Musculoskeletal

The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder? Select one: a. osteoarthritis b. rheumatoid arthritis c. Gout d. Systemic lupus erythematosus

c. Gout.

A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? Select one: a. decreased uric acid levels b. Decreased prothrombin time c. Decreased white blood cell count d. Increased hemoglobin and hematocrit levels

a. Decreased uric acid levels.

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen? Select one: a. "You will take both drugs initially and then stop taking the colchicine." b. "Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy." c. "The colchicine is given to enhance the effects of the allopurinol." d. "Allopurinol helps reduce the gastrointestinal side effects of colchicine."

a. "You will take both drugs initially and then stop taking the colchicine."

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of: a. having routine renal and hepatic function tests. b. reporting alopecia and rash. c. taking the medication on a daily basis. d. limiting folic acid consumption.

a. Having routine renal and hepatic function tests. Methotrexate is chemo agent; used for the treatment of RA. The major Adverse effects: bone marrow suppression (infection, swollen lymph nodes). It also alters the liver function (causes bleeding, bruising), kidney failure. So liver and kidney functions should be checked routinely.

A client with gout has begun to take allopurinol. The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply. a. Naproxen b. Hydromorphone c. Indomethacin d. Colchicine e. Oxycodone

a. Naproxen c. Indomethacin d. Colchine Clients beginning medication therapy with allopurinol may also have to take colchicine and nonsteroidal antiinflammatory drugs (NSAIDs) because of the risk of an acute gouty attack after first starting allopurinol. Colchicine and NSAIDs (Naproxen & Indomethacin) help to prevent the acute gouty attack from occurring. Oxycodone and hydromorphone are opioid analgesics and do not assist in preventing an attack.

A patient with gout has not experienced relief with conventional drug therapy. The nurse anticipates which agent will be prescribed for the patient? a. Pegloticase b. Allopurinol c. Probenecid d. Solu-Medrol

a. Pegloticase. Pegloticase IV is indicated for patients refractory to conventional treatment.

A patient is prescribed allopurinol for chronic tophaceous gout. The patient develops a rash. What is the priority intervention by the nurse? a. Stop the medication and assess the patient for liver and kidney failure. b. Instruct the patient to avoid exposing the skin to sunlight. c. Administer diphenhydramine (Benadryl) with the dose of allopurinol. d. Monitor the patient for respiratory depression.

a. Stop the med and assess the pt for liver and kidney failure. A serious toxic reaction to allopurinol is hypersensitivity syndrome. These syndromes casuse clinical features, including fever, eosinophilia, hepatic and renal dysfunction and rash. The medication should be immediately discontinued; the patient should be observed for rash, fever, eosinophilia, and liver and kidney dysfunction.

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a. "I will take this medication when I feel a migraine headache starting." b. "I will take this medication regularly to prevent a migraine headache from occurring." c. "I will keep a journal to record the headaches I have and how the injections are working." d. "This medication does not reduce the number of migraines I will have."

b. "I will take this med regularly to prevent a migraine headache from occurring." Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient's responses to the medication are helpful.

A nurse is teaching a client who experiences migraine headaches and is prescribed a beta-blocker. Which statement would the nurse include in this client's teaching? a. "Take this drug only when you have prodromal symptoms indicating the onset of a migraine headache." b. "Take this drug as prescribed, even when feeling well, to prevent vascular changes associated with migraine headaches.". c. "This drug will relieve the pain during the aura phase soon after a headache has started." d. "This medication will have no effect on your heart rate or blood pressure because you are taking it for migraines."

b. "Take this drug as prescribed, even when feeling well, to prevent vascular changes associated w migraine headaches." Beta-blockers are prescribed as prophylactic treatment to prevent the vascular changes that initiate migraine headaches. Heart rate and blood pressure will also be affected, and the client would monitor these side effects. The other responses do not discuss appropriate uses of the medication.

A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex), a serotonin agonist or triptan, for migraine headaches. Which condition would alert the nurse to hold the medication and contact the healthcare provider? a. Bronchial asthma b. Angina c. Diabetes mellitus d. Chronic kidney disease

b. Angina Sumatriptan succinate effectively reduces pain and other associated symptoms of migraine headache by binding to serotonin receptors and triggering cranial vasoconstriction. Vasoconstrictive effects are not confined to the cranium and can cause coronary vasospasm in clients with underlying angina or cardiovascular disease. The other conditions would not affect the client's treatment.

Which statement about enteracept (Enbrel), a Biologic non-TNF) Inhibitors, does the nurse identify as true? a. The patient should stop taking the drug if redness appears at the injection site. b. Enteracept can cause liver injury. c. Live vaccines can be administered with enteracept. d. Enteracept is used to treat CNS demyelinating disorders.

b. Enteracept can cause liver injury. Tumor necrosis factor (TNF) inhibitors have been associated with severe liver injury, including acute liver failure. Injection-site reactions (redness, swelling, itching, pain) are common with these drugs. Inform patients that symptoms usually subside in a few days, and advise them to contact the prescriber if the reaction persists. TNF antagonists may increase the risk of acquiring or transmitting infection after immunization with a live vaccine, and live vaccines should be avoided. Inform parents that pediatric vaccinations should be current before therapy with a TNF antagonist starts. TNF antagonists have been associated with rare cases of CNS demyelinating disorders, including multiple sclerosis, myelitis, and optic neuritis. Avoid TNF antagonists in patients with a preexisting or recent-onset demyelinating disorder.

A hospitalized older client with rheumatoid arthritis needs to increase activity, but is unsteady and complains of dizziness with activity. The nurse establishes the nursing diagnosis of Activity Intolerance. Which action by the nurse is most important to implement next? a. Reassure the client that someone will help with ambulation. b. Evaluate the client's medications. c. Ask the client if he or she is just afraid of falling. d. Perform lower extremity strength testing.

b. Evaluate the client's meds. Many medications can lead to decreased functional ability, particularly beta-blockers, lipid-lowering agents, some anti-psychotics, and other anti-hypertensives. The nurse should assess the client's medications for any medication that could be contributing to this issue. Asking if the client is "just" afraid is demeaning. Lower extremity strength testing may be needed, but is not causing the dizziness. Reassuring the client does not provide any solution to the problem.

A client receiving propranolol (Inderal) as a preventative for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse? a. Dry mouth b. Slow heart rate c. Tingling feelings d. Warm sensation

b. Slow HR. The side effect that is the greatest concern for a client taking propranolol for migraine headaches is a slow heart rate. Beta blockers such as propranolol (Inderal) may be prescribed as a preventive medication for migraines. Propranolol causes blood vessels to relax and improves blood flow although the exact mechanism of action in migraines is unclear. The client would be taught how to monitor his or her heart rate and appropriately report any deviations to the primary care provider.

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? Select one: a. Calcium level of 9.0 mg/dL b. Uric acid level of 9.0 mg/dL c. Phosphorus level of 3.1 mg/dL d. Potassium level of 4.1 mEq/L

b. Uric acid level of 9.0 mg/dL.

A patient is receiving instructions regarding the use of caffeine for migraine headaches. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. Tension headache b. A history of kidney stones c. A history of peptic ulcers d. Asthma

c. A history of peptic ulcers. Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine.

A client with rheumatoid arthritis is receiving Hydroxychloroquine (Plaquenil) in the recent months. The nurse tells the client to visit which of the following while on the treatment? Select one: a. Pulmonologist b. Endocrinologist c. Ophthalmologist d. Dentist

c. Ophthalmologist. Plaquenil can adversely affect the eyes such as retinal damage. Clients taking this medicine should be seen by an ophthalmologist at least once a year.

A 17 year-old high school athlete with a history of asthma comes to your clinic seeking a preventative medication for migraine headaches. Which of the following would be contraindicated? a. Amitriptyline (Axert) b. Topiramate (Topamax) c. Propranolol (Inderal) d. Valproate (valproic acid)

c. Propranolol (Inderal) Propranolol, a beta 1-blocker (antagonist) would be contraindicated (not a good choice for this patient). Propranolol would likely keep the patients heart rate down during exercise, and would interfere with any beta-2 agonist bronchodilator, such as Albuterol, used to treat asthma.

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient? Select one: a. Colchicine b. Nonsteroidal anti-inflammatory drugs c. Urate-lowering drugs d. Glucocorticoid

c. Urate-lowering drugs.

The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session? Select one: a. "Fluids should be restricted while on colchicine therapy." b. "Call your doctor if you have increased pain or blood in the urine." c. "Take colchicine with meals." d. "The drug will be discontinued when symptoms are reduced."

d. "The drug will be d/c when symptoms are reduced."

Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis? a. Probenecid b. Colchicine c. Febuxostat (Uloric) d. Allopurinol (Zyloprim)

d. Allopurinol (Zyloprim)

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage? Select one: a. Lefluomide (Arava) b. Sulfasalazine (Azulfidine) c. Methylprednisolone (Medrol) d. Hydroxychloroquine (Plaquenil)

d. Hydroxychloroquine (Plaquenil) This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen? a. Reduced anti-inflammatory effects of the NSAID b. Increased risk for falls c. Increased nephrotoxic effects d. Increased chance for GI bleeding

d. Increased chance for GI bleeding.

A patient with acute gouty arthritis requests information on the preferred drug to take to treat a painful flare-up. The nurse should recommend which medication? a.Allopurinol b. Febuxostat c. Probenecid d. Naproxen

d. Naproxen NSAIDs and glucocorticoids are preferred drugs for treating acute gouty attacks. Benefits derive mainly from anti-inflammatory actions. Naproxen (or a nonsteroidal anti-inflammatory drug) is considered the agent of first choice to treat acute gouty arthritis.

A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to? Select one: a. Pregnancy is not contraindicated with the use of the medication. b. Get a daily source of sunlight during the day. c. Clay-colored stool is a normal response of the treatment d. Strict hand washing.

d. Strict hand washing. Clients taking Methotrexate are more likely to get infections or may worsen any current infections. Therefore. hand washing will help to prevent the spread of infection.

A 23 year old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI (selective serotonin repute inhibitor) Citalopram for her depression and an estrogen/progesterone combined oral contraceptive. What medication would you avoid using for her acute treatment? a. Topiramate (Topamax) b. Ergotamine (Ergomar) c. Morphine d. Sumatriptan (Imitrex)

d. Sumatriptan (Imitrex) Migraine is a comorbidity (occur together) with depression- those suffering from migraines are 2-4 times more likely to have depression. Therefore it is no surprise that patients may try to take both a triptan and either an SSRI or SNRI at the same time. Since these different classes of medications both elevate serotonin levels, when combined they can "potentially" cause a serotonin syndrome which can produce hypertension, tachycardia & hyperthermia. Its best to avoid combining two serotonergic drugs whenever possible.

A client is taking large doses of acetylsalicylic acid (ASA) for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication? a. Dizziness, sore throat, and purpura b. Gastrointestinal upset and dizziness c. Gastrointestinal bleeding, ecchymosis, and dizziness d. Tinnitus, hearing loss, dizziness, and ataxia

d. Tinnitus, hearing loss, dizziness, and ataxia. Ototoxicity can occur as a result of the administration of acetylsalicylic acid. Signs and symptoms of tinnitus, hearing loss, dizziness, and ataxia reflect damage to the VIIIth cranial nerve, the organ of hearing and balance. Purpura and ecchymosis are caused by prolonged bleeding but not ototoxicity. Gastrointestinal bleeding and upset may be caused by acetylsalicylic acid irritation but are not symptoms of ototoxicity.

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply. a. Radiological findings that show no progression of joint degeneration b. A low-grade temperature on rising in the morning that remains throughout the day c. Control of symptoms during periods of emotional stress d. Inflammation and irritation at the injection site 3 days after the injection is given e. An increased range of motion in the affected joints 3 months into therapy f. Normal white blood cell, platelet, and neutrophil counts

a. Radiological findings that show no progression of joint degeneration. c. Control of symptoms during periods of emotional waste. e. An increased ROM in the affected joints 3 months into therapy. f. Normal WBC, platelet, and neutrophil counts. Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow the progression of joint degeneration. In addition, an improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient? Select one: a. That an eye exam is necessary at the beginning of therapy with this drug b. That the dose of NSAIDs may be decreased when beginning hydroxychloroquine c. To stop taking methotrexate when starting hydroxychloroquine d. To obtain tests of renal and hepatic function while taking this drug

a. That an eye exam is necessary at the beginning of therapy with this drug.

Jane is a 67 year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceeded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea and occasional vomiting. What medication would be contraindicated for acute treatment of Jane's headaches? a. Acetaminophen b. Sumatriptan c. Caffeine d. Aspirin e. Propranolol

b. Sumatriptan Sumatriptan is a serontoninergic agonist that could produce vasoconstriction, and is therefore contraindicated in patients with a history of ischemic heart disease (as well as other peripheral vascular diseases, or pregnancy).