NCLEX Musculoskeletal Medication Practice (Saunders)

The nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse should include which instruction in the plan? A. Instruct the client to drink 3000 mL of fluid per day. B. Instruct the client to take the medication on an empty stomach. C. Inform the client that the effect of the medication will occur immediately. D. Instruct the client that if swelling of the lips occurs, this is a normal expected response.

A. Instruct the client to drink 3000 mL of fluid per day. Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the health care provider because this may indicate hypersensitivity.

Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication? A. Depresses spinal reflexes B. Acts directly on the skeletal muscle to relieve spasticity C. Acts within the spinal cord to suppress hyperactive reflexes D. Acts on the central nervous system (CNS) to suppress spasms

B. Acts directly on the skeletal muscle to relieve spasticity Dantrolene acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. Options 1, 3, and 4 are not actions of the medication.

The nurse is reinforcing discharge instructions to a client receiving baclofen. Which should the nurse include in the instructions? A. Restrict fluid intake. B. Avoid the use of alcohol. C. Stop the medication if diarrhea occurs. D. Notify the health care provider if fatigue occurs.

B. Avoid the use of alcohol. Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Constipation rather than diarrhea is an adverse effect of baclofen. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test(s) would identify an adverse effect associated with the administration of this medication? A. Creatinine B. Liver function tests C. Blood urea nitrogen D. Hematological function tests

B. Liver function tests Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. Options 1 and 3 are tests that assess kidney function.

Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? A. Myxedema B. Renal failure C. Hypothyroidism D. Diabetes mellitus

B. Renal failure Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic, or cardiac disorders, or those with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired hepatic function, older clients, and debilitated clients.

The nurse is caring for a client with gout who is taking colchicine (Colcrys). The client has been instructed to restrict the diet to low-purine foods. Which food should the nurse instruct the client to avoid while taking this medication? A. Spinach B. Scallops C. Potatoes D. Ice cream

B. Scallops Colchicine is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.

The client has been on treatment for rheumatoid arthritis for 3 weeks. Which is most important for the nurse to check during the administration of etanercept (Enbrel)? A. The injection site for itching and edema B. The white blood cell counts and platelet counts C. A metallic taste in the mouth and a loss of appetite D. Whether the client is experiencing fatigue and joint pain

B. The white blood cell counts and platelet counts Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect? A. Polyuria B. Diarrhea C. Drowsiness D. Muscular excitability

C. Drowsiness Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

Dantrolene (Dantrium) is prescribed for a client with a spinal cord injury for discomfort resulting from spasticity. The nurse tells the client about the importance of follow-up and the need for which blood study? A. Creatinine level B. Sedimentation rate C. Liver function studies D. White blood cell count

C. Liver function studies Dantrolene can cause liver damage, and the nurse should monitor liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks.

The nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide (Arava). During data collection, the nurse asks which question to determine medication effectiveness? A. "Do you have any joint pain?" B. "Are you having any diarrhea?" C. "Do you have frequent headaches?" D. "Are you experiencing heartburn?"

A. "Do you have any joint pain?" Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other options are unrelated to medication effectiveness.

Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the health care provider regarding the administration of this medication? A. Glaucoma B. Emphysema C. Hyperthyroidism D. Diabetes mellitus

A. Glaucoma Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy. The disorders in options 2, 3, and 4 are not a concern when the client is taking cyclobenzaprine.

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the health care provider? A. Seizure disorders B. Hyperthyroidism C. Diabetes mellitus D. Coronary artery disease

A. Seizure disorders Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking? A. 1 g daily B. 4 g daily C. 325 mg daily D. 1000 mg daily

B. 4 g daily Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or stroke ( brain attack) or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in 2 to 4 divided doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses.

A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle relaxant. Which data would indicate that the client is experiencing a side effect related to this medication? A. Headache B. Drowsiness C. Urinary retention D. Increased salivation

B. Drowsiness Incoordination and drowsiness are common side effects resulting from this medication. Options 1, 3, and 4 are incorrect.

The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data? A. The injection site for itching and edema B. The white blood cell counts and platelet counts C. A metallic taste in the mouth, with a loss of appetite D. Whether the client is experiencing fatigue and joint pain

B. The white blood cell counts and platelet counts Infection and suppression can occur as a result of etanercept. Laboratory studies are performed before and during medication treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection or potential bleeding. Injection site itching and edema are common occurrences following administration. A metallic taste and loss of appetite are not associated with this medication. Fatigue and joint pain occur with rheumatoid arthritis.

A client receives a prescription for methocarbamol (Robaxin), and the nurse reinforces instructions to the client regarding the medication. Which client statement should indicate a need for further teaching? A. "My urine may turn brown or green." B. "This medication is prescribed to help relieve my muscle spasms." C. "If my vision becomes blurred, I don't need to be concerned about it." D. "I need to call my doctor if I experience nasal congestion from this medication."

C. "If my vision becomes blurred, I don't need to be concerned about it." The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that if these adverse effects occur, the health care provider needs to be notified. The medication is used to relieve muscle spasms.

A health care provider prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which data would indicate to the nurse that the client is experiencing toxicity related to the medication? A. Joint pain B. Constipation C. Ringing in the ears D. Complaints of a metallic taste in the mouth

D. Complaints of a metallic taste in the mouth Ridaura is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy, but these usually subside in the first 3 months of therapy. Early symptoms of toxicity include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings should the nurse interpret as acceptable responses? Select all that apply. A. Symptom control during periods of emotional stress B. Normal white blood cell, platelet, and neutrophil counts C. Radiological findings that show nonprogression of joint degeneration D. An increased range of motion in the affected joints 3 months into therapy E. Inflammation and irritation at the injection site 3 days after injection is given F. A low-grade temperature upon rising in the morning that remains throughout the day

A. Symptom control during periods of emotional stress B. Normal white blood cell, platelet, and neutrophil counts C. Radiological findings that show nonprogression of joint degeneration D. An increased range of motion in the affected joints 3 months into therapy Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the 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 client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking 2 or 3 aspirin every 4 hours for the past week, and it hasn't helped my back." Aspirin intoxication is suspected. Which complaint would indicate aspirin intoxication? A. Tinnitus B. Constipation C. Photosensitivity D. Abdominal cramps

A. Tinnitus Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production. Options 2, 3, and 4 are incorrect.

A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which is a side effect of this medication? A. Muscle pain B. Hypertension C. Slurred speech D. Photosensitivity

C. Slurred speech Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. Options 1, 2, and 4 are not side effects of this medication.

Alendronate (Fosamax) is prescribed for a client with osteoporosis. The nurse should reinforce instructing the client taking this medication to do which? A. Take the medication at bedtime. B. Take the medication in the morning with breakfast. C. Lie down for 30 minutes after taking the medication. D. Take the medication with a full glass of water after rising in the morning.

D. Take the medication with a full glass of water after rising in the morning. Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

Alendronate (Fosamax) is prescribed for a client with osteoporosis and the nurse is providing instructions on administration of the medication. Which instruction should the nurse reinforce? A. Take the medication at bedtime. B. Take the medication in the morning with breakfast. C. Lie down for 30 minutes after taking the medication. D. Take the medication with a full glass of water after rising in the morning.

D. Take the medication with a full glass of water after rising in the morning. Precautions need to be taken with the administration of alendronate to prevent gastrointestinal side/adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? A. "You should never stop the medication." B. "It is best that you taper the dose if you intend to stop the medication." C. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." D. "Weakness and fatigue commonly occur and will diminish with continued medication use."

D. "Weakness and fatigue commonly occur and will diminish with continued medication use." The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.