PHARM - Musculoskeletal
A primary health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which medication would the nurse expect to be prescribed and administered by this route?
Baclofen Rationale: Baclofen is a skeletal muscle relaxant that can be administered intrathecally.
The nurse prepares to reinforce instructions to a client who is taking allopurinol. The nurse should include which instruction in the plan?
Instruct the client to drink 3000 mL of fluid per day. Rationale: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. Allopurinol is an antigout medication used to decrease uric acid levels. 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 primary health care provider because this may indicate hypersensitivity.
A client is receiving baclofen for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which is a side effect of this medication?
Slurred speech Rationale: Slurred speech is a one of the side effects of baclofen. Other side effects 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. The other side effects are not related to this medication.
A client is taking large doses of acetylsalicylic acid for rheumatoid arthritis. The nurse tells the client to report which signs/symptoms of ototoxicity?
Tinnitus, hearing loss, dizziness, ataxia Rationale: Ototoxicity is damage to the eighth cranial nerve, which is responsible for hearing and balance. Purpura and ecchymosis are caused by prolonged bleeding, but not ototoxicity. GI bleeding and upset may be caused by acetylsalicylic acid (aspirin) irritation but are not symptoms of ototoxicity.
The nurse is providing instructions to a client with a diagnosis of rheumatoid arthritis (RA) who is receiving acetylsalicylic acid 5 g orally daily. Which statement by the client would indicate an understanding of the instructions?
"I should notify the primary health care provider if I get any ringing in my ears." Rationale: Aspirin is a nonsteroidal anti-inflammatory medication. Adverse reactions include gastrointestinal bleeding and/or gastric mucosal lesions, ringing in the ears (tinnitus), and generalized pruritus. Headache, dizziness, flushing, tachycardia, hyperventilation, sweating, and thirst also are adverse reactions
A client receives a prescription for methocarbamol, and the nurse reinforces instructions to the client regarding the medication. Which client statement should indicate a need for further teaching?
"If my vision becomes blurred, I don't need to be concerned about it." Rationale: There is a need for further teaching when the client says that if my vision becomes blurred, I don't need to be concerned. 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 primary health care provider needs to be notified. The medication is used to relieve muscle spasms.
The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the primary health care provider (PHCP)?
A seizure disorder Rationale: Clients with a seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication
Dantrolene sodium 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?
Acts directly on the skeletal muscle to relieve spasticity Rationale: 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.
Allopurinol has been prescribed for a client with chronic tophaceous gout. The nurse explains to the client that what condition can occur during the first few months of treatment?
Acute gouty arthritis Rationale: Allopurinol is an antigout medication. It decreases uric acid production by inhibiting the enzyme xanthine oxidase and reduces uric acid concentrations in serum and urine. During the initial months of treatment, allopurinol may increase the incidence of acute gouty arthritis. The risk of an attack can be reduced by concurrent treatment with colchicine or a nonsteroidal anti-inflammatory drug (NSAID).
A client with osteoarthritis is receiving diclofenac sodium. The licensed practical nurse (LPN) reviewing the client's medication prescription sheet should verify the prescription with the registered nurse (RN) if which other medication is listed?
Warfarin Rationale: Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID). Interactions may occur with anticoagulants such as warfarin, resulting in increased risk for bleeding. The LPN should consult with the RN regarding a potential medication interaction. The other medications do not interact with diclofenac sodium. Mysoline is an anticonvulsant, calcium carbonate is an antacid, and vitamin C is a nutritional supplement. These medications are not contraindicated when diclofenac sodium is administered.
A client is receiving a maintenance dose of oral dantrolene sodium for the treatment of spasticity. The nurse reviews the medication record, expecting which dose to be prescribed?
100 mg twice daily Rationale: For treatment of spasticity, dantrolene is administered orally. The initial dosage in adults is 25 mg once daily. The usual maintenance dosage is 100 mg 2 to 4 times daily. If beneficial effects do not develop within 45 days, dantrolene therapy should be discontinued.
A client with multiple sclerosis is receiving dantrolene for relief of muscle spasticity. When would this medication be discontinued if there is no relief of spasticity?
2 months Rationale: Dantrolene is discontinued if no relief of spasticity is achieved in 6 to 8 weeks.
The nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide. During data collection, the nurse asks which question to determine if the medication is effective?
"Do you have any joint pain?" Rationale: Asking the client, "do you have any joint pain?" is the question to ask to determine if the medication is effective. 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 questions are unrelated to medication effectiveness.
A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse reinforce to the client?
"Swallow the tablets with large amounts of water or milk." Rationale: The initial instruction the nurse would reinforce to the client is to swallow the tablets with large amounts of water or milk. Taking the medication with a large amount of water or milk should be tried before contacting the primary health care provider. Diflunisal may be given with water, milk, or meals. The tablets would not be crushed or broken open.
The nurse notes that meloxicam is prescribed for a client. The nurse knows that what are the specific actions of this medication? Select all that apply.
Analgesic Antipyretic Anti-inflammatory Rationale: Meloxicam is used for the treatment of osteoarthritis. It is a medication with some cyclooxygenase (COX-2) selectivity and has analgesic, anti-inflammatory, and antipyretic actions.
The nurse is reinforcing discharge instructions to a client receiving baclofen. Which should the nurse include in the instructions?
Avoid the use of alcohol. Rationale: 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 PHCP if fatigue occurs.
A client has been taking indomethacin for gout and experiencing side/adverse effects. Which assessment should the nurse expect the primary health care provider to prescribe?
Checking for occult blood Rationale: One adverse effect of indomethacin is gastrointestinal bleeding. The stool guaiac test is noninvasive and is widely used as a gross screening for blood in the gastrointestinal tract.
A primary health care provider prescribes auranofin for a client with rheumatoid arthritis. Which data would indicate to the nurse that the client is experiencing toxicity related to the medication?
Complaints of a metallic taste in the mouth Rationale: Early symptoms of toxicity of auranofin include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth. Auranofin 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.
A client with multiple sclerosis is receiving baclofen. The nurse monitoring this client should look for which outcome to indicate a primary therapeutic response from the medication?
Decreased muscle spasms Rationale: A primary therapeutic response from baclofen is to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and multiple sclerosis. Baclofen is a skeletal muscle relaxant and acts at the spinal cord level. Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication. Decreased nausea is incorrect
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?
Drowsiness Rationale: 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.
A client with a history of spinal cord injury is receiving baclofen for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences which sign/symptom?
Drowsiness Rationale: Baclofen is a centrally acting skeletal muscle relaxant. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion.
The nurse is assessing a client recently diagnosed with rheumatoid arthritis. Besides joint inflammation, what are some early systemic sign/symptoms of this disease that the nurse expects to assess? Select all that apply.
Fatigue Weakness Paresthesias Low-grade fever Rationale: Early systemic signs/symptoms of rheumatoid arthritis include fatigue, anorexia, weakness, paresthesias, and low-grade fever. Anemia and weight loss are not early signs/symptoms.
Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, should indicate a need to contact the health care provider about the administration of this medication?
Glaucoma Rationale: Because cyclobenzaprine has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure. Cyclobenzaprine should be used only for a short time (2 to 3 weeks).
The nurse is caring for a client who just been prescribed alendronate. Which conditions contraindicate this medication being given to the client? Select all that apply.
Hypocalcemia Poor renal function Gastroesophageal reflux disease (GERD) Rationale: A client with hypocalcemia, poor renal function, and gastroesophageal reflux disease (GERD) should not take alendronate. Alendronate is a bisphosphonate. The other conditions do not prevent a client from taking alendronate.
A client is receiving diazepam for its skeletal muscle relaxant effects. The nurse would monitor this client for which side effect of this medication?
Incoordination Rationale: Diazepam is a centrally acting skeletal muscle relaxant. Incoordination and drowsiness are common side effects resulting from this medication.
The nurse is reviewing medications with the client receiving colchicine for the treatment of gout. The nurse determines that the medication is effective if the client reports a decrease in which?
Joint inflammation Rationale: Colchicine is effective if the client has a decrease in joint inflammation. This medication is classified as an antigout agent. It interferes with the ability of the white blood cells to initiate and maintain an inflammatory response to monosodium urate crystals. The client would also report a decrease in pain as well as inflammation in the affected joints. There will also be a decrease in the number of gout attacks. Colchicine has no effect on the client's blood glucose or blood pressure and is not used to treat a headache.
The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication?
Liver function tests Rationale: 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.
The nurse is caring for a client with Paget's disease. The nurse knows that when serum calcium levels are lowered, what hormone secretion increases to release calcium to the blood?
Parathyroid hormone (PTH) Rationale: Calcitonin is a hormone that the C-cells in the thyroid gland produce and release. It opposes the action of the parathyroid hormone, helping to regulate the blood's calcium and phosphate levels. When serum calcium levels are lowered, parathyroid hormone (PTH), or parathormone secretion increases and stimulates bone to promote osteoclastic activity and release calcium to the blood. PTH reduces the renal excretion of calcium and facilitates its absorption from the intestine. If serum calcium levels increase, PTH secretion diminishes to preserve the bone calcium supply. This process is an example of the feedback loop system of the endocrine system.
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?
Renal failure Rationale: 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 would 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. The client has been instructed to restrict the diet to low-purine foods. Which food would the nurse instruct the client to avoid while taking this medication?
Scallops Rationale: High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. 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.
A client has been prescribed cyclobenzaprine in the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client had which concurrent prescriptions to take?
Tranylcypromine Rationale: The client would not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors (MAOIs) such as tranylcypromine or phenelzine within the past 14 days. Otherwise, the client could experience hyperpyretic crisis, seizures, or death.
A client is being given a transcutaneous electrical nerve stimulation (TENS) unit to use for relief of chronic pain. Which instructions should the nurse reinforce to the client about the TENS unit? Select all that apply.
Using this unit will help relieve the pain. The unit works after attaching electrodes to the skin. The unit needs to be prescribed by the primary health care provider. The unit will decrease the amount of pain medication needed. The electrodes attached to the unit are placed on the skin around the area of pain. Rationale: The TENS unit is a portable system that relieves pain and reduces the need for analgesics. It is attached to the skin of the body around the area of pain by electrodes. It is not necessary that the client remain in the hospital for this treatment. However, this pain relief method needs to be prescribed by a primary health care provider.
The nurse is teaching a client with osteoporosis who is being discharged with a prescription for a bisphosphonate. What comment by the client shows a need for further teaching?
"I'll take it before supper with 8 ounces of water and stay in an upright position for 30 to 60 minutes." Rationale: There is a need for further teaching when the client states," I'll take the medication before supper with 8 ounces of water and stay in an upright position for 30 to 60 minutes." Bisphosphonates (BPs) must be taken early in the morning and not as just described. Bisphosphonates (BPs) slow bone resorption by binding with crystal elements in bone, especially spongy, trabecular bone tissue. The nurse needs to teach the client to have an oral assessment and preventive dentistry before beginning any bisphosphonate therapy and to inform any dentist who is planning invasive treatment, such as a tooth extraction or implant, that they are taking a BP drug.
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?
"Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: 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.
The nurse is caring for a client with muscle spasticity characterized by heightened muscle tone, spasm, and loss of dexterity caused by multiple sclerosis. Which centrally acting skeletal muscle relaxants might be prescribed for this client? Select all that apply.
Baclofen Diazepam Dantrolene Rationale: Baclofen, dantrolene, and diazepam may be prescribed for this client with muscle spasticity. Centrally acting skeletal muscle relaxants are prescribed as an adjunct to rest and physical therapy for relief of discomfort associated with acute, painful musculoskeletal disorders such as multiple sclerosis, cerebral palsy, spinal cord lesions, and CVA. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Trazadone is given for anxiety and depression.
The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect should the nurse monitor?
Bradycardia Rationale: Intravenous administration of methocarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these adverse effects.
A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which data would indicate that the client is experiencing a side effect related to this medication?
Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication.
Cyclobenzaprine 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 primary health care provider (PHCP) regarding the administration of this medication?
Glaucoma Rationale: 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.
A licensed practical nurse (LPN) is reviewing laboratory results for a client taking dantrolene sodium. The LPN should suggest that the registered nurse notify the primary health care provider if which finding is noted on the laboratory report sheet?
Lactate dehydrogenase (LDH) 600 units/L Rationale: Dantrolene sodium is a skeletal muscle relaxant. Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, tests of liver function would be performed before treatment and throughout the treatment interval. It is administered in the lowest effective dosage for the shortest time necessary. The LDH level reported is high. The other laboratory results are considered normal.
Baclofen is prescribed for a client with a spinal cord injury who is experiencing muscle spasms, and the nurse prepares a list of the associated side effects of the medication and reviews the list with the client. Which side effect identified by the client indicates a need for further teaching?
Photosensitivity Rationale: There is a need for further teaching when the client identifies photosensitivity as a side effect of baclofen. Photosensitivity is not a side effect of this medication. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias 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.
A client diagnosed with rheumatoid arthritis (RA) has been started on medication therapy with hydroxychloroquine. The nurse reinforces teaching with this client regarding the most serious adverse effect of this medication?
Retinal damage Rationale: The most serious adverse effect of hydroxychloroquine is retinal damage. This drug slows the progression of mild rheumatoid disease before it worsens. The nurse needs to teach the client to report blurred vision or headache. Remind clients to have an eye examination before taking the drug and every 6 months to detect changes in the cornea, lens, or retina. If this rare complication occurs, the primary health care provider discontinues the drug.
An adult client with severe muscle spasticity is receiving intrathecal baclofen (ITB). The nurse knows that what adverse effects may occur if the medication is suddenly withdrawn. Select all that apply.
Seizures Hallucinations Rationale: Seizures and hallucinations may occur if ITB is suddenly withdrawn. Other centrally-acting skeletal muscular relaxants, such as tizanidine, may cause severe drowsiness and sedation in most clients and may not be effective in reducing spasticity. As an alternative to other centrally-acting skeletal muscular relaxants, intrathecal baclofen (ITB) therapy may be prescribed. This drug is administered through a programmable, implantable infusion pump and intrathecal catheter directly into the cerebrospinal fluid. The pump is surgically placed in a subcutaneous pouch in the lower abdomen. Common adverse effects include sedation, fatigue, dizziness, and possible changes in mental status.
Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions for the administration of the medication. Which instruction should the nurse reinforce?
Take the medication with a full glass of water after rising in the morning. Rationale: 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.
The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data?
The white blood cell and platelet counts Rationale: Infection and suppression can occur as a result of etanercept. Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell and 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 has been started on cyclobenzaprine for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. The nurse interprets these signs/symptoms as which response?
These are the common side effects of this medication. Rationale: Drowsiness, dizziness, and dry mouth are the most common side effects of cyclobenzaprine. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm that accompanies a variety of conditions.
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?
Tinnitus Rationale: Tinnitus (ringing in the ears) is the most frequently occurring effect noted with acetylsalicylic acid intoxication. Mild intoxication with acetylsalicylic acid is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. 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.
The nurse has given medication instructions to a client beginning therapy with carisoprodol. The nurse determines that the client understands the effects of the medication if the client makes which statement?
"I need to avoid alcohol while taking this medication." Rationale: Carisoprodol, a centrally acting skeletal muscle relaxant, may cause central nervous system (CNS) side effects of drowsiness and dizziness. For this reason, the client avoids other CNS depressants, such as alcohol, while taking this medication. Driving or other activities requiring mental alertness are also avoided until the client's reaction to the medication is known. The medication is used to reduce muscle spasticity and pain. Missed doses would be taken if remembered within 1 hour.
The nurse has reinforced discharge instructions to a client with multiple sclerosis who is receiving baclofen. Which statement by the client indicates an understanding of the medication?
"I need to watch for urinary retention." Rationale: Baclofen is a central nervous (CNS) depressant. It is not necessary to restrict fluids, but the client would be warned that urinary retention can occur. 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 for the client to notify the primary health care provider. Constipation rather than diarrhea is an adverse effect of baclofen. Additionally, the client would be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents.
The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan?
Avoid the use of alcohol. Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the PHCP about fatigue.
A client with rheumatoid arthritis is taking acetylsalicylic acid on a daily basis. Which medication dose should the nurse expect the client to be taking?
4 g daily Rationale: Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses. Acetylsalicylic acid 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.
A primary health care provider instructs a client with rheumatoid arthritis to take ibuprofen. The nurse reinforces the instructions, knowing that the normal adult dose for this client is which?
400 mg orally 3 times a day Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg 3 or 4 times daily.
A licensed practical nurse (LPN) is reviewing the medical record of a newly assigned client and notes that the client is receiving cyclobenzaprine hydrochloride for the treatment of muscle spasms. The LPN questions the prescription if which disorder is noted in the admission history?
Angle-closure glaucoma Rationale: Cyclobenzaprine hydrochloride is a skeletal muscle relaxant. Because cyclobenzaprine hydrochloride has anticholinergic effects, it should be used cautiously in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. It is intended for short-term (2- to 3-week) therapy. The other disorders are not contraindications or concerns for the client receiving cyclobenzaprine hydrochloride.
A client with multiple sclerosis is receiving diazepam, and the home care nurse reinforces instructions to the client regarding the side effects of the medication. The nurse tells the client that which is a side effect of this medication?
Incoordination Rationale: Incoordination and drowsiness are common side effects resulting from this medication. Insomnia, inability to urinate and increased salivation are unrelated to the use of this medication.
Carisoprodol is been prescribed for a client to relieve muscle spasms. The client is being discharged and the nurse is instructing the client and family about the medication. What comment by the client indicates a need for further teaching?
"I'm glad there are no withdrawal problems when I stop taking this medication." Rationale: There is a need for further teaching when the client states, "I'm glad there are no withdrawal problems when I stop taking this medication." There is a risk for withdrawal problems when carisoprodol is stopped. The client needs to be taught to report withdrawal symptoms such as syncope, tachyarrhythmia, excessive fatigue or unusual mental status changes. The client needs to avoid tasks that require alertness and motor skills until response to the medication is established, and also avoid alcohol. Carisoprodol would only be used for short periods of time (2 to 3 weeks).
Auranofin has been prescribed for a client with rheumatoid arthritis. The nurse who is collecting data 2 weeks later interprets that the client may be experiencing the signs of medication toxicity based on what data collection findings? Select all that apply.
Observes several mouth lesions Notes a rash on trunk and neck Reports a metallic taste in the mouth Notes purplish blotches on the skin Rationale: Auranofin is the one gold preparation that is given orally rather than by injection. Gastrointestinal side effects, including diarrhea, abdominal pain, nausea, and loss of appetite, are common early in therapy but usually subside in the first 3 months. Early symptoms of toxic effects include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.
During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings should the nurse interpret as acceptable responses? Select all that apply.
Symptom control during periods of emotional stress Normal white blood cell, platelet, and neutrophil counts Radiological findings that show nonprogression of joint degeneration An increased range of motion in the affected joints 3 months into therapy Rationale: 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.
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?
The white blood cell counts and platelet counts Rationale: When the client is taking etanercept, it is most important for the nurse to check the client's white blood cell count. Infection and pancytopenia are adverse effects of etanercept. 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.
An older client with rheumatoid arthritis has been instructed by the primary health care provider to take acetaminophen 3000 mg to 4000 mg daily. Which laboratory test needs to be monitored on this client?
Liver function test (LFTs) Rationale: LFTs need to be monitored on this client. The standard ceiling dose of acetaminophen is 4000 mg each day. However, patients may be at risk for liver damage if they take more than 3000 mg daily, have alcoholism, or have liver disease. Older adults are particularly at risk because of normal changes of aging, such as slowed excretion of drug metabolites. Remind clients to read the labels of over-the-counter (OTC) or prescription drugs that could contain acetaminophen before taking them. Clients need to know that their liver enzyme levels may be monitored while taking this drug. Kidney function tests (KFTs) include serum creatinine that if elevated could be an early sign of kidney failure. Another KFT is the glomerular filtration rate (GFR) that measures how well the kidneys are removing wastes and excess fluid from the blood. The third KFT is blood urea nitrogen (BUN). As kidney function decreases, the BUN level rises. The CBC test examines cellular elements in the blood, including red blood cells, various white blood cells, and platelets. A lipoprotein panel is a blood test that can help show whether you're at risk for coronary heart disease (CHD). A lipoprotein panel measures the levels of LDL and HDL cholesterol and triglycerides in your blood. Abnormal cholesterol and triglyceride levels may be signs of increased risk for CHD.
