Pharm Success: Musculoskeletal

The client with rheumatoid arthritis is taking phenylbutazone (Butazolidin), a pyrazoline nonsteroidal anti-inflammatory drug (NSAID). Which statement requires the nurse question administering this medication? 1. "I have had a sore throat and fever the last few days." 2. "I have not had a bowel movement in more than 3 days." 3. "I can't believe I have gained 3 pounds in the last month." 4. "I have been having trouble sleeping at night."

1. "I have had a sore throat and fever the last few days." Most dangerous adverse reaction to this classification of medication is blood dyscrasias, which are manifested in client by flulike symptoms

The client with osteoarthritis is prescribed the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID). Which statement by the client warrants intervention by the nurse? 1. "I take aspirin daily to help prevent heart disease." 2. "I am allergic to penicillin and aminoglycosides." 3. "I know I am overweight and need to lose 50 pounds." 4. "I walk 30 minutes at least three times a week."

1. "I take aspirin daily to help prevent heart disease." Client should not take aspirin with NSAIDs because it can increase risk of GI bleeding

The client diagnosed with low back pain is scheduled to have a steroid injection into the intrathecal space. Which statement by the client indicates the client understands the procedure? 1. "I will have to curl up like a halloween cat." 2. "This procedure will cure my back pain." 3. "I will have an injection in each of my hips." 4. "There is no risk with this procedure."

1. "I will have to curl up like a halloween cat." Intrathecal indicated into the CNS via a lumbar puncture. Client will be positioned with the back arched for HCP to be able to insert needle between the vertebrae

The client is admitted with severe low back pain and prescribed the muscle relaxant methocarbamol (Robaxin), IVPB every 8 hours. Which nursing intervention has priority when administering this medication? 1. Ask the client to lie flat for 15 minutes following the IV infusion. 2. Infuse at a rapid rate of 200-250 mL/hr via an infusion pump. 3. Assess the IV site for extravasation after the infusion is complete. 4. Monitor liver function laboratory tests daily.

1. Ask the client to lie flat for 15 minutes following the IV infusion. Client should be kept recumbent during and for at least 15 minutes after administration of Robaxin to reduce risk of orthostatic hypotension

The female client with osteoarthritis tells the clinic nurse that she started taking the herb ginkgo. Which intervention should the nurse implement? 1. Determine what medications the client is currently taking. 2. Praise the client because this herb helps decrease inflammation. 3. Notify the health-care provider that the client is taking ginkgo. 4. Examine why the client thought she needed to take herbs.

1. Determine what medications the client is currently taking. Determine if client is taking any medications that may interact with the herb. Gingko, dong quai, feverfew, and garlic may cause bleeding when taking with NSAIDs

The client diagnosed with low back pain is prescribed morphine sulfate, an opioid analgesic. Which interventions should the nurse implement? Select all that apply. 1. Discuss with the HCP starting the client on a stool softener. 2. Teach the client about rating the pain on a numeric pain scale. 3. Inform the client to rise quickly from a supine position. 4. Administer anticonvulsant medications around the clock. 5. Tell the client to call for assistance when getting out of bed.

1. Discuss with the HCP starting the client on a stool softener. 2. Teach the client about rating the pain on a numeric pain scale. (so that effectiveness of interventions can be evaluated) 5. Tell the client to call for assistance when getting out of bed.

The client is taking acetylsalicylic acid (ASA) four to five times a day for severe osteoarthritic pain. Which teaching interventions should the nurse discuss with the client? Select all that apply. 1. Do not drink any type of alcoholic beverages. 2. Keep the ASA bottle out of the reach of children. 3. Inform the dentist about taking high doses of ASA. 4. Maintain a serum salicylate level between 15 and 30 mg/dL. 5. Explain that ringing in the ears is a common side effect.

1. Do not drink any type of alcoholic beverages. 2. Keep the ASA bottle out of the reach of children. 3. Inform the dentist about taking high doses of ASA. 4. Maintain a serum salicylate level between 15 and 30 mg/dL.

The nurse is administering medications to clients on an orthopedic unit. Which medication should the nurse question? 1. Ibuprofen (Motrin), an NSAID, to a client with back pain and a history of ulcers 2. Morphine, an opioid analgesic, to a client with chronic back pain 3. Methocarbamol (Robaxin), a muscle relaxant, to a client with chronic back pain 4. Propxyphene (Darvon N), a narcotic agonist, to a client with mild back pain

1. Ibuprofen (Motrin), an NSAID, to a client with back pain and a history of ulcers NSAIDs decrease prostaglandin production in stomach which increases client'r risk of developing ulcers

The client is prescribed raloxifene (Evista), a selective estrogen receptor modulator (SERM). Which information should the nurse discuss with the client? 1. Instruct the client to walk for 10 minutes every hour when traveling in a car. 2. Encourage the client to decrease smoking cigarettes and drinking alcohol. 3. Explain that Evista will decrease the hot flashes experienced with menopause. 4. Discuss the importance of performing non-weightbearing activities.

1. Instruct the client to walk for 10 minutes every hour when traveling in a car. Raloxifene (Evista) increases the risk of venous thrombosis, client should avoid prolonged immobilization such as driving long distances

The client with osteoporosis is prescribed sodium fluoride, a mineral. Which information should the nurse discuss with the client? Select all that apply. 1. Monitor serum fluoride levels every 3 months. 2. Have bone mineral density studies monthly. 3. Maintain an adequate calcium intake. 4. Sprinkle medication on food. 5. Walk 30 minutes a week on a hard surface.

1. Monitor serum fluoride levels every 3 months. 3. Maintain an adequate calcium intake. (client should continue taking calcium no matter what medication is prescribed to help prevent or treat osteoporosis) 5. Walk 30 minutes a week on a hard surface. (helps increase bone density)

Which assessment data should the nurse expect for the client with rheumatoid arthritis who is taking sulfasalazine (Azulfidine), an antirheumatic medication? 1. Orange or yellowish discoloration of the urine. 2. Ulcers and irritation of the mouth. 3. Ecchymosis of the lower extremities. 4. A red, raised skin rash over the back.

1. Orange or yellowish discoloration of the urine. This is expected and is not significant

Which instruction should the nurse discuss with the client diagnosed with rheumatoid arthritis who is prescribed methotrexate, a disease-modifying antirheumatic drug (DMARD)? 1. Use a soft-bristled toothbrush when brushing teeth. 2. Wear warm clothes when it is less than 40°F. 3. Gargle with mouthwash at least four times a day. 4. Use a sunscreen with an SPF 15 or lower when outside.

1. Use a soft-bristled toothbrush when brushing teeth. Methotrexate may cause bone marrow depression which may lead to abnormal bleeding

Which statement indicates the postmenopausal client with osteoporosis understands the medication teaching concerning the bisphosphonate alendronate (Fosamax)? 1. "I do not use sunscreen when working outside in my yard." 2. "I take the medication with 6-8 ounces of tap water." 3. "I drink orange juice when I take the medication at breakfast." 4. "I may experience some heartburn when taking this medication."

2. "I take the medication with 6-8 ounces of tap water." Must be taken with water to ensure proper swallowing and reduces risk of mouth or throat irritation

The client with rheumatoid arthritis is prescribed prednisone, a glucocorticoid, for an acute episode of pain. The client asks the nurse, "Why can't I be on this forever since it helps the pain so much?" Which statement is the nurse's best response? 1. "The medication will cause you to have a buffalo hump or moon face." 2. "The medication has long-term side effects, such as osteoporosis." 3. "If you continue taking the medication, it may cause an addisonian crisis." 4. "There are other medications that can be prescribed to help the pain."

2. "The medication has long-term side effects, such as osteoporosis." Prednisone has serious long-term effects that can lead to possible life-threatening complications

The client presents to the outpatient clinic complaining of back pain. Which assessment question should the nurse ask first? 1. "What activity did you do to hurt your back?" 2. "Which over-the-counter medications have you taken?" 3. "Have you used illegal drugs to treat the back pain?" 4. "Did you miss any work time because of this pain?"

2. "Which over-the-counter medications have you taken?" Priority is to determine what medications have been tried in order to assess full extent of injury

The client with rheumatoid arthritis has been taking methotrexate, a disease modifying antirheumatic drug (DMARD), for 2 weeks. Which laboratory data warrants intervention by the nurse? 1. A serum creatinine level of 0.9 mg/dL. 2. A red blood cell count of 2.5 million/mm. 3. A white blood cell count of 9000 mm. 4. A hemoglobin of 14.5 g/dL and hematocrit of 43%

2. A red blood cell count of 2.5 million/mm. This RBC count indicates anemia. Normal RBC is 4.6-6million/mm for men and 4.0-5.0 million for women

The client with severe osteoarthritis of the left knee is receiving sodium hyaluronate (Hyalgan) injected directly into the left knee. Which information should be discussed with the client? 1. Explain that this medication will cause some bleeding into the joint. 2. Instruct the client to avoid any strenuous activity for 48 hours after injection. 3. Discuss that the medication will be injected daily for 7 days. 4. Tell the client that strict bed rest is required for 24 hours after the injection.

2. Instruct the client to avoid any strenuous activity for 48 hours after injection. Client can walk and perform routine daily activities but running, cycling, or strenuous activity should be avoided. Hyalgan is a preparation of a chemical normally found in high amounts in the synovial fluid. The injection replaces body's natural hyaluronic acid that deteriorates as a result of osteoarthritis.

The client with osteoarthritis who is taking the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID), calls the clinic and reports having black, tarry stools. Which intervention should the clinic nurse implement? 1. Ask if the client is taking any type of iron preparation. 2. Tell the client to not take any more of the Celebrex. 3. Instruct the client to bring a stool specimen to the clinic. 4. Explain that this is a side effect of the medication.

2. Tell the client to not take any more of the Celebrex. NSAIDs are notorious for causing gastrointestinal upset and peptic ulcer disease. Black tarry stools indicate GI bleeding and client should stop taking medication

The nurse is completing the preoperative checklist for a client diagnosed with a herniated disc. Which information is priority for the nurse to notify the operating room staff? 1. The client complaining of a headache 2. The client allergic to iodine and aspirin 3. The client has not had anything to drink 4. The client's hematocrit is 43%

2. The client allergic to iodine and aspirin Standard surgical scrub is a povidone-iodine (Betadine) antiseptic skin preparation, allergy to Iodine should be reported immediately

Which assessment data best indicates to the nurse that the medication therapy for a client with osteoporosis has been effective? 1. The client's serum calcium level is 7.5 mg/dL. 2. The client does not experience any pathological fractures. 3. The client has adequate urinary output. 4. The client loses less than 1 inch in height.

2. The client does not experience any pathological fractures. Normal calcium level is 8.5-11.5. Decreased bone density puts a client with osteoporosis at risk for pathologic fractures.

Which statement indicates the 30-year-old client does not understand the teaching concerning how to prevent osteoporosis? 1. "I need to take at least 1500 mg of calcium daily." 2. "Milk and dairy products are good sources of vitamin D." 3. "I must get shots weekly to increase my calcium level." 4. "I should take steps to prevent osteoporosis now."

3. "I must get shots weekly to increase my calcium level." Calcium is not available as an injection. Dietary treatment, sunshine, or calcium supplements are recommended to maintain adequate calcium levels

The client recently diagnosed with rheumatoid arthritis is prescribed 4 grams of aspirin daily. Which statement indicates the client needs more teaching concerning the medication? 1. "I will decrease my dose for a few days if my ears start ringing." 2. "I should take my aspirin with meals, food, milk, or antacids." 3. "I need to take the entire aspirin dose at night before going to bed." 4. "If I have any stomach upset, I will take enteric-coated aspirin."

3. "I need to take the entire aspirin dose at night before going to bed." Should be taken in divided doses

The client diagnosed with rheumatoid arthritis is taking the disease-modifying antirheumatic drug (DMARD) leflunomide (Arava). Which comment by the client warrants intervention by the nurse? 1. "I have noticed that I am starting to lose my hair." 2. "I sometimes get dizzy and drowsy." 3. "My spouse and I are trying to start a family." 4. "I will not get any vaccines while taking this medication."

3. "My spouse and I are trying to start a family." This medication is teratogenic, women must undergo drug elimination and men must take 8g of cholestyramine 3x daily for 11 days to minimize possible risk of harm to fetus his partner is carrying

The nurse is discussing ways to prevent osteoporosis to a group of elderly women. A woman in the audience asks, "Why aren't doctors prescribing hormone replacement therapy?" Which statement by the nurse is most appropriate? 1. "There are many other, better ways to treat osteoporosis than HRT." 2. "HRT treatment is very expensive and many insurances will not pay." 3. "There is an increased risk of cancer and deep vein thrombosis associated with HRT." 4. "Research has shown that it is not effective in treating osteoporosis."

3. "There is an increased risk of cancer and deep vein thrombosis associated with HRT." Research has shown that serious complications can occur from HRT use; therefore, it is no longer recommended

The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. Ibuprofen (Motrin), an NSAID, to a client receiving furosemide (Lasix). 2. Nabumetone (Relafen), a COX-2 inhibitor, to a client receiving digoxin (Lanoxin). 3. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin). 4. Ketorolac (Toradol), an NSAID, intramuscularly to a client on a morphine PCA.

3. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin). Aspirin displaces Warfarin from protein binding sites and will increase the client's bleeding

The elderly client in the hospital is complaining of arthritic pain. Which intervention should the nurse implement? 1. Administer meloxicam (Mobic), an NSAID COX-2 inhibitor. 2. Administer acetylsalicylic acid (ASA), a salicylate. 3. Administer acetaminophen (Tylenol), a nonnarcotic analgesic. 4. Administer morphine intravenous push, a narcotic analgesic.

3. Administer acetaminophen (Tylenol), a nonnarcotic analgesic. Acetaminophen is generally preferred for use in older adults because it has fewer toxic effects

At 0900 the charge nurse observes the primary nurse crushing an enteric-coated aspirin in the medication room. Which action should the charge nurse implement? 1. Take no action because this is an acceptable standard of practice. 2. Correct the primary nurse's behavior in the medication room. 3. Explain that enteric-coated medication should not be crushed. 4. Complete an adverse occurrence report on the primary nurse.

3. Explain that enteric-coated medication should not be crushed. ASA should be crushed, enteric coating ensures that medication will dissolve in small intestine. Crushing pill will lead to absorption in the stomach.

The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with back pain. Which HCP order should the charge nurse question? 1. Physical therapy for hot packs and massage 2. CBC and CMP (complete metabolic panel) 3. Hydrocodone (Vicodin), an opioid analgesic, PRN. 4. Carisoprodol (Soma), a muscle relaxant, po, b.i.d.

3. Hydrocodone (Vicodin), an opioid analgesic, PRN. This medication is incomplete, nurse should contact HCP for a time limitation

Which statement best describes the scientific rationale for administering calcitonin (Calcimar) to a client diagnosed with osteoporosis? 1. It blocks estrogen receptors in the uterus and breast. 2. It inhibits bone reabsorption by suppressing osteoclast activity. 3. It increases bone density and reduces the risk of vertebral fractures. 4. It increases the progesterone and estrogen levels in the blood.

3. It increases bone density and reduces the risk of vertebral fractures. Calcimar is a natural product obtained from salmon and is approved for treatment of osteoporosis in women who are more than 5 years postmenopause

The client is diagnosed with low back pain and is prescribed the muscle relaxant cyclobenzaprine (Flexeril). Which instruction should the clinic nurse teach the client? Select all that apply 1. Take the medication just before leaving home from work each day 2. Drink a full glass of water with each dose of medication 3. The medication can cause drowsiness that will make driving unsafe 4. Divide the dose of medication between early morning and bedtime 5. Suck on a hard candy if the client experiences dry mouth

3. Medication can cause drowsiness that will make driving unsafe (medication acts on CNS and can cause drowsiness) 5. Suck on a hard candy if dry mouth is experienced (side effect of medication is dry mouth)

The long-term care nurse is preparing to administer calcium gluconate (Kalcinate) to a client with osteoporosis. Which data warrants the nurse questioning administering this medication? 1. The client asks the nurse for a walker to ambulate. 2. The client's oral intake is 850 mL and urinary output is 1250 mL. 3. The client is lethargic, is drowsy, and has increasing weakness. 4. The client has abnormal bleeding when brushing the teeth.

3. The client is lethargic, is drowsy, and has increasing weakness. Nurse must monitor for signs of hypercalcemia such as drowsiness, lethargy, weakness, headache, anorexia, nausea or vomiting, increased urination and thirst.

The client with chronic low back pain has been taking baclofen (Lioresal), a muscle relaxant. Which instruction should the nurse review with the client? 1. The medication can cause gastric ulcer formation. 2. The client may consume no more than one glass of wine per day. 3. The medication must be tapered off when discontinued. 4. The client should not take the medication before bedtime.

3. The medication must be tapered off when discontinued. Abrupt withdrawal after prolonged use can cause anxiety, agitated behavior, hallucinations, severe tachycardia, acute spasticity, and seizures.

The HCP is administering an intraarticular corticosteroid mixed with lidocaine to a client with severe osteoarthritis in the right knee. Which statement by the client warrants intervention by the nurse? 1. "I have taken off work tomorrow so I can rest my knee." 2. "I am attending physical therapy once a week." 3. "I alternate heat and ice on my knee when I am having pain." 4. "I had one of these just last month and it really helped the pain."

4. "I had one of these just last month and it really helped the pain." Injection should not be done more than every 4-6 months because it can hasten the rate of cartilage break down

The client with rheumatoid arthritis is prescribed hydroxychloroquine sulfate (Plaquenil), a disease-modifying antirheumatic drug (DMARD). Which statements indicate the client needs more teaching concerning the medication? Select all that apply. 1. "I will get my eyes checked every 6 months." 2. "I should not drink alcohol while taking this drug." 3. "It is important to take this medication with milk." 4. "I will call my HCP if the pain is not relieved in 2 weeks." 5. "It is common to have a loss of balance while taking Plaquenil."

4. "I will call my HCP if the pain is not relieved in 2 weeks." (medication takes 3-6 months to achieve desired outcome) 5. "It is common to have a loss of balance while taking Plaquenil." (loss of balance and coordination is an adverse effect and client should notify HCP)

The client with rheumatoid arthritis is taking etodolac (Lodine), a nonsteroidal anti-inflammatory drug (NSAID). The client is complaining of a headache. Which intervention should the nurse implement? 1. Administer two aspirins to the client. 2. Administer an additional dose of Lodine. 3. Administer one oral narcotic analgesic. 4. Administer two acetaminophen (Tylenol).

4. Administer two acetaminophen (Tylenol). Acetaminophen a nonnarcotic analgesic is me most appropriate medication to give to a patient experiencing a headache and is taking an NSAID

The nurse is administering 0900 medications to clients on a medical unit. Which medication should be administered first? 1. MS Contin, a narcotic analgesic, to a client with low back pain. 2. Chlorzoxazone (Parafon Forte), a muscle relaxant, to a client on bedrest. 3. Acetaminophen (Tylenol), an analgesic, to a client with a headache. 4. Diazepam (Valium), a benzodiazepine, to a client with muscle spasms.

4. Diazepam (Valium), a benzodiazepine, to a client with muscle spasms. Muscle spasms can be extremely painful, this medication should be administered first

The client with osteoarthritis of the hands is prescribed capsaicin (Capsin) cream, a nonopioid topical analgesic. Which intervention should the nurse discuss with the client concerning this medication? 1. Wash the hands immediately after applying the cream. 2. Remove cream immediately if burning of the skin occurs. 3. Apply a heating pad to the affected area after applying the cream. 4. Do not remove the cream for at least 30 minutes after application

4. Do not remove the cream for at least 30 minutes after application Cream should be kept in place at least 30 minutes because it is being administered for osteoarthritis of the hands, if not being applied for hands then the cream should be washed of immediately

The client with postmenopausal osteoporosis is prescribed calcitonin (Calcimar) intranasal. Which instruction should the nurse discuss with the client? 1. Notify the health-care provider if nausea and vomiting occur. 2. Decrease calcium and vitamin D intake during drug therapy. 3. Remove the nasal spray from the refrigerator immediately before using. 4. Expect to experience rhinitis when taking the medication.

4. Expect to experience rhinitis when taking the medication. Rhinitis, or a runny nose, is the most common side effect with calcitonin nasal spray. Patient should not quit medication if this side effects occurs.

The client with rheumatoid arthritis is prescribed capsaicin (Zostrix), a topical analgesic. Which information should the nurse discuss with the client? 1. Apply the cream as needed for severe arthritic pain. 2. Notify the HCP if burning of the skin occurs after application. 3. It may take up to 3 months for the medication to become effective. 4. Rub the cream into skin until no cream is left on the surface

4. Rub the cream into skin until no cream is left on the surface Hand should also be washed immediately after cream is applied to skin

The postmenopausal client is prescribed alendronate (Fosamax), a bisphosphonate, to help prevent osteoporosis. Which information should the nurse discuss with the client? Select all that apply. 1. Chew the tablet thoroughly before swallowing. 2. Eat a meal prior to taking the medication. 3. Drink one glass of water when taking the medication. 4. Take the medication first thing in the morning. 5. Remain upright 30 minutes after taking the medication

4. Take the medication first thing in the morning. (medication will irritate stomach and esophagus if client lies down - should be taken first thing in the morning) 5. Remain upright 30 minutes after taking the medication (facilitates passage to stomach and minimizes risk of esophageal irritation)