ATI Pharm Made Easy 4.0 The Musculoskeletal System

A nurse is teaching about self-administering methotrexate to a client who has RA. Which of the following statements should the nurse make? "Use a nonsteroidal anti-inflammatory drug to reduce toxicity." "You should have your liver function checked every 6 months." "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 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 pt about adverse effects of etanercept. Which of the following statements by the pt 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 pt about methotrexate therapy for rheumatoid arthritis. Which of the following statements indicates an 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 pt 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 teaching a pt about methotrexate therapy for RA. Which of the following information should the nurse include? (select all...) -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 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...) -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 w. the calcium tablet -chew calcium tablets before swallowing them -take the drugs 1 hr apart -divide the daily dosage of calcium into three 500-mg doses

A nurse is teaching a pt about raloxifene. Which of the following info should the nurse include? (select all...) -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 activity, such as walking. -Use a contraceptive if there is any risk of pregnancy. -Increase intake of calcium and vitamin D.

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

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...) -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 (the client should spray calcitonin-salmon once in one nostril each day. alternate nostrils)

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 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.

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

A nurse is caring for a pt 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 fevers are common while taking this medication. -Determine if the client has chronic hypertension. -Mix the medication with methotrexate prior to administration.

Administer a tuberculin skin test prior to starting 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 pt about raloxifene therapy to prevent osteoporosis. The nurse should instruct the pt to monitor for which of the following indications of an adverse reaction? -Loss of hair -Numbness of the fingertips -Calf pain -Blisters on mucous membranes

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

Decreases activity of osteoclasts

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 RA? 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. 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? 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? -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.

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 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 (& thrombocytopenia, blurred vision, dysarthria, transient blindness, diarrhea)

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