Musculoskeletal system test 4.0

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 action? a. decreases activity of osteoclasts b. increases calcium excretion c. promotes intestinal absorption of calcium and phosphorus d. reduces action of osteoblasts

Decreases activity of osteoclasts OsteoBlasts are cells that cause bone resorption or bone loss. Alendronate reduces the activity of osteoclasts, reducing bone loss and increasing bone mass. Alendronate does not reduce the action of osteoBlasts, which are cells that form new bone. Alendronate can interact with the osteoblasts to reduce the number of osteoclasts.

What administration considerations apply to raloxifene? (prevent and treat osteoporosis in postmenopausal women and those on glucocorticoids)

Give orally daily. May give with or without food.

A nurse is teaching a client who is taking etanercept for rheumatoid arthritis. The nurse should instruct the client to monitor for which of the following indications of an adverse reaction to this drug? Skin rash Tinnitus Diarrhea Dysphagia

Skin rash 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 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.

What administration considerations apply to calcium citrate and calcium carbonate?

Can be given orally or intravenously. Give calcium supplements 1 hr before or 1 to 2 hr after glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics. Give calcium-based antacids 1 hr after meals and at bedtime. Chewable tablets should be chewed before swallowing. Give clients glass of water after swallowing.

Alendronate is contraindicated for administration to clients who have which of the following conditions? Heart failure Fish protein allergy Inability to sit upright Tuberculosis

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

jont pain

What administration considerations apply to etanercept? (immunosuppressant for RA)

Administer by subcutaneous injection. Give once weekly Monitor site for redness, pain, and swelling after administration.

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." "Take it with food to reduce gastric irritation." "Drink 2 to 3 liters of water per day to promote the drug's excretion. " "Take it in the morning to prevent insomnia."

"Drink 2 to 3 liters of water per day to promote the drug's excretion. " Methotrexate can cause kidney damage. Adequate hydration bicarbonate tablets to increase urine alkalinity and reduce the drug precipitation that can lead to kidney damage optimizes drug excretion and helps prevent kidney damage. Clients can also take sodium

A nurse is teaching a client about adverse effects 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.". "I may lose part or all of my hair." "I may wake up with a very dry mouth." "I will leave the needle cap off during the time the medication comes to room temperature."

"I will need to get my blood drawn periodically while on this medication." 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 about methotrexate therapy for rheumatoid arthritis. Which of the following statements by the client indicates understanding of the teaching? "I will take a birth control pill every day." "Methotrexate decreases my chances of developing an infection." "I take methotrexate every day with breakfast." "I will aim to drink five 8-ounce glasses of water per day."

"I will take a birth control pill every day." 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 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 MMR 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.

A nurse is caring for a client who has a new prescription for etanercept. Which of the following actions should the nurse take? Administer a tuberculin skin test prior to starting the medication. Teach the client that tevers are common while taking this medication. Determine if the cient has chronic hypertension. Mix the medication with methotrexate prior to administration

Administer a tuberculin skin test prior to starting the medication. 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 is teaching a client about methotrexate therapy for rheumatold arthritis. Which of the following Information should the nurse Include? (Select all that apply.) Avoid being near people who are sick with a communicable illness. Periodic laboratory tests are required. The drug's effects are immediate. Report bruising or petechiae. Avoid drinking alcohol.

Avoid being near people who are sick with a communicable illness. Periodic laboratory tests are required. Report bruising or petechiae. Avoid drinking alcohol.

A nurse is teaching a client about methotrexate. The nurse should inform the client to monitor for which of the following as an adverse effect of this drug? Muscle pain Peripheral edema Black, tarry stools Redness in the calf

Black, tarry stools 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.

A nurse is planning care for a client who has anew rx for methotrexate. The nurse should plan to monitor the client for which of the following adverse effects? a. bone marrow depression b. thrombocythemia c. double vision d. constipation

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.

nurse is teaching a client about raloxifene therapy to prevent osteoporosis. The nurse should instruct the client to monitor for which of the following indications of an adverse reaction to this drug? Loss of hair Numbness of the fingertips Calf pain Blisters on mucous membranes

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

A nurse is teaching a client who has a prescription for prednisone and takes 1,500 mg/day of calcium carbonate to reduce the risk of osteoporosis. Which of the following information should the nurse include? (Select all that apply.) Take the calcium tablets with food. Drink 240 mL (8 oz) of water with the calcium tablets. Chew calcium tablets before swallowing them. Take the drugs 1 hr apart. Divide the daily dosage of calcium into three 500-mg doses.

Drink 240 mL (8 oz) of water with the calcium tablets. Chew calcium tablets before swallowing them. Take the drugs 1 hr apart. Divide the daily dosage of calcium into three 500-mg doses. -- Take the calcium tablets with food is incorrect. It is not necessary to take calcium carbonate tablets with food when using them for calcium supplementation.Drink 240 mL (8 oz) of water with the calcium tablets is correct. Clients should drink 240 mL (8 oz) of water after taking the calcium carbonate to ensure complete passage of the drug and to maintain hydration.Chew calcium tablets before swallowing them is correct. Clients should chew the tablets before swallowing them to increase bioavailability. Clients should not swallow chewable tablets whole.Take the drugs 1 hr apart is correct. Glucocorticoids, such as prednisone, reduce the absorption of calcium carbonate. Clients should allow 1 hr in between the two to ensure optimal absorption.Divide the daily dosage of calcium into three 500-mg doses is correct. Clients should not take more than 600 mg of calcium carbonate at one time. Clients should divide the daily dosage into three doses to increase absorption of the calcium carbonate.

What administration considerations apply to alendronate? bone loss (osteoporosis)

Give drug 30 minutes before breakfast with a full glass of water. Have client sit or stand for 30 minutes after administration. Avoid giving calcium-containing drugs/supplements within 30 minutes of administration.

What administration considerations apply to Methotrexate ? (chemotherapy agent and immune-system suppressant for RA)

Give methotrexate once a week via route prescribed (oral, subcutaneous, or intramuscular). Folic acid supplement may be prescribed to decrease risk of toxicity

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 weeks for DMARDS to reach therapeutic levels and begin client more comfortable while waiting for methotrexate's therapeutic effects. relieving joint inflammation and pain, so during the initial course of treatment for rheumatoid arthritis. It can take ibuprofen can be administered concurrently to help make the

A nurse is caring for a client who has a prescription for etanercept. The nurse should identify that etanercept treats rheumatoid arthritis by which of the following actions? Inactivation of tumor necrosis factor Inhibition of osteoclast activity Decreasing the reuptake of serotonin Interference with the production of lymphocytes

Inactivation of tumor necrosis factor 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 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. -- Perform a breast self-examination twice per month is incorrect. Completing a breast self-examination once per month is sufficient. Additionally, raloxifene can help reduce the risk of breast cancer.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.Take the drug on an empty stomach is incorrect. Clients may take raloxifene with or without food.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 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.

What administration considerations apply to calcitonin-salmon? (treats postmenopausal osteoporosis)

Intranasal spray: - Hold nasal pump upright. - If using pump for the first time, prime pump according to manufacturer's instructions. - Spray once in nostril opposite of previous instillation. Intramuscular/Subcutaneous: - Rotate injection sites. - Subcutaneous is preferred route - Administer IM if dose more than 2ml - Protect from light. - Keep calcitonin salmon refrigerated.

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? Venous thromboemboli Ventricular dysrhythmias Breast cancer Joint pain

Joint pain 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.

Which of the following is a therapeutic action of raloxifene? Blocks the effects of estrogen on endometrial tissue Mimics the effects of estrogen on bone tissue Stimulates secretion of parathyroid hormone Stimulates menstruation

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

A nurse is teaching a client about calcitonin-salmon intranasal spray to treat osteoporosis. Which of the following info should the nurse include? (Select all...) Report rash or itching. Deliver two sprays to each nostril. Prime the pump before the first dose. Report nasal irritation. Hold the pump horizontally.

Report rash or itching. Prime the pump before the first dose. Report nasal irritation. -- Report rash or itching is correct. The nurse should tell the client to stop using the drug and seek medical attention if any swelling or rash develops.Deliver two sprays to each nostril is incorrect. The client should spray calcitonin-salmon once in one nostril each day. The client should use alternate nostrils to avoid irritation.Prime the pump before the first dose is correct. The client should prime the pump before using the spray for the first time to ensure proper dosage.Report nasal irritation is correct. The client should report any nasal irritation or bleeding. The client might require parenteral administration if there is severe nasal irritation.Hold the pump horizontally is incorrect. The client should hold the nasal pump upright to deliver the spray intranasally.

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.

A nurse is teaching a client who has a prescription for calcitonin-salmon about manifestations of hypercalcemia. Which of the following manifestations should the nurse include in the teaching? Muscle twitching Fever Nervousness Vomiting

Vomiting The nurse should teach the client that rebound hypercalcemia can occur when taking this drug. Manifestations of hypercalcemia include nausea, vomiting, flank pain, lethargy, and deep bone pain.

A nurse should instruct a client who is taking alendronate to monitor which of the following effects? (select all...) a. jaw pain b. drowsiness c. blurred vision d. tinnitus e. muscle pain

jaw pain blurred vision muscle pain --- Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, and clients who develop it should report it to the provider.Drowsiness is incorrect. Alendronate is unlikely to cause drowsiness. It can cause a headache.Blurred vision is correct. Alendronate can cause ocular inflammation. The client should report any eye pain or blurred vision to the provider.Tinnitus is incorrect. Alendronate is unlikely to cause tinnitus. Salicylate toxicity can cause tinnitus.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 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 adverse reaction to the drug? a. excessive salivation b. increased thirst c. blood in the urine d. 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.