Ch. 48 Drugs for Bones and Joint

Which of the following teaching points will the nurse provide to a client with a new prescription for alendronate (Fosamax)? 1. Take the medication with a full glass of water 30 minutes before breakfast. 2. Take the medication with a small snack or meal containing dairy. 3. Take the medication immediately before bed. 4. Take the medication with a calcium supplement

Answer: 1. Take the medication with a full glass of water 30 minutes before breakfast. Rationale: Alendronate (Fosamax) should be taken on an empty stomach with a full glass of water and the client should remain upright for a minimum of 30 minutes to prevent esophageal irritation . Option s 2, 3, and 4 are incorrect. The drug should not be taken with food and should be taken early in the day.

A 62-year -old female has received a prescription for alendronate (Fosamax) for treatment of osteoporosis. The nurse would be concerned about this order if the client reported which condition? (Select all that apply.) 1. She enjoys milk, yogurt, and other dairy products and tries to consume some with each meal. 2. She is unable to sit upright for prolonged periods because of severe back pain. 3. She is lactose intolerant and rarely consumes dairy products. 4. She has had trouble swallowing and has been told she has "problems with her esophagus." 5. She has a cup of green tea every night before bed

Answer: 2, 3, 4 2. She is unable to sit upright for prolonged periods because of severe back pain. 3. She is lactose intolerant and rarely consumes dairy products. 4. She has had trouble swallowing and has been told she has "problems with her esophagus." Rational e: Bisphosphonates such as alendronate require the client to take the drug on an empty stomach and remain upright for 30 minutes to 1 hour. Adequate serum calcium levels should be confirmed before starting bisphosphonates and adequate calcium and vitamin D intake should be encouraged while on drug therapy. Any narrowing of the esophagus may place the patient at risk of increased adverse esophageal effects from the drug. Options 1 and 5 are incorrct. Adequate calcium intake is advised while on bisphosphonates to maintain normal serum calcium levels. The use of green tea is not a contraindication to the use of biphosphanates.

The nurse is explaining to a student nurse the physiological principle for how colchicine (Colcrys) achieves its effect. What response will the nurse give to the student? 1. It decreases the deposits of uric acid inthe joint spaces. 2. It reduces the pain associated with joint inflammation by uric acid crystals. 3. It increases renal excretion of uric acid. 4. It prevents the formation of uric acid in the liver.

Answer: 2. It reduces the pain associated with joint inflammation by uric acid crystals. Rationale: Colchicine (Colcrys) decreases inflammation caused by uric acid crystals and thus reduces pain. Once a main stay of gout therapy, it has been replaced by NSAIDs for treatment of inflammation and pain and is reserved for clients who have not responded well to NSAIDs or who cannot tolerate them Options 1, 3, and 4 are incorrect. Colchicine does not decrease the deposits of uric acid crystals, increase renal excretion, or reduce production of uric acid.

A client has been taking hydroxychloroquine (Piaquenil) for rheumatoid arthritis. Which of the following symptoms may alert the nurse to a possible toxic effect? 1. Cardiac dysrhythmias 2. Joint stiffness or effusions 3. Blurred vision or diminished ability to read 4. Decreased muscle strength

Answer: 3. Blurred vision or diminished ability to read Rationale: Hydroxychloroquinel (Plaquenil) may cause visual disturbances such as blurred vision, photophobia, diminished ability to read. Irreversible retinal changes may occur and any change in vision or other symptoms should be immediately reported. Options 1, 2, and 4 are incorrect. Hydroxychloroquine is not associated with cardiac dysrhythmias or decreased muscle strength. Decreased muscle strength and joint stiffness or effusions may be associated with rheumatoid arthritis.

Which assessment findings in a client who is receiving calcitriol (Calcijex, Rocaltrol) should the nurse immediately report to the health care provider? 1. Muscle aches, fever, dry mouth 2. Tremor, abdominal cramping, hyperactive bowel sounds. 3. Bone pain, lethargy, anorexia 4. Muscle twitching, numbness and tingling of the extremities

Answer: 3. Bone pain, lethargy, anorexia Rationale: Toxicity from calcitriol (Calcijex, Rocaltrol) includes symptoms of hypercalcemia and bone pain, anorexia, nausea and vomiting, increased urination , hallucinations, and dysrhythmia s. Options 1 , 2, and 4 are incorrect. Muscle aches, fever, and dry mouth are not related to calcitriol toxicity and other causes, including infection , should be investigated . Tremor, abdominal cramping, hyperactive bowel sounds, muscle twitching, numbness, and tingling of the extremities are signs of hypocalcemia . Calcitriol may cause symptoms of hypercalcemia .

The client who is receiving allopurinol (Lopurin) for treatment of gout asks why he should avoid consumption of alcohol. The nurse's response is based on the knowledge that the use of alcohol along with allopurinol may result in which of the following? 1. It significantly increases the drug levels of allopurinol. 2. It interferes with the absorption of antigout medications 3. It raises uric acid levels. 4. It causes the urine to become more alkaline

Answer: 3. It raises uric acid levels. Rationale: Gout is a metabolic disorder characterized by the accumulation of uric acid in the bloodstream or joint cavities. Alcohol increases uric acid levels. Options 1, 2, and 4 are incorrect. Alcohol does not cause a significant increase in drug levels of allopurinol. Alcohol does not affect the absorption of antigout medications. Alcohol increases urine acidity.

The client receiving allopurinol (Lopurin) for treatment of gout asks why he should avoid consumption of _____________. a. Alcohol b. Carbohydrates c. Fat intake d. Caffeine

Answer: Alcohol Rationale: Gout is a metabolic disorder characterized by the accumulation of uric acid in the blood stream or joint cavities. Alcohol increases uric acid levels.

A client admitted with a diagnosis of gout complains of red, swollen, and inflamed tissues of the big toes, heels, and ankles. The nurse recognizes that this type of gout is most likely classified as: a. Acute gouty arthritis. b. Primary gout. c. Secondary gout. d. Tertiary gout.

Answer: a. Acute gouty arthritis. Rationale: Acute gouty arthritis occurs when needle-shaped uric acid crystals accumulate in the joints of the toes, heels, ankles, wrists, fingers, knees, and elbows. The joints become red, swollen, and inflamed.

The nurse completing a physical exam on a child diagnosed with osteomalacia would expect to find: a. Bowlegs and a pigeon breast. b. Deformities of the fingers and toes. c. Shortness of breath. d. The use of crutches for walking

Answer: a. Bowlegs and a pigeon breast. Rationale: Osteomalacia, referred to as rickets in children, is a disorder characterized by softening of bones without alteration of basic bone structure. Classic signs of rickets in children include bowlegs and a pigeon breast.

A nurse is caring for a client who is prescribed adalimumab (Humira) for treatment of rheumatoid arthritis. For which adverse drug effect should the nurse monitor the client? a. Opportunistic infections b. Hepatotoxicity c. Tumor lysis syndrome d. Ulcerative stomatitis

Answer: a. Opportunistic infections Rationale: A client taking biologic therapy, such as adalimumab, for treatment of RA should be monitored for opportunistic infections, including tuberculosis (TB), sepsis, hepatitis B reactivation, and invasive fungal infections. Hepatotoxicity can occur with use of the biologics leflunomide and infliximab. Tumor lysis syndrome can occur with rituximab. Ulcerative stomatitis can occur with methotrexate.

A client asks the nurse about the advantage of using raloxifene (Evista) for osteoporosis prevention. What is the nurse's most appropriate response? a. The drug can decrease the risk for breast cancer. b. The drug increases development of bone resorption. c. The drug increases the absorption of calcium. d. The drug prevents risk of death from stroke.

Answer: a. The drug can decrease the risk for breast cancer. Rationale: Raloxifene is primarily used for the prevention of osteoporosis in postmenopausal women. However, in 2007, the drug was approved for invasive breast cancer prophylaxis in postmenopausal women at high risk for breast cancer. It decreases bone resorption and increases bone mass and density by acting through the estrogen receptor. Raloxifene increases the risk of venous thromboembolism and death from strokes,

The nurse explains to a client that an advantage of using tamoxifen (Nolvadex) instead of estrogen replacement therapy (ERT) for increasing bone density is that: a. The risk of uterine cancer is reduced. b. There is increased development of bone density. c. There is increased absorption of calcium. d. Vaginal bleeding does not occur.

Answer: a. The risk of uterine cancer is reduced. Rationale: Tamoxifen (Nolvadex) provides the benefit of increasing bone density without the risk of uterine cancer. It mimics the effect of estrogen, reducing the risk of bone fracture. The incidence of blood clots is less than with other drugs

Which medication should the nurse anticipate administering to a client with symptoms of moderate to severe pain from osteoarthritis (OA)? a. Tramadol (Ultram) b. Aspirin (Ecotrin) c. Acetaminophen (Tylenol) d. Ibuprofen (Motrin)

Answer: a. Tramadol (Ultram) Rationale: Tramadol (Ultram) is a non-NSAID option for the treatment of moderate to severe pain. Aspirin is no longer recommended, because the high doses needed to produce pain relief in patients with OA may cause GI bleeding. The initial treatment of ©2017 by Pearson Education, Inc.Adams/Holland/Urban, Pharmacology for Nurses: A Pathophysiologic Approach, 5th Edition choice for mild to moderate pain is acetaminophen because it is inexpensive and relatively safe. For patients whose pain is unrelieved by acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen and ibuprofen-like drugs, are usually given.

Sodium hyaluronate (Hyalgan) is prescribed for a client with osteoarthritis. Which is the most appropriate nursing action for drug administration? a. Intramuscular injection in the thigh b. Direct injection into the joint c. Peripheral intravenous drip d. Subcutaneous injection in the abdomen

Answer: b. Direct injection into the joint Rationale: Hyaluronate is administered by injection directly into the knee joint. The drug replaces or supplements the body's natural hyaluronic acid that deteriorated because of the inflammation of OA. Treatment consists of one injection per week for 3-5 weeks

An explanation of the disease process of osteoporosis is included in the discharge teaching for a client. The nurse explains that the most common risk factor for this disorder is: a. Alcohol consumption. b. Onset of menopause. c. Smoking. d. Limited exercise.

Answer: b. Onset of menopause. Rationale: The most common risk factor associated with the development of osteoporosis is the onset of menopause. When women reach menopause, estrogen levels decline in the bloodstream. When estrogen levels are low, bones become weak and fragile.

Which instruction about proper administration of oral calcium supplements should the nurse provide the client? a. The medication should be taken on an empty stomach. b. The medication should not be taken with caffeinated drinks. c. The medication can be taken with foods high in oxalic acid. d. The medication should be taken with a full glass of water.

Answer: b. The medication should not be taken with caffeinated drinks. Rationale: Alcohol, caffeine, and carbonated beverages affect the absorption of calcium, and therefore should not be taken with the medication. Oral calcium supplements should be taken with meals or within 1 hour following meals. Oxalic acid in spinach, rhubarb, Swiss chard, and beets can suppress calcium absorption.

The nurse should monitor a client taking excess calcium supplements for which adverse effect? a. Convulsions b. Osteomalacia c. Cardiac dysrhythmias d. Muscle spasm

Answer: c. Cardiac dysrhythmias Rationale: Calcium ions influence the excitability of all neurons. Whenever calcium concentrations are too high, sodium permeability decreases across cell membranes. This is a dangerous state because nerve conduction depends on the proper influx of sodium into cells.

The client's calcium level is reported as 5.6 mg/dL. For what should the nurse assess in the client? a. Headache b. Anorexia c. Muscle spasms d. Drowsiness

Answer: c. Muscle spasms Rationale: Normal serum calcium level is 8.5-11.5 mg/dL. Signs of hypocalcemia include seizures, muscle spasms, facial twitching, and paresthesias.

A client asks the nurse what the action of alendronate (Fosamax) is in treating osteoporosis. Which is the nurse's best response? a. The drug increases bone density. b. The drug increases calcium absorption. c. The drug inhibits bone resorption. d. The drug inhibits calcium production.

Answer: c. The drug inhibits bone resorption. Rationale: Alendronate (Fosamax) is classified as a bisphosphonate drug and acts by lowering ALP, the enzyme associated with bone turnover. These drugs strengthen bones with continued use.

A nurse is caring for a client experiencing exacerbation of acute gout of the wrist. Which medication should the nurse anticipate administering to the client? a. Allopurinol b. Colchicine c. Ibuprofen d. Corticosteroids

Answer: d. Corticosteroids Rationale: Corticosteroids may be used to treat exacerbations of acute gout, particularly when the symptoms are in a single joint, and the medication can be delivered intra-articularly. NSAIDs are the preferred drugs for treating the pain and inflammation associated with acute gout attacks. The use of colchicine has declined, although it may still be prescribed for patients whose symptoms cannot be controlled with NSAIDs. Low doses may be prescribed for gout prophylaxis. Allopurinol is used to control the hyperuricemia that causes severe gout and to reduce the risk of acute gout attacks.

A client is prescribed calcitriol (Rocaltrol) for chronic kidney disease. Which medication should the nurse avoid coadministering with calcitriol? a. Cardiac glycosides b. Calcium supplements c. Thiazide diuretics d. Magnesium antacids

Answer: d. Magnesium antacids Rationale: Magnesium antacids or supplements should not be given concurrently due to the increased risk of hypermagnesemia. Too much vitamin D may cause dysrhythmias in patients who are receiving the cardiac glycoside digoxin. Thiazide diuretics may enhance the effects of vitamin D, causing hypercalcemia. The effectiveness of calcitriol depends on an adequate amount of calcium; therefore, it is usually prescribed in combination with calcium supplements.

The nurse cautions a client receiving calcium gluconate to avoid adding foods such as nuts, legumes, and tofu to the diet. The rationale for this instruction is that: a. These foods cause GI distress. b. These foods can cause hypercalcemia. c. These foods are high in fat. d. These foods, rich in zinc, can decrease calcium absorption.

Answer: d. These foods, rich in zinc, can decrease calcium absorption. Rationale: Consuming food rich in zinc can decrease calcium absorption. Teach clients to avoid zinc-rich foods such as nuts, legumes, seeds, sprouts, and tofu.