Pharm: Sherpath (Wk 12)
A patient who was diagnosed with rheumatoid arthritis (RA) 7 years ago is currently managed with weekly oral methotrexate, hydroxychloroquine taken twice daily, and etanercept 50 mg SC weekly. The patient is currently experiencing a worsening of RA symptoms and has tried numerous tumor necrosis factor (TNF)-α antagonists with minimal success. The rheumatologist decides to start abatacept 125 mg SC weekly after a loading dose and discontinue therapy with etanercept. Which instructions would a nurse include when teaching a patient about the administration of the newly prescribed abatacept? Select all that apply. "Inject abatacept into the abdomen, thighs, or upper arm." "Rotate injection sites, avoiding areas that are bruised, hard, or red." "Expect to observe improvements within a few days of starting abatacept." "You may experience changes in blood pressure, injection site reactions, headaches, and dizziness with abatacept." "You will be closely monitored for potential development of heart failure and demyelinating disorders such as seizures."
"Inject abatacept into the abdomen, thighs, or upper arm." "Rotate injection sites, avoiding areas that are bruised, hard, or red." "You may experience changes in blood pressure, injection site reactions, headaches, and dizziness with abatacept."
A nurse is providing discharge teaching to a patient prescribed cyclobenzaprine. Which statement would be appropriate to include in the teaching? "Notify your health care provider if you think you might be pregnant." "Finish the entire prescription, even if you feel better." "You may drive 4 hours after you take the medication." "You may take a sleeping pill, if needed, but only if you have 8 hours to sleep."
"Notify your health care provider if you think you might be pregnant."
patient has been prescribed a skeletal muscle relaxant and asks the nurse, "Why was I told not to drive or participate in activities that require mental alertness while taking this drug?" Which response by the nurse is appropriate? "Sedation is a common side effect of skeletal muscle relaxants." "A decrease in peripheral vision is a side effect of skeletal muscle relaxants." "A decrease in muscle tone is a side effect of skeletal muscle relaxants." "Short-term memory loss is a side effect of skeletal muscle relaxants."
"Sedation is a common side effect of skeletal muscle relaxants."
Which patient would a nurse determine cannot safely receive therapy with leflunomide? A 38-year-old patient with hypothyroidism A 49-year-old patient with end-stage liver disease A 58-year-old patient with type 2 diabetes A 66-year-old patient with NYHA Class I heart failure
A 49-year-old patient with end-stage liver disease
Which patients diagnosed with rheumatoid arthritis (RA) would a nurse determine can safely receive therapy with methotrexate? Select all that apply. A 33-year-old pregnant patient A 34-year-old breastfeeding patient A 44-year-old patient with chronic hepatitis B A 49-year-old patient with hypertension A 55-year-old patient with active pneumonia A 56-year-old patient with dyslipidemia
A 49-year-old patient with hypertension A 56-year-old patient with dyslipidemia
Which method would the nurse use to administer cyclobenzaprine to facilitate the greatest amount of absorption? Administer with grapefruit juice Administer with a full meal Administer on an empty stomach Administer intravenously
Administer on an empty stomach Administering the medication on an empty stomach will increase absorption because cyclobenzaprine is absorbed from the GI tract and food acts as a barrier to absorption.
The nurse educates a patient to avoid which drugs while taking muscle relaxants? Select all that apply. Alcohol Ibuprofen Over-the-counter vitamins Kava kava Valerian
Alcohol Kava kava Valerian
Which nursing assessments, if applicable, must be completed before the administration of midazolam? Select all that apply. Allergy history Medication history Auscultation of lung sounds Blood pressure Pregnancy test
Allergy history Medication history Blood pressure Pregnancy test
A nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who has been prescribed leflunomide 100 mg PO daily for 3 days then 10 mg PO daily. Before the patient begins leflunomide, which baseline parameters would the nurse assess? Select all that apply. Blood cell counts Blood pressure Lipid panel Liver function tests Purified protein derivative (PPD) test
Blood cell counts Blood pressure Liver function tests Purified protein derivative (PPD) test
Which assessment finding would require the nurse to hold the prescribed midazolam? Heart rate 110 beats/minute Respiratory rate 26/minute Oxygen saturation 93% Blood pressure 90/60 mm Hg
Blood pressure 90/60 mm Hg
The nurse administered midazolam intravenously. Which assessment, if noted by the nurse, would require immediate intervention? Confusion Nausea Blurred vision Cough
Cough - may be indicative of bronchospasm, which is an adverse effect of midazolam. The nurse should intervene to ensure the patient's airway is not compromised.
Which side effects of muscle relaxants would the nurse educate a patient about? Select all that apply. Coughing Headache Nausea Tinnitus Amber urine Muscle weakness
Headache Nausea Muscle weakness
Use of muscle relaxants is contraindicated in patients with which condition? Brain tumor Diabetes Acromegaly Hepatic disease
Hepatic disease
A patient who has received an intravenous (IV) dose of midazolam will be switched to oral (PO) formulation. Which adjustment in dosing does the nurse anticipate? Lower PO dose Higher PO dose No adjustment in dose This medication cannot be given PO
Higher PO dose
A nurse is caring for a patient prescribed tofacitinib extended-release 11 mg PO daily who is also receiving methotrexate, HCTZ, and ethinyl estradiol/levonorgestrel. Which teaching point would the nurse provide to the patient about administration? It cannot be crushed or chewed. It should be given 2 hours before all other drugs. It should be taken with food to increase absorption. It should be taken on an empty stomach to enhance absorption.
It cannot be crushed or chewed.
The nurse understands that excretion of cyclobenzaprine occurs via which organ system? Kidneys Liver Lungs Skin
Kidneys
Which disease-modifying antirheumatic drug (DMARD) requires a "washout" if it needs to be quickly removed from the body? Etanercept Methotrexate Leflunomide Tofacitinib
Leflunomide
A patient who has been taking 5 mg of oral cyclobenzaprine PO tid for 6 weeks asks for a renewal of the prescription. Which information is of concern to the nurse? Length of time patient has been on medication Frequency that the medication is prescribed Dose of the medication that is prescribed Route that current medication is prescribed
Length of time patient has been on medication
Which nursing assessments are important for a patient prescribed cyclobenzaprine? Select all that apply. Level of consciousness Breathing Blood pressure Blood glucose Vision checks
Level of consciousness Breathing Blood pressure
The nurse would monitor which laboratory values for a patient taking cyclobenzaprine? Liver function tests Creatine kinase Serum amylase and lipase Arterial blood gases
Liver function tests
A nurse is caring for a patient with rheumatoid arthritis who has been prescribed abatacept. Which drug-drug product can be safely administered to a patient who is receiving abatacept? Anakinra Etanercept Methotrexate Measles, mumps, and rubella (MMR) vaccine
Methotrexate
Which disease-modifying antirheumatic drug (DMARD) may be given orally, subcutaneously, or intramuscularly? Abatacept Etanercept Methotrexate Tofacitinib
Methotrexate
A patient is complaining of gastrointestinal symptoms when taking a prescribed muscle relaxant. The nurse would recommend which beverage to help alleviate these symptoms? Water Lemonade Milk Tea
Milk
Which medication would the nurse instruct an otherwise healthy patient to avoid while taking midazolam? Morphine Loratadine Acetaminophen Aspirin
Morphine
The nurse will teach the patient that cyclobenzaprine can relieve which symptoms? Muscle stiffness Muscle paralysis Localized muscle spasms Pain with range of motion Spasticity caused by myasthenia gravis
Muscle stiffness Localized muscle spasms Pain with range of motion
A nurse is caring for a patient with rheumatoid arthritis (RA) who has prescribed leflunomide. The patient is currently taking metformin and pioglitazone for type 2 diabetes, lisinopril for hypertension, and simvastatin for dyslipidemia. Which drug is expected to interact with leflunomide? Lisinopril Metformin Pioglitazone Simvastatin
Pioglitazone
Which instruction would the nurse provide a patient taking cyclobenzaprine to avoid dizziness and fainting? Select all that apply. Stand slowly from a sitting position Take medication without food Check blood glucose levels Maintain adequate hydration Stop the medication immediately
Stand slowly from a sitting position Maintain adequate hydration
Match the disease-modifying antirheumatic drug (DMARD) to its associated drug class. T-cell costimulation modulator Tumor necrosis factor (TNF)-α antagonist Dihydroorotate dehydrogenase inhibitor Janus kinas inhibitor Etanercept Abatacept Leflunomide Baricitinib
T-cell costimulation modulator: Abatacept Tumor necrosis factor (TNF)-α antagonist:Etanercept Dihydroorotate dehydrogenase inhibitor: Leflunomide Janus kinase inhibitor: Baricitinib
The nurse teaches a patient that a muscle relaxant should not be abruptly stopped based on which rationale? To avoid rebound spasms To prevent heart palpitations To decrease chances of depression associated with chronic pain To prevent permanent nerve damage
To avoid rebound spasms
For which reason should a patient taking cyclobenzaprine report adverse effects to the health care provider? To prevent respiratory depression To decrease prescribed dose To increase prescribed dose To prevent hypertension
To prevent respiratory depression
A patient with rheumatoid arthritis (RA) asks the nurse why he or she was told to take folic acid with methotrexate. Which rationale would the nurse provide? To reduce gastrointestinal and hepatic toxicity To prevent nephrotoxicity To prevent bone loss and fractures To reduce the risk for myocardial infarction and stroke
To reduce gastrointestinal and hepatic toxicity
Which disease-modifying antirheumatic drug (DMARD) is beneficial in rheumatoid arthritis (RA) by inhibiting the enzyme Janus kinase? Abatacept Etanercept Methotrexate Tofacitinib
Tofacitinib
Which disease-modifying antirheumatic drug's (DMARD's) metabolism occurs through CYP3A4 and is subject to drug interactions involving this isoenzyme? Abatacept Methotrexate Leflunomide Tofacitinib
Tofacitinib