, you give 4mg of the drug. The client weighs 63 kg, so 63 x 4= 252mg.

A nurse is planning care for a client who has a new prescription for methotrexate. The nurse should plan to monitor the client for which of the following adverse effects? Bone marrow depression Thrombocythemia Double vision Constipation

Bone marrow depression

Define Paget disease. Disorder characterized by porous bone, making weaker bone strength and greater risk of fracture of a bone. Condition where bones grow too large and become weak. Inflammatory changes in connective tissue. Blockage of parasympathetic nervous system.

Condition where bones grow too large and become weak.

A nurse is caring for a client who has a prescription for methotrexate. Which of the following drugs would likely be prescribed in conjunction during the initial treatment for rheumatoid arthritis? Aspirin Salicylates Sulfonylureas Ibuprofen

Ibuprofen NSAID analgesics, such as ibuprofen, are often prescribed along with methotrexate during the initial course of treatment for rheumatoid arthritis.

What should the nurse include in Client Teaching for clients taking alendronate and risedronate? Take with meals Sit up 30 minutes after taking medication Limit fluids intake Do Not abruptly stop taking

Sit up 30 minutes after taking medication One of the adverse reactions for alendronate is esophageal reflux. Clients should sit up for 30 minutes after taking medication to avoid Esophagitis(scarring in the esophagus).

List the types of drugs used to treat musculoskeletal disorders. Select all that apply. Skeletal muscle relaxants Antibacterial Drugs That Disrupt the Bacterial Cell Wall Disease-modifying antirheumatic drugs (DMARDs) Antitubercular Drugs Bone resorption inhibitors—bisphosphonates Uric acid inhibitors

Skeletal muscle relaxants Disease-modifying antirheumatic drugs (DMARDs) Bone resorption inhibitors—bisphosphonates Uric acid inhibitors

When given a uric acid inhibitor, the nurse assesses the client for the most common adverse reactions, which are _________. related to the GI tract urinary retention hypertension related to the nervous system

related to the GI tract

Which is the most common adverse reaction for Calcium Citrate? Constipation Headache Kidney failure Hypertension

Constipation (Calcium= make the bone hard➡️ it make the bowels hard as well. ⬆️Calcium=⬆️Constipation)

A client is about to start therapy with methotrexate for rheumatoid arthritis. Knowing the adverse effects of methotrexate, you advise the client to watch for which of the following? Dysphagia Sore throat Edema Paresthesia

Sore throat Methotrexate may cause bone marrow suppression. The client should report any sign of infection, such as a sore throat or fever.