Pharmacology HESI - Musculoskeletal System Drugs

The client is given medication instructions for maintenance therapy for oral dantrolene sodium for the treatment of spasticity. Which client statement indicates understanding of the instructions? "I will take 50 mg once a day." "I will take 100 mg twice a day." "I will take 100 mg of this medication once a day." "I will take 200 mg of this medication 4 times a day."

"I will take 100 mg twice a day." 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 two to four times daily. If beneficial effects do not develop within 45 days, dantrolene therapy should be discontinued. Strategy: Focus on the subject, dantrolene sodium. Knowledge of the adult oral dosage is required to answer this question. Recall that this maintenance dosage is 100 mg two to four times daily.

Centrally Acting Skeletal Muscle Relaxants: **Cyclobenzabrine** **Baclofen** Metaxolone Carisoprodol

Action: reduces tonic somatic muscle activity Therapeutic effect: Reduction in muscle spasm and hyperactivity Side effects: dizziness, drowsiness, dry mouth, blurred vision, constipation, urinary retention (can't see pee, spit, or shit) Teaching: may cause drowsiness, dizziness, blurred vision -- don't take w/ alcohol or other CNS depressants -- take with food -- increase fluid intake to prevent constipation -- good oral hygiene and sugarless gum or candy for dry mouth

Allopurinol

Class: Antigout Action: inhibits production of uric acid Therapeutic effect: lowers serum uric acid levels Side effects: drowsiness, diarrhea, hepatitis, N/V, renal failure, rash, urticaria, bone marrow supression (AV) Life threatening: stevens-johnson syndrome Teaching: report skin rash or flu symptoms (indicates hypersensitivity rxn) -- take with food to minimize GI distress -- increase fluid intake

Celecoxib

Class: COX-2 inhibitor Inducations: arthritis, acute pain, ankylosing spondylitis, primary dysmenorrhea Action: Inhibits the enzyme COX-2 (needed for prostaglandin synthesis) -- analgesic, anti-inflammatory, and antipyretic properties Therapeutic effects: Decreased pain and inflammation Side effects: abdominal pain, diarrhea, flatulence, nausea, edema, hypertension, rash Life threatening: HF, MI, stroke, thrombosis, exfoliate dermatitis, Stevens-johnson syndroms, toxic epidermal necrolysis Contraindications: Hypertension, HF, stomach ulcers, past GI bleeding, allergy to sulfonamides, asprin, or NSAIDs Teaching: report rash, nausea, fatigue, lethargy, itching, jaundice, URQ tenderness, flu-like symptoms, or edema -- watch for GI bleeding (stomach pain, black-red tarry, odorous stools)

Dantroline

Class: Direct0Acting Skeletal Muscle Relaxant Indications: stoke, spinal cord injury, cerebral palsy, multiple sclerosis -- EMGY treatment of malignant hyperthermia Action: Acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells -- prevents catabolic process with malignant hyperthermia Theraputic effect: reduced muscle spasticity Side effects: flushing, diarrhea, dizziness, drowsiness, muscle weakness, visual disturbances Life threatening: hepatotoxicity, anaphylaxis Lab considerations: Monitor liver fxn frequently (AST, ALT, alkaline phosphatase, bilirubin, GGT) Teaching: If a dose is missed, do not take unless remembered within 1 hr -- may cause dizziness, drowsiness, visual disturbances, and muscle weakness -- avoid taking alcohol or other CNS depressants -- wear sunscreen

Colchicine

Class: antigout Action: interferes with WBCs in the inflammatory response to monosodium urate crystals Therapeutic effects: decreased pain and inflammation in acute gout attacks -- reduced number of gout attacks Contraindications: renal and hepatic impairment Side effects: diarrhea, N/V, abdominal pain, anuria, renal damage, alopecia, peripheral neuritis, bone marrow supression (AV), thrombocytopenia Life threatening: Agranulocytosis, aplastic anemia Teaching: don't consume alcohol -- report N/V, abdominal pain, diarrhea, unusual bleeding, brusing, sore throat, fatigue, malaise, or rash -- increase fluid intake -- take oral doses with food to reduce GI upset Other: cumulative dose by any route should not exceed 4 mg as it can be fatal

Neostigmine Pyridostigmine

Class: cholinergic -- antimyasthenics Indications: myasthenia gravis, postoperative bladder distention/urinary retention Action: Inhibits the breakdown of acetylcholine -- causes muscular contraction Side effects: SLUDGE (salivation, lacrimation, urination, diarrhea, GI distress, emisis), sweating, bradycardia, abdominal cramps, bronchospasm Life threatening: Seizures Teaching: lifelong treatment required -- space out activities to avoid fatigue

Calcitonin

Class: hormone, hypocalcemic agent Indications: Paget's disease of bone, postmenopausal osteoporosis, hypercalcemia Action: Inhibits osteoclastic bone resorption and promotes renal excretion of calcium Therapeutic effects: decreases bone turnover rate -- lowers serum calcium Side effects: facial flushing, rhinitis, N/V, altered taste, injection site rxn Life threatening: Malignancy, anaphylaxis Teaching: report allergy to salmon or other seafood -- have high calcium and vitamin D diet -- flushing and warmth may occur -- report nasal irritation Other: Assess for tetany, monitor ECG and Ca levels (9-10.5), check for Chvostek's and Trousseau's signs

The nurse reviews the medication history of a client and notes that the client is taking leflunomide. During assessment of the client, the nurse should ask which question to determine the effectiveness of this medication. a. "Do you have any joint pain?" b. "Are you having any diarrhea?" c. "Are you experiencing heartburn?" d. "Do you have frequent headaches?"

a. "Do you have any joint pain?" Rationale: Leflunomide is an immunomodulatory 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 questions in the remaining options are unrelated to the action, use, or effectiveness of the medication. Strategy: Note the strategic word, effectiveness, and focus on the subject, determining medication effectiveness. It is necessary to know the medication classification of leflunomide. Recalling that leflunomide has anti-inflammatory effects will direct you to option a.

The nurse teaches the client with hypocalcemia how to take calcium carbonate. Which statement by the client indicates an understanding of the instructions? a. "I should take the tablet an hour after lunch." b. "I should swallow the tablet whole with toast at breakfast." c. "I should crush the tablet and take it with applesauce at breakfast." d. "I should cut the tablet in half and take it with ice cream after dinner."

a. "I should take the tablet an hour after lunch." Rationale: Calcium carbonate is best administered 1 to 1½ hours after meals. The tablets should be given with a full glass of water. Therefore, options 2, 3, and 4 are incorrect times and methods for administration. Strategy: Eliminate options 2, 3, and 4 because they are comparable or alike and indicate that the medications should be taken with food. Remember that it is best to take calcium carbonate 1 to 1½ hours after meals.

The nurse is giving medication instructions to a client who is receiving baclofen as maintenance therapy. Which client statement about the maintenance dose of baclofen indicates that education was effective? a. "I will take 15 mg four times daily." b. "I will take 30 mg four times daily." c. "I will take 25 mg of this medication four times daily." d. "I will take 40 mg of this medication four times daily."

a. "I will take 15 mg four times daily." Rationale: Baclofen is dispensed in tablets of 10 and 20 mg for oral use. Dosages are low initially and then are increased gradually. Maintenance doses range from 15 to 20 mg administered 3 to 4 times a day. Strategy: Note the strategic word, effective, and the subject, dosing for this medication. Knowledge about the normal adult maintenance dosage is required to answer this question. Remember that maintenance doses range from 15 to 20 mg administered 3 to 4 times a day.

The nurse overhears the primary health care provider (PHCP) tell a client with rheumatoid arthritis that the condition needs to be treated with gold therapy. The nurse interprets that the PHCP is referring to which medication? a. Auranofin b. Prednisone c. Pentostatin d. Fludarabine phosphate

a. Auranofin Rationale: Auranofin is a gold preparation used to manage rheumatoid arthritis in clients with insufficient therapeutic response to nonsteroidal anti-inflammatory drugs. Prednisone is a corticosteroid. Pentostatin and fludarabine phosphate are antineoplastic agents. Strategy: Eliminate pentostatin and fludarabine phosphate first because they are comparable or alike and are both antineoplastic agents. Regarding the remaining choices, recalling that prednisone is a corticosteroid will direct you to the correct option.

The primary health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication will be administered intrathecally. Which medication should the nurse expect to be prescribed and administered by this route? a. Baclofen b. Chlorzoxazone c. Dantrolene sodium d. Cyclobenzaprine hydrochloride

a. Baclofen Rationale: Baclofen is the skeletal muscle relaxant that can be administered intrathecally, which means within the spinal column. Therefore, the remaining options are incorrect. Strategy: Focus on the subject, the medication that can be administered by the intrathecal route. Knowledge about intrathecal administration of muscle relaxants is required to answer this question. Remember that baclofen is the skeletal muscle relaxant that can be administered intrathecally within the spinal column.

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply. a. Control of symptoms during periods of emotional stress b. Normal white blood cell, platelet, and neutrophil counts c. Radiological findings that show no progression 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 the injection is given f. A low-grade temperature on rising in the morning that remains throughout the day

a. Control of symptoms during periods of emotional stress b. Normal white blood cell, platelet, and neutrophil counts c. Radiological findings that show no progression of joint degeneration d. 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 the progression of joint degeneration. In addition, an improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection. Strategy: Focus on the subject, acceptable responses to therapy. Recalling that signs of an infection can indicate an unexpected and unwanted finding will assist in eliminating options e and f.

Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide? a. Drink 3000 mL of fluid a day. b. Take the medication on an empty stomach. c. The effect of the medication will occur immediately. d. Any swelling of the lips is a normal expected response.

a. Drink 3000 mL of fluid a day. Rationale: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day, unless otherwise contraindicated. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with, or immediately after, meals or milk. A client who develops a rash, irritation of the eyes, or swelling of the lips or mouth should contact the primary health care provider because this may indicate hypersensitivity. Strategy: Focus on the subject, client instructions for allopurinol. Option d can be eliminated easily because it indicates hypersensitivity, which is not a normal expected response. From the remaining options, recalling that this medication is used to treat gout and recalling the pathophysiology of this disorder will direct you to the correct option.

Etanercept is prescribed for a client with rheumatoid arthritis. The nurse should monitor the client for which side/adverse effect of the medication following administration? a. Dyspnea b. Headache c. Dizziness d. Abdominal discomfort

a. Dyspnea Rationale: Etanercept is an antiarthritic medication that is administered via the subcutaneous route. Side/adverse effects include heart failure (noted by manifestations of dyspnea and congested lung sounds on auscultation), hypertension or hypotension, pancreatitis, or gastrointestinal hemorrhage. Headache, dizziness, and abdominal discomfort are not side/adverse effects of the medication. Strategy: Focus on the subject, side/adverse effects. Use the ABCs-airway, breathing, and circulation-to direct you to the correct option.

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, would indicate a need to contact the primary health care provider about the administration of this medication? a. Glaucoma b. Emphysema c. Hypothyroidism d. Diabetes mellitus

a. 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 conditions in options 2, 3, and 4 are not a concern with this medication. Strategy: Focus on the subject, a contraindication to cyclobenzaprine. Recalling that this medication has anticholinergic effects will direct you to the correct option.

Allopurinol has been prescribed for a client with a diagnosis of gout. The nurse develops a list of instructions for the client regarding the use of this medication. Which measures should be included on the list? Select all that apply. a. Increase fluid intake. b. Take the medication with food. c. Consume items to maintain an alkaline urine. d. Take vitamin C daily to enhance the effects of the medication. e. Return to the health care clinic for liver and renal function tests.

a. Increase fluid intake. b. Take the medication with food. c. Consume items to maintain an alkaline urine. e. Return to the health care clinic for liver and renal function tests. Rationale: The client taking allopurinol should be instructed to return to the clinic for monitoring of liver and renal function studies, particularly during the first month of therapy because of the risk of hepatotoxicity and nephrotoxicity. The client should take the medication with food and should maintain an adequate fluid intake. The client should be instructed to maintain an alkaline urine and to avoid large doses of vitamin C. Strategy: Focus on the subject, client instructions for gout. Think about the pathophysiology associated with gout. Recalling that the goal is to decrease uric acid will assist you in answering correctly.

What should the nurse anticipate when evaluating for the effects of raloxifene in an older client? a. Increased bone density b. Relief of leg cramps and tenderness c. A decrease in severity of hot flashes d. A resumption of the menstrual cycle

a. Increased bone density Rationale: Raloxifene is an estrogen receptor modulator. It was developed to limit the side and adverse effects of estrogen while producing beneficial effects. The purpose of this medication is to increase bone mineral density. Leg tenderness or cramps can indicate deep vein thrombosis, which is an adverse effect of raloxifene. The modulating effects of this medication can lead to hot flashes and vaginal bleeding. Strategy: Focus on the subject, the therapeutic effect of this medication. Note that decrease in severity of hot flashes and resumption of the menstrual cycle are hormone-related effects that will not be seen in an older client who is taking this medication for osteoporosis. In addition, leg cramps and tenderness can be eliminated because they suggest deep vein thrombosis, which would be an adverse effect of this medication. Recalling that this medication is an estrogen receptor modulator used for osteoporosis will assist in directing you to the correct option.

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

a. Naproxen b. Colchicine d. Indomethacin Rationale: Clients beginning medication therapy with allopurinol may also have to take colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs) because of the risk of an acute gouty attack after first starting allopurinol. Colchicine and NSAIDs help to prevent the acute gouty attack from occurring. Oxycodone and hydromorphone are opioid analgesics and do not assist in preventing an attack. Strategy: Focus on the subject, client instructions for allopurinol. Think about the pathophysiology associated with the client's diagnosis. Note that the correct options assist in preventing an acute attack.

An older client with rheumatoid arthritis has been instructed by the primary health care provider to take ibuprofen 400 mg orally (PO) three times daily. The home care nurse reading the medication prescription knows that the instruction has been effective when the client states the instructed dose is which? a. The normal adult dose b. Higher than the normal adult dose c. An unusual dosage for this diagnosis d. Two times higher than the normal adult dose

a. The normal adult dose Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose for an older client is 400 to 800 mg three or four times daily. The other options are incorrect. Strategy: Note the strategic word, effective. Focus on the subject, proper dosing for ibuprofen. Knowledge of the normal dosage for ibuprofen is required to answer this question. Noting the diagnosis of the client in the question and that the client is an older client will assist in directing you to the correct option.

The nurse is reviewing the primary health care provider's prescriptions for an adult client who has been admitted to the hospital after a back injury. Carisoprodol is prescribed for the client to relieve the muscle spasms. The primary health care provider has prescribed 350 mg to be administered 4 times a day. What should the nurse conclude? a. The prescription is the normal adult dosage. b. The prescription is lower than normal dosage. c. The prescription is higher than normal dosage. d. The dosage prescribed requires further clarification with the health care provider.

a. The prescription is the normal adult dosage. Raionale: The normal adult dosage for carisoprodol is 350 mg orally three to four times daily. Strategy: Focus on the subject, normal dosing for this medication. This question may be difficult if you are not familiar with the normal medication dosage. Remember that the normal adult dosage for carisoprodol is 350 mg orally three to four times daily.

The home care nurse is visiting a client who sustained a severe muscle sprain to the back. Carisoprodol is prescribed for the client. The nurse provides instructions to the client regarding the medication and should teach the client to take which measure? a. To avoid driving until the reaction to the medication is known b. To understand that muscle spasms will be reduced but the pain may increase c. To limit alcohol consumption to 2 drinks daily while taking the medication d. To try to avoid missing doses, but if a dose is missed to take it as soon as it is remembered

a. To avoid driving until the reaction to the medication is known 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 also should be avoided until the client's reaction to the medication is known. The medication is used to reduce muscle spasticity and pain. Missed doses should be taken if remembered within 1 hour. Strategy: Focus on the subject, client medication instructions, and on the client's diagnosis, severe muscle sprain. Recalling that this medication is a skeletal muscle relaxant will assist in directing you to the correct option.

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information should the nurse include in the instructions? a. Watch for urinary retention as a side effect. b. Stop taking the medication if diarrhea occurs. c. Restrict fluid intake while taking this medication. d. Notify the primary health care provider if fatigue occurs.

a. Watch for urinary retention as a side effect. Rationale: Baclofen, a skeletal muscle relaxant, also is a central nervous system (CNS) depressant, which can cause urinary retention. The client should not restrict fluid intake. Constipation, rather than diarrhea, is an adverse effect of baclofen. Fatigue is a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary to notify the primary health care provider if fatigue occurs. Strategy: Focus on the subject, client teaching related to baclofen. Recalling that baclofen has CNS depressant properties will direct you to the correct option. Also, using general principles of medication administration and side effects will assist you in selecting the correct option.

The nurse is preparing discharge instructions for a client who sustained a skeletal muscle injury and is receiving baclofen. Which instruction should be included in the teaching plan? a. Restrict fluid intake. b. Avoid the use of alcohol. c. Stop the medication if diarrhea occurs. d. Notify the primary health care provider (PHCP) if fatigue occurs.

b. 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 a 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. Strategy: Focus on the subject, teaching points for baclofen. Recalling that baclofen is a skeletal muscle relaxant will direct you easily to the correct option. If you were unsure of the correct option, use general principles related to medication administration. Alcohol should be avoided with the use of medications.

A client with multiple sclerosis is receiving baclofen. The nurse assessing the client monitors for which finding as an indication of a primary therapeutic response to the medication? a. Decreased nausea b. Decreased muscle spasms c. Increased muscle tone and strength d. Increased range of motion of all extremities

b. Decreased muscle spasms Rationale: Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases or with multiple sclerosis. 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 an incorrect option. Strategy: Note the strategic word, primary, and focus on the medication classification. Recalling that this medication is a skeletal muscle relaxant will guide you to the correct option.

A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which finding, if noted during the nursing assessment, would indicate that the client is experiencing a side/adverse effect of this medication? a. Headache b. Drowsiness c. Urinary retention d. Increased salivation

b. Drowsiness Rationale: Incoordination and drowsiness are common side/adverse effects of diazepam. The remaining options are unrelated to the use of this medication. Strategy: Focus on the subject, side/adverse effects associated with this medication. Note that the question addresses a centrally acting skeletal muscle relaxant. This will assist in directing you to the correct option.

Dantrolene is prescribed for a client experiencing discomfort caused by spasticity. In providing instructions to the client regarding the medication, what should the nurse emphasize? a. Return to the clinic in 1 month for an eye examination. b. Expect that periodic liver function studies will be required. c. Return to the clinic weekly for blood pressure measurements. d. Expect that the medication may take 8 weeks to begin to have an effect.

b. Expect that periodic liver function studies will be required. Rationale: Dantrolene is a skeletal muscle relaxant and can cause liver damage; the nurse should monitor results of the client's 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 remaining options are not related to the administration of this medication. Strategy: Focus on the subject, the side/adverse effects of dantrolene. Specific knowledge regarding this medication is needed to answer this question. Remember that this medication is hepatotoxic to assist in answering questions similar to this one.

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder? a. Myxedema b. Kidney disease c. Hypothyroidism d. Diabetes mellitus

b. Kidney disease Rationale: Colchicine is used with caution in older clients, debilitated clients, and clients with cardiac, kidney, or gastrointestinal disease. The disorders in options 1, 3, and 4 are not concerns with administration of this medication. Strategy: Focus on the subject, the cautions associated with colchicine. Note that options 1, 3, and 4 are comparable or alike and are endocrine-related disorders. The correct option is different from the others.

The home health nurse is caring for a client who is taking probenecid. The client has been instructed to restrict the diet to low-purine foods. Which food item should the nurse instruct the client to avoid? a. Spinach b. Scallops c. Potatoes d. Ice cream

b. Scallops Rationale: Probenecid is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidneys and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diets to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, yeast, wine, and alcohol. Strategy: Focus on the subject, high-purine foods. Knowledge of food items high in purines is needed to answer correctly. Remember that scallops are high in purines.

The nurse is teaching a client who will be discharged on alendronate about the medication. Which should be included in the teaching plan? Select all that apply. a. Report musculoskeletal pain immediately. b. Take the medication at the same time daily. c. Take the medication on an empty stomach. d. Consume coffee when taking the medication. e. Remain upright for 30 minutes following ingestion.

b. Take the medication at the same time daily. c. Take the medication on an empty stomach. e. Remain upright for 30 minutes following ingestion. Rationale: Alendronate is a bisphosphonate that is used to prevent or treat osteoporosis. The medication needs to be taken in the morning at the same time. In the presence of any solid food, essentially none of the alendronate is absorbed. Even coffee or orange juice can decrease absorption by 60%. Thus, taking the medication on an empty stomach is a priority. The client needs to remain upright for 30 minutes after ingestion to prevent esophagitis. The presence of muscle pain is not associated with alendronate. Strategy: Focus on the subject, client teaching about alendronate. Eliminate option 1 because of the word immediately. Next eliminate option 4 because of the word coffee. The medication needs to be taken with water.

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

b. The white blood cell counts and platelet counts Infection and pancytopenia are adverse effects of etanercept. Laboratory studies are performed prior to 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. Injection site itching is a common occurrence following administration. A metallic taste and loss of appetite are not common signs of adverse effects of this medication.

A client newly diagnosed with gout has been prescribed allopurinol. The nurse would be concerned if the client was also currently taking which medication? a. Digoxin b. Warfarin c. Adenosine d. Ergonovine maleate

b. Warfarin Rationale: Allopurinol is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium is an anticoagulant, and, if this medication was prescribed for the client, the nurse should verify the prescription. The dosage of warfarin may need to be decreased. Digoxin is a cardiac glycoside. Adenosine is an antidysrhythmic. Ergonovine maleate is an antimigraine medication. Strategy: Focus on the subject, medication interactions of allopurinol. Knowledge regarding the medication interactions related to allopurinol is required to answer this question. Remember that allopurinol may increase the effects of an oral anticoagulant.

The nurse is giving medication instructions to a client who is receiving dantrolene sodium. Which statement by the client indicates that the educational session was effective? a. "This medication helps by depressing spinal reflexes." b. "This medication acts on the central nervous system to suppress spasms." c. "This medication acts directly on the skeletal muscle to relieve spasticity." d. "This medication acts within the spinal cord to suppress hyperactive reflexes."

c. "This medication acts directly on the skeletal muscle to relieve spasticity." Rationale: Dantrolene sodium 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. Strategy: Note the strategic word, effective. Focus on the subject, the therapeutic action of dantrolene sodium. Options 1 and 4 address the depression of reflexes, are comparable or alike, and therefore can be eliminated. From the remaining options, it is necessary to know the action of this medication.

Dantrolene sodium has been administered to a client with a spinal cord injury. The nurse determines that the client is experiencing a side or adverse effect of the medication if which is noted? a. Dizziness b. Drowsiness c. Abdominal pain d. Lightheadedness

c. Abdominal pain Rationale: Dantrium is hepatotoxic. The nurse observes for indications of liver dysfunction, which include jaundice, abdominal pain, and malaise. The nurse notifies the primary health care provider if these occur. The signs and symptoms in the remaining options are expected side effects due to the central nervous system-depressant effects of the medication. Strategy: Focus on the subject, an adverse or side effect. Eliminate options 1, 2, and 4 because they are comparable or alike in identifying central nervous system effects.

The nurse is reviewing laboratory results for a client taking dantrolene sodium. The nurse should notify the primary health care provider if which finding is noted on the laboratory report sheet? a. Creatinine level 0.6 mg/dL (53 mcmol/L) b. Platelet count 290,000 mm3 (290 × 109/L) c. Alanine aminotransferase (ALT) 96 U/L (96 U/L) d. Blood urea nitrogen level 10 mg/dL (3.6 mmol/L)

c. Alanine aminotransferase (ALT) 96 U/L (96 U/L) 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 prior to treatment and throughout the treatment interval. It is administered in the lowest effective dosage for the shortest time necessary. The normal alanine aminotransferase is 4 to 36 U/L (same as SI units). The other options indicate normal laboratory results. Strategy: Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate the options creatinine and blood urea nitrogen because these tests both assess kidney function. From the remaining options, it is necessary to recall that this medication affects liver function. Additionally, the ALT is the only abnormal value.

A client has been administered cyclobenzaprine for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. How should the nurse interpret these findings? a. Represent an allergic reaction to the medication b. Are related to the problem with the cervical spine c. Are the most common side effects of this medication d. Are dose related, so the client should cut the medication dose in half

c. Are the most common side effects of this medication Rationale: Drowsiness, dizziness, and dry mouth are the most common side effects of cyclobenzaprine, and these side effects usually diminish with continued therapy. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm that accompanies a variety of conditions. The remaining options are incorrect. Strategy: First, eliminate the option that advises the client to cut the medication dose in half because a client should not be told to adjust a medication dosage. Recalling the signs of an allergic reaction will assist in eliminating that option. Regarding the remaining options, focusing on the subject, expected side effects of medication, and the client's signs and symptoms will direct you to the correct option.

The nurse is administering an intravenous dose of methocarbamol to a client with a muscle skeletal injury. For which adverse effect should the nurse monitor? a. Tachycardia b. Rapid pulse c. Bradycardia d. Hypertension

c. Bradycardia Rationale: Intravenous administration of methocarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these adverse effects. Options 1, 2, and 4 are not effects with administration of this medication. Strategy: Eliminate options a and b first because they are comparable or alike. Knowledge about the specific adverse effects related to the intravenous use of this medication will direct you to the correct option. Remember that hypotension and bradycardia can occur with intravenous administration of methocarbamol

Dantrolene is prescribed for a client with spinal cord injury for discomfort caused by spasticity. Which finding would alert the nurse to a potential adverse effect associated with this medication? a. Headache b. Blurred vision c. Elevated temperature d. Abdominal distention

c. Elevated temperature Rationale: Dantrolene is a centrally acting muscle relaxant. Malignant hyperthermia is a rare but life-threatening adverse effect that can occur with use of this medication. Therefore, an elevated temperature would alert the nurse to this potential adverse effect. Strategy: Focus on the subject, a finding indicative of an adverse effect. Knowledge that this medication can cause malignant hyperthermia will direct you to the correct option.

The nurse is analyzing the laboratory studies on a client receiving dantrolene to treat muscle spasms from an injury. Which laboratory test would identify an adverse effect associated with the administration of this medication? a. Platelet count b. Creatinine level c. Liver function tests d. Blood urea nitrogen level.

c. 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 throughout the treatment interval. Dantrolene is administered at the lowest effective dosage for the shortest time necessary. Strategy: Eliminate options 2 and 4 because these tests assess kidney function and are comparable or alike. From the remaining options, you must recall that this medication affects liver function.

A client is receiving baclofen for muscle spasms because of a spinal cord injury. Which side/adverse effect related to this medication should the nurse monitor the client for? a. Muscle pain b. Hypertension c. Slurred speech d. Photosensitivity

c. Slurred speech Rationale: Side/adverse effects of baclofen include drowsiness, dizziness, weakness, and nausea. Others 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. Strategy: Focus on the subject, side/adverse effect of baclofen. Think about the classification of this medication. Also, focus on the client's diagnosis of spinal cord injury. The correct option is the one that is most closely associated with a neurological disorder.

Probenecid has been prescribed for a client with a diagnosis of gout, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? a. "I need to increase my fluid intake." b. "I need to take the medication with food." c. "I need to have a periodic uric acid level drawn." d. "I should take acetylsalicylic acid for relief of headache."

d. "I should take acetylsalicylic acid for relief of headache." Rationale: The nurse should instruct the client taking probenecid to increase fluid intake to minimize calculous formation. Serum uric acid levels should also be monitored. The client should be instructed to take the medication with food to prevent gastrointestinal upset and to avoid the use of salicylates because they decrease the uricosuric effects of probenecid. Strategy: Note the strategic words, need for further instruction. This phrasing indicates a negative event query and asks you to select an option that is an incorrect statement. Knowledge regarding the medication interactions associated with the use of probenecid is required to answer the question. Remember that salicylates decrease the uricosuric effects of probenecid.

A client is to receive a prescription for methocarbamol. The nurse provides instructions to the client about the medication. Which client statement would indicate a need for further education? a. "My urine may turn brown or green." b. "I might get some nasal congestion from this medication." c. "This medication is prescribed to help relieve my muscle spasms." d. "If my vision becomes blurred, I don't need to be concerned about it."

d. "If my vision becomes blurred, I don't need to be concerned about it." Rationale: Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations) that are sent to the brain. 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 to notify the primary health care provider if these side/adverse effects occur. Strategy: Note the strategic words, need for further education. These words indicate a negative event query and ask you to select an option that is an incorrect statement. This will assist in directing you to the correct option. Blurred vision is an adverse effect and needs to be reported.

Calcium carbonate is prescribed for a client with hypocalcemia. How should the nurse instruct the client to take the medication? a. With meals b. Every 4 hours c. Just before meals d. 1 hour after meals

d. 1 hour after meals Rationale: Calcium carbonate tablets should be taken with a full glass of water 30 to 60 minutes after meals; therefore, the remaining options are incorrect. Strategy: Focus on the subject, method of administration of calcium carbonate. Eliminate options 1 and 3 because they are comparable or alike with regard to time frames. For the remaining options, eliminate the option of every 4 hours because calcium is usually administered daily or twice a day.

The nurse is assigned to care for a client with multiple sclerosis who is receiving an intravenous dose of methocarbamol. The nurse monitors the client knowing that which is an expected side effect? a. Insomnia b. Excitability c. Hypertension d. Dark green-colored urine

d. Dark green-colored urine Rationale: Methocarbamol is a skeletal muscle relaxant. It may cause the urine to turn a brown, black, or dark green color, and the client needs to be told that this is a harmless effect. This medication can cause hypotension. Drowsiness and dizziness can also occur. Therefore, the remaining options are incorrect.

A client with muscle spasms in the lumbar area of the spine has been started on cyclobenzaprine. The nurse should monitor for which most frequent side effect of the medication? a. Weakness b. Confusion c. Excitability d. Drowsiness

d. Drowsiness Rationale: The most common side effects of cyclobenzaprine are drowsiness, dizziness, and dry mouth. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm due to a variety of conditions. Weakness, confusion, and excitability are less frequent central nervous system effects of cyclobenzaprine. Strategy: Note the strategic word, most. Note that the medication is being used to treat muscle spasms. Recalling that the medication is a muscle relaxer and used to treat muscle spasms will assist in directing you to the correct option.

The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem? a. Nausea b. Diarrhea c. Muscle spasms d. Hyperuricemia

d. Hyperuricemia Rationale: Chemotherapy destroys cells, leading to the release of uric acid into the bloodstream. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute kidney injury. Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil therapy to prevent stomatitis. Allopurinol is not used to treat nausea, diarrhea, or muscle spasms. Strategy: Focus on the subject, the purpose of allopurinol in the client receiving chemotherapy. Remember that allopurinol is also used to remove uric acid from the body in clients with gout. This will assist in directing you to hyperuricemia.

The nurse notes that a client has been taking colchicine. The nurse assesses the client for which finding that is an indication for the use of this medication? a. Double vision b. Difficulty urinating c. Migraine headaches d. Joint inflammation and pain

d. Joint inflammation and pain Rationale: Colchicine is classified as an antigout agent that interferes with the ability of the white blood cells to initiate and maintain an inflammatory response to monosodium urate crystals. The client should report a decrease in pain and inflammation in the affected joints and a decrease in the number of gout attacks. The other options are incorrect. Strategy: Focus on the subject, the use of colchicine. Focus on the name of the medication and think about its classification. Recalling that this medication is used in the treatment of gout will direct you to the correct option.

Auranofin has been prescribed for a client with rheumatoid arthritis. The nurse provides instructions to the client about the medication and tells the client to notify the primary health care provider if which occurs? a. Nausea b. Diarrhea c. Loss of appetite d. Metallic taste in the mouth

d. Metallic taste in the mouth Rationale: Auranofin is a gold preparation that is given orally rather than by injection. Gastrointestinal (GI) reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy but usually subside in the first 3 months. Early signs and symptoms of toxic reactions include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth. Signs and symptoms of toxic reactions are reported to the primary health care provider (PHCP). Strategy: Note the words notify the PHCP. Recalling that auranofin is a gold preparation will direct you to the correct option. Also, the options of nausea, diarrhea, and loss of appetite are comparable or alike in that they all are GI signs and symptoms.

The home health nurse is providing dietary instructions to a client who is taking probenecid for the treatment of gout. Which food should the nurse instruct the client to continue to eat? a. Liver b. Shrimp c. Scallops d. Spinach

d. Spinach Rationale: Probenecid inhibits the reabsorption of uric acid by the kidney and promotes excretion of uric acid in the urine. Clients taking this medication are instructed to 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. Strategy: Remember that the client with gout is instructed to limit purine intake. Eliminate the options of shrimp and scallops first because they are comparable or alike in that they are both shellfish that are high in purines. Recalling that organ meats are also high in purines will then direct you to the correct option from the remaining options.

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide? 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. Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal 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. Strategy: Focus on the subject, the administration of alendronate. Recalling that this medication can cause esophageal irritation will direct you to the correct option.

A client who has rheumatoid arthritis has begun treatment with anakinra and has received the first injection. What finding would indicate that the primary health care provider should be notified and that the medication should be discontinued? a. Irritation and erythema at the injection site b. Concurrent therapy with a tumor necrosis factor inhibitor c. No relief of arthritic symptoms during the first week of treatment d. White blood cell count of 12,000 mm3 (12 × 109/L) and a temperature of 99.9º F (37.7º C)

d. White blood cell count of 12,000 mm3 (12 × 109/L) and a temperature of 99.9º F (37.7º C) Rationale: Leukocytosis and a slight temperature elevation can indicate an infection in a client on a biological response modifier. These findings warrant primary health care provider notification and possible discontinuation of the medication. Irritation and erythema are common and can be decreased by rotating the injection sites. Arthritic medications often are given with other medications, such as a tumor necrosis factor inhibitor. Arthritic symptoms often do not lessen early in the treatment.