Pharmacology Made Easy 5.0 The Musculoskeletal System Test

A nurse is caring for a client who has osteoporosis. Provider Prescriptions 6 months ago: Raloxifene 60 mg PO once daily Today: Platelet count INR Laboratory Results 6 months ago: Platelet count 300,000/mm3 (150,000 to 400,000/mm3) INR 1.1 (0.8 to 1.1) Calcium 8 mg/dL (9 to 10.5 mg/dL) 1 week ago: Calcium 8.5 mg/dL (9 to 10.5 mg/dL) Today: Platelet count 600,000/mm3 (150,000 to 400,000/mm3) INR 0.8 (0.8 to 1.1) Nurses' Notes Today: Client here today for follow-up appointment and to discuss recent calcium level. Client reports hot flashes and calf pain in the right lower extremity pain. Left pedal pulse +2. Left foot is warm to touch. Right pedal pulse +1. Right foot is cool to touch. Client reports decreased appetite and occasional nausea.

The nurse is evaluating the client's response to therapy. Click to highlight the findings that indicate an adverse effect of the medication the client was prescribed for osteoporosis. To deselect a finding, click on the finding again. Nurses' Notes Today: Client here today for follow-up appointment and to discuss recent calcium level. Client reports hot flashes and calf pain in the right lower extremity pain. Left pedal pulse +2. Left foot is warm to touch. Right pedal pulse +1. Right foot is cool to touch. Client reports decreased appetite and occasional nausea. Laboratory Results 6 months ago: Platelet count 300,000/mm3 (150,000 to 400,000/mm3) INR 1.1 (0.8 to 1.1) Calcium 8 mg/dL (9 to 10.5 mg/dL) 1 week ago: Calcium 8.5 mg/dL (9 to 10.5 mg/dL) Today: Platelet count 600,000/mm3 (150,000 to 400,000/mm3) INR 0.8 (0.8 to 1.1) When evaluating the client's response to medication therapy, the nurse should identify that calf pain, a temperature difference of the lower extremities, a diminished pedal pulse on the right lower extremity, and an elevated platelet count are findings that indicate a deep vein thrombosis.

A nurse is caring for a client who has osteoporosis. Nurses' Notes 2 months ago: Client is a 58-year-old female who is recently diagnosed with osteoporosis. Reports a history of non-insulin dependent diabetes mellitus, managed with diet and exercise. Walks 3 to 4 miles 5 to 6 days per week. Today: Client reports burning with urination and urinary frequency. Client reports occasional fatigue and occasional back pain that is relieved with acetaminophen. Reports back pain level today is 4 on a scale from 1 to 10. Has recently noticed numbness in hands. Client reports decrease in walking because of work obligations; currently walking 1 day per week. Provider Prescriptions 2 months ago: Denosumab 60 mg subcutaneously every 6 months Medication Administration Record 2 months ago: Denosumab 60 mg subcutaneously in abdomen Complete the following sentence by using the lists of options.

The nurse should first address the client's calcium level followed by the client's urinalysis. While prioritizing hypotheses, the nurse should determine that the priority for the nurse to address is the client's calcium level followed by the client's urinalysis results. The most serious adverse effects from denosumab include hypocalcemia and infections. The client has a calcium level below the expected range and is reporting numbness. The client has findings that indicate a urinary tract infection.

A nurse is caring for a client who has rheumatoid arthritis. Nurses' Notes 1 week ago: Client reports taking meloxicam for RA for several years and discontinued it a few months ago when it was no longer effective. Currently taking acetaminophen 650 mg as needed for arthritis pain. The provider discussed with the client the plan to prescribe methotrexate after laboratory results are complete. Today: Client in clinic to discuss laboratory results and treatment plan for RA. Vital Signs 1 week ago: Temperature 36.6°​ C (97.9° F) Heart rate 80/min Respiratory rate 18/min Blood pressure 116/78 mm Hg Oxygen saturation 100% on room air Today: Temperature 36.8° C (98.2° F) Heart rate 82/min Respiratory rate 20/min Blood pressure 110/68 mm Hg Oxygen saturation 100% on room air

Which findings should the nurse determine are contraindications to the client taking the newly prescribed medication? Select all that apply. a. CBC b. Glucose c. Liver enzymes d. Temperature e. Use of NSAID a. CBC c. Liver enzymes When analyzing cues, the nurse should determine that the client's liver enzymes and CBC indicate contraindications for the use of methotrexate. The adverse effect of hepatotoxicity increases the risk for liver failure, and the adverse effect of bone marrow suppression could worsen the client's leukopenia and thrombocytopenia.

A nurse is teaching a client about the adverse effects of etanercept. Which of the following statements by the client indicates understanding of the teaching? a. "I will need to get my blood drawn periodically while on this medication." b. "I may lose part or all of my hair." c. "I may wake up with a very dry mouth." d. "I will leave the needle cap off during the time the medication comes to room temperature."

a. "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? a. "I will take my prescribed birth control pill every day." b. "Methotrexate decreases my chances of developing an infection." c. "I take methotrexate every day with breakfast." d. "I will aim to drink five 8-ounce glasses of water per day."

a. "I will take my prescribed 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 caring for a client who has a new prescription for etanercept. Which of the following actions should the nurse take? a. Administer a tuberculin skin test prior to starting the medication. b. Teach the client that fevers are common while taking this medication. c. Determine if the client has chronic hypertension. d. Mix the medication with methotrexate prior to administration.

a. 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 rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? (Select all that apply.) a. Avoid being near people who are sick with a communicable illness. b. Periodic laboratory tests are required. c. The effects of the medication are immediate. d. Report bruising or petechiae. e. Avoid drinking alcohol.

a. Avoid being near people who are sick with a communicable illness. b. Periodic laboratory tests are required. d. Report bruising or petechiae. e. Avoid drinking alcohol. 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 medication 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. The effects of the medication are immediate is incorrect. It can take 3 to 6 weeks to achieve the medication's therapeutic effects. 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 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? a. Bone marrow depression b. Thrombocythemia c. Double vision d. Constipation

a. 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 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? a. Inactivation of tumor necrosis factor b. Inhibition of osteoclast activity c. Decreasing the reuptake of serotonin d. Interference with the production of lymphocytes

a. 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 should instruct a client who is taking alendronate to monitor for which of the following adverse effects? (Select all that apply.) a. Jaw pain b. Drowsiness c. Blurred vision d. Tinnitus e. Muscle pain

a. Jaw pain c. Blurred vision e. 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 teaching a client about calcitonin-salmon intranasal spray to treat osteoporosis. Which of the following information should the nurse include? (Select all that apply.) a. Report rash or itching b. Deliver 2 sprays to each nostril c. Prime the pump before the first dose d. Report nasal irritation e. Hold the pump horizontally

a. Report rash or itching c. Prime the pump before the first dose d. Report nasal irritation Report rash or itching is correct. The nurse should tell the client to stop using the medication and seek medical attention if any swelling or rash develops. Deliver 2 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 teaching a client who has a new prescription for etanercept. Which of the following statements should the nurse include in the teaching? a. "You will inject this medication once a week in your thigh muscle." b. "You should immediately report signs of infection to your provider." c. "You will need to avoid taking ibuprofen while on this medication." d. "You will need to receive an MMR vaccine 1 month after starting this medication."

b. "You should immediately report signs of infection to your provider." The nurse should teach the client that they are susceptible to infections when taking disease-modifying antirheumatic drug (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 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.) a. Take the calcium tablets with food. b. Drink 240 mL (8 oz) of water with the calcium tablets. c. Chew calcium tablets before swallowing them. d. Take the medications 1 hr apart. e. Divide the daily dosage of calcium into three 500-mg doses.

b. Drink 240 mL (8 oz) of water with the calcium tablets. c. Chew calcium tablets before swallowing them. d. Take the medications 1 hr apart. e. 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 medication 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 medications 1 hr apart is correct. Glucocorticoids, such as prednisone, reduce the absorption of calcium carbonate. Clients should allow 1 hr in between the 2 medications 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 3 doses to increase absorption of the calcium carbonate.

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? a. Kidney toxicity b. Infection c. Gout d. Deep-vein thrombosis

b. 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.

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

b. 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 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 medication? a. Tinnitus b. Skin rash c. Diarrhea d. Dysphagia

b. 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? a. Hypertension b. Thrombocytopenia c. Glaucoma d. Edema

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

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? a. Check the client's urine for sedimentation. b. Assess the client's liver function. c. Evaluate the client's breath sounds. d. Use skin testing to check the client for allergies.

d. 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 about self-administering methotrexate to a client who has rheumatoid arthritis. Which of the following statements should the nurse make? a. "Use a nonsteroidal anti-inflammatory drug (NSAID) to reduce toxicity." b. "You should have your liver function checked every 6 months." c. "Drink a minimum of 2 liters of water per day to promote the excretion of the medication." d. "Take it in the morning to prevent insomnia."

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

A 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 medication? a. Loss of hair b. Numbness of the fingertips c. Calf pain d. Blisters on mucous membranes

c. Calf pain 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? a. Promotes intestinal absorption of calcium and phosphorus b. Increases calcium excretion c. Decreases activity of osteoclasts d. Reduces action of osteoblasts

c. 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.

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

c. 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 medication and sit upright or stand for at least 30 min to prevent esophagitis.

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

d. Ibuprofen 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 disease-modifying antirheumatic drugs (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.

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

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

A nurse is teaching a client who has a prescription for calcium citrate about manifestations of hypercalcemia. Which of the following manifestations should the nurse include in the teaching? a. Muscle twitching b. Laryngospasm c. Paresthesia d. Vomiting

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