ATI Pharmacology Made Easy 4.0: The Musculoskeletal System

A nurse is teaching about self-administering methotrexate to a client who has rheumatoid arthritis. Which of the following statements should the nurse make?

"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. 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 caring for a client who has a new prescription for etanercept. Which of the following actions should the nurse take?

Administer a TB 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 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.)

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.

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. 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.

Which of the following is a therapeutic action of raloxifene?

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 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?

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

joint pain alendronate can cause joint and muscle pain. Clients can treat with analgesics. Other adverse effects include nausea, visual disturbances, and esophagitis.

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?

shortness of breath This medication can cause heart failure, manifesting as shortness of breath, cough, elevated blood pressure and heart rate, and the 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?

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 therapy for rheumatoid 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 is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Clients taking the drug 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 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?

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

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 is correct. Alendronate can cause osteonecrosis of the jaw, and clients who develop it should report it to the provider. Blurred vision is correct. Alendronate can cause ocular inflammation. The client should report any eye pain or blurred vision to the provider. 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.)

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. 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.

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?

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

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 everyday 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.

Alendronate is contraindicated for administration to clients who have which of the following conditions?

inability to sit upright Alendronate is contraindicated for administration to a client who cannot sit upright or stand for 30 min. Clients should remain upright for 30 min after taking to prevent esophagitis.

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 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 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?

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 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?

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 has a prescription for methotrexate. Which of the following drugs would likely be prescribed in conjunction during the initial treatment for rheumatoid arthritis?

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.

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 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.)

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. 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?

infection Etanercept increases the risk of developing a serious infection. Providers should not prescribe for clients who have an exsisting infection and should use cautiously in clients who have diabetes mellitus because the disease itself already causes an increased risk for infection.

A nurse is teaching a client who has a new prescription for etanercept. Which of the following statements should the nurse make?

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.