prepu ch 25 questions
Connie, age 43, is being discharged on methotrexate. Which statement by the patient indicates that she understands how the medication will work and how to take the medication? "I should take the drug twice a day as prescribed." "I will start to see an improvement in my symptoms within the week." "I need to limit my fluid intake to prevent excretion of the drug." "I should take the medication on an empty stomach to promote absorption of the drug."
"I should take the medication on an empty stomach to promote absorption of the drug."
A patient being placed on drug therapy for rheumatoid arthritis (RA) asks the nurse why she will have to take methotrexate as well as naprosyn (Naproxyn). What is the best response by the nurse? "Methotrexate will work only with a nonsteroidal anti-inflammatory drug (NSAID)." "NSAIDs begin the immunosuppression until methotrexate takes over." "NSAIDs reduce the disease activity more than methotrexate." "NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts."
"NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts."
Which is a true statement for the nurse to teach the patient about disease modifying anti-rheumatic drugs (DMARDs)? "These medications suppress the immune system." "These medications cause severe depression." "The medications may or may not help you." "The medications are not very strong."
"These medications suppress the immune system."
What should the nurse teach the patient about gold salts therapy? "This therapy can decrease inflammation." "This therapy is contraindicated in patients with rheumatoid arthritis." "This is a therapy for pain relief that is similar to opioids." "This therapy can cause excessive bleeding."
"This therapy can decrease inflammation."
A patient sees a physician for pain in the joints of fingers with significant swelling. X-rays reveal extensive joint damage from theumatoid arthritis (RA); laboratory results are definitive. Which medication does the nurse anticipate the patient will receive to decrease the extensive joint damage? A glucocorticoid steroid, such as prednisone A disease-modifying antirheumatic drug (DMARD), such as methotrexate A nonsteroidal anti-inflammatory medication, such as Ibuprofen An uricosuric medication, such as Allopurinol
A disease-modifying antirheumatic drug (DMARD), such as methotrexate
The nurse administers methotrexate (Rheumatrex). What will the nurse determine is a therapeutic effect? Decreased itching Decreased blood pressure Absence of joint pain Bradycardia
Absence of joint pain
A patient on methotrexate therapy complains of mouth ulcers. Which treatment does the nurse anticipate the patient will be prescribed? Nystatin oral suspension, swish and swallow Allopurinol 300 mg dissolved in 50 mg of water, swish and spit Ibuprofen 400 mg every 6 hours by mouth Folic acid 1 mg daily by mouth
Allopurinol 300 mg dissolved in 50 mg of water, swish and spit
A patient with rheumatoid arthritis is taking gold salts. What drugs should the nurse teach this patient are contraindicated when taking gold salts? (Select all that apply.) Penicillamine Salicylates Cytotoxic drugs Anti-coagulants Antimalarials
Antimalarials Cytotoxic drugs Penicillamine
The development of gout has four distinct phases. Place in order each phase of the development of gout. Asymptomatic hyperuricemia Intercritical gout Chronic advanced gout Acute gouty arthritis
Asymptomatic hyperuricemia Acute gouty arthritis Intercritical gout Chronic advanced gout
A client with intractable rheumatoid arthritis has been prescribed a gold salt. What medication should the nurse look for on the client's medication administration record? Anakinra Mesalamine Auranofin Celecoxib
Auranofin
Kate, age 32, is being prescribed methotrexate for rheumatoid arthritis. The physician also discussed with Kate the types of birth control available and the effectiveness of each formulation. Why is it essential to discuss contraceptive therapy with Kate? Because the patient has to undergo extensive renal and hepatic function tests, which could harm the fetus Because the fetus' liver and kidneys may not be able to adequately clear the drug Because the fetus may also develop rheumatoid arthritis Because fetal abnormality has been documented in patients undergoing methotrexate drug therapy
Because fetal abnormality has been documented in patients undergoing methotrexate drug therapy
A nurse is caring for a patient with severe rheumatoid arthritis. The physician has ordered an anti-inflammatory medication for the patient. What should the nurse question if ordered by the physician? Antihypertensive agent Oral anticoagulant Oral antidiabetic agent Antibiotic
Oral anticoagulant
The patient on methotrexate therapy should have lab work performed every 4 to 8 weeks. Which test(s) should be closely monitored at this time? (Select all that apply.) Serum albumin Complete blood count Rheumatoid factor Liver profile Serum creatinine
Complete blood count Liver profile Serum albumin Serum creatinine
A client is to receive etanercept. What characteristic of the client may contraindicate the use of this medication? Lack of social support Occasional dysphagia Fear of injections Employment involving heavy machinery
Fear of injections
What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals? Cox 2 inhibitors Gold salts Fenamates Propionic Acids
Gold salts
Matt, age 35, is being treated with methotrexate for osteosarcoma. He has a history of alcohol abuse, drinking 6 to 10 beers per day. Based on Matt's history, which adverse effects is he at a risk for? Hepatic dysfunction Immunosuppression Blood dyscrasias Methotrexate photosensitivity
Hepatic dysfunction
A nurse administers methotrexate (Rheumatrex). What assessment finding is attributable to the effect of this medication? Increased hemoglobin Decreased urination Immunosuppression Increased red blood cell count
Immunosuppression
A patient with rheumatoid arthritis is receiving cyclophosphamide (Cytoxan) for treatment of his disease. When administering an immunosuppressant, the nurse must be alert to which of the following side effects of this medication? Nystagmus Infection Hyperthermia Muscle rigidity
Infection
The patient is having an acute exacerbation of rheumatoid arthritis. What medication does the nurse anticipate giving as "pulse therapy"? Prednisone Cyclosporine Etanercept Remicade
Prednisone
The patient informs the nurse that he has been taking methotrexate for 1 week and it is not working to control the rheumatoid arthritis (RA) symptoms. What should the nurse explain to the patient about the onset of action? Relief of symptoms should occur within 1 week. Relief of symptoms should occur within 2 months. Relief of symptoms should occur within 3 days. Relief of symptoms should occur within 3-6 weeks.
Relief of symptoms should occur within 3-6 weeks.
Marge, a 38-year-old woman, is seen in the physician's office for the first time. She complains of fatigue, decreased range of motion in her hands, pain with activities that require her to use her hands, loss of strength in her hands and arms, and a low-grade fever. What is the most likely diagnosis that would explain Marge's symptoms? Inflammatory osteoarthritis Multiple sclerosis Gouty arthritis Rheumatoid arthritis
Rheumatoid arthritis
Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema? Rheumatoid arthritis (RA) Osteoporosis Systemic lupus erythematosus Polymyositis
Rheumatoid arthritis (RA)
A patient has been diagnosed with rheumatoid arthritis. he patient shows the nurse small nodules on both elbows and hands. What does the nurse understand that these nodules are? Rheumatoid nodules Tophi Lipomas Calcification nodules
Rheumatoid nodules
Disease-modifying antirheumatic drugs (DMARDs) are administered to produce which therapeutic effect? Stop the progression of the disease. Increase the immune response. Increase cerebrospinal fluid secretion. Reverse joint deformity.
Stop the progression of the disease.
The nurse is administering etanercept (Enbrel). Which administration technique would be considered appropriate? The nurse administers the medication topically on the abdomen. The nurse administers the medication subcutaneously weekly. The nurse administers the medication IV. The nurse administers the medication orally with other drugs.
The nurse administers the medication subcutaneously weekly.
The nurse is obtaining nutritional information prior to the patient beginning methotrexate therapy for psoriatic arthritis. What information obtained by the nurse would be of greatest concern? The patient eats three fruits per day. The patient eats two eggs daily for breakfast. The patient drinks two glasses of wine once every 2 weeks. The patient drinks six cups of coffee daily.
The patient drinks six cups of coffee daily.
Which patient should not receive their 8 a.m. medication as scheduled? The patient receiving glucocorticoid therapy who has decreased urination The patient receiving cyclosporine (Neural) who has a cold The patient receiving cyclophosphamide (Cytoxan) with neutropenia The patient receiving etanercept (Enbrel) who has increased WBCs
The patient receiving cyclophosphamide (Cytoxan) with neutropenia
The nurse is administering morning medications. Which patient should not receive the medication as ordered at 9 a.m.? The patient receiving cyclosporine (Neoral) who has muscle weakness The patient who is receiving cyclophosphamide (Cytoxan) who has elevated BUN and creatinine The patient receiving etanercept (Enbrel) who has a headache The patient who is receiving glucocorticoids who has a headache
The patient who is receiving cyclophosphamide (Cytoxan) who has elevated BUN and creatinine
Which patient is most at risk for adverse effects from disease modifying anti-rheumatic drugs (DMARDs)? The patient with hepatic insufficiency The patient with joint pain The patient with chronic constipation The patient with supraventricular tachycardia
The patient with hepatic insufficiency
Danny has been diagnosed with rheumatoid arthritis and begins methotrexate drug therapy. Why should the nurse document the severity of joint inflammation and any restriction in the range of motion when assessing Danny's health status? To identify the signs of hepatic or renal insufficiency To maximize the therapeutic effects of methotrexate therapy To later compare and assess the efficacy of methotrexate therapy To minimize the adverse effects of methotrexate therapy
To later compare and assess the efficacy of methotrexate therapy
Danny has been diagnosed with rheumatoid arthritis and begins methotrexate drug therapy. Why should the nurse document the severity of joint inflammation and any restriction in the range of motion when assessing Danny's health status? To maximize the therapeutic effects of methotrexate therapy To later compare and assess the efficacy of methotrexate therapy To minimize the adverse effects of methotrexate therapy To identify the signs of hepatic or renal insufficiency
To later compare and assess the efficacy of methotrexate therapy
What would the nurse identify as the primary purpose of administering penicillamine (Cuprimine)? For use as a immunosuppressant to prevent organ transplant rejection To treat acute gouty arthritis To treat severe, erosive rheumatoid arthritis To treat early, mild, and nonerosive rheumatoid arthritis
To treat early, mild, and nonerosive rheumatoid arthritis
What is chrysotherapy? Treatment with anti-malerials Treatment with salicylates Treatment with DMARDs Treatment with gold salts
Treatment with gold salts
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction. False True
True
A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? Subcutaneous Intramuscular Intravenous Oral
oral