Musculoskeletal (EXAM#3)

Calcitonin

acts similarly to the calcitonin the thyroid gland produces by increasing the excretion of calcium.

Prior to administering an oral dose of neostigmine (Prostigmin), a cholinesterase inhibitor, to a patient who has myasthenia gravis, you should check for which of the following? Abdominal distention Ability to swallow Excessive oral secretions Presence of bowel sounds

Ability to swallow ​Muscle weakness associated with myasthenia gravis may affect the ability to swallow. Prior to giving an oral medication, the health care provider should evaluate the patient's ability to swallow with sips of water. Neostigmine may cause increased gastric and oral secretions and increased gastric motility.

The health care provider prescribes alendronate (Fosamax) to reduce bone resorption and instructs the patient to monitor for which of the following indications of a serious adverse effect of this drug? Calf inflammation Chest pain Dizziness Dysphagia

Dysphagia Dysphagia (difficulty swallowing) can indicate esophagitis, a rare but serious adverse effect of alendronate. The patient must understand that she has to notify the provider of any pain or difficulty swallowing and of worsening heartburn. Alendronate is unlikely to cause deep-vein thrombosis. This serious adverse effect is more likely with raloxifene (Evista). Alendronate is more likely to cause musculoskeletal pain than chest pain. Alendronate is unlikely to cause dizziness. Dizziness might accompany bradycardia, a potentially serious adverse effect of neostigmine (Prostigmin) and of parenteral calcium interacting with digoxin (Lanoxin).

A patient with rheumatoid arthritis is taking methotrexate. Toxicity from methotrexate may be reduced with which of the following? Folic acid Magnesium sulfate Ferrous sulfate Niacin

Folic acid Folic acid may reduce the toxic effects of methotrexate. Toxicity may be reduced with 5 mg or more of a folic acid supplement per week.

A patient is given raloxifene (Evista), a selective estrogen receptor modulator (SERM), to treat osteoporosis. Which of the following is an adverse effect of raloxifene (Evista)? Hot flashes Breast cancer Blurred vision Jaw pain

Hot flashes Raloxifene may cause hot flashes, leg cramps, and pulmonary embolism. It is used to reduce the risk of breast cancer. Bisphosphonates may cause jaw pain and blurred vision.

Which of the following information in the patient's history causes the health care provider to suspect the patient has osteoporosis? (Select all that apply.) Menopause Calcium supplements Long-term corticosteroid use Weight Loss of height

Menopause Long-term corticosteroid use Loss of height Menopause and long-term corticosteroid use are causes of osteoporosis due to increased bone resorption. Loss of height may be an indication of a compression fracture in the spine due to diminished bone density. Osteoporosis is more common in women who are thin and have a low body mass index (BMI). This patient's BMI is 31.2, which is classifed as overweight. The calcium supplements are not an indication of osteoporosis. Calcium supplements can help prevent osteoporosis.

A calcium supplement is prescribed to prevent osteoporosis in a patient who is postmenopausal. You should instruct the patient to monitor for which of the following indications of hypercalcemia? Eye twitching Bleeding gums Tinnitus Nausea

Nausea Manifestations of hypercalcemia include anorexia, nausea, vomiting, and constipation. Hypocalcemia may cause twitching, tetany, and muscle spasms. Vitamin C deficiency may cause bleeding gums and gingivitis.

The health care provider instructs the patient about the importance of taking the prescribed 1,500 mg/day dosage of calcium carbonate (Tums). Which of the following instructions should the health care provider recommend? Set up a simple reminder system. Take the three tablets at the same time. Reduce fluid intake to increase effectiveness. Take the drug with meals to reduce gastric irritation.

Set up a simple reminder system. If the patient's nonadherence is unintentional, the health care provider can work with her to devise a reminder system that will work for her, such as a calendar, a tablet counter, or a watch alarm routine. Patients should take no more than 600 mg of calcium at one time for optimal absorption. Patients should take calcium carbonate that is supplied in a chewable formulation such as Tums on an empty stomach followed by a full glass of water. Calcium carbonate is also used as an antacid to neutralize gastric acid. It is not necessary to take it with meals to reduce gastric irritation.

A patient is prescribed methotrexate for rheumatoid arthritis. Knowing the adverse effects of methotrexate, you should advise the patient to monitor for which of the following? Dysphagia Sore throat Edema Paresthesia

Sore throat ​Methotrexate may cause bone marrow suppression. The patient should report any sign of infection, such as a sore throat or fever. Dysphagia, edema, and paresthesia (numbness or tingling sensations on the skin) are not common adverse effects of methotrexate. Adverse effects this drug does cause include headache, mucositis, gastric ulcers, gingivitis, and hepatotoxicity.

When instructing the patient about alendronate, which of the following information should the health care provider include? (Select all that apply) Take the drug on an empty stomach. Take the drug before bedtime. Take the drug with an antacid. Sit upright for 30 minutes following dosage. Take with a full glass of water.

Take the drug on an empty stomach. Sit upright for 30 minutes following dosage. Take with a full glass of water. Alendronate should be taken in the morning on an empty stomach for optimal bioavailability. Alendronate should be taken first thing in the morning before breakfast. Patients should wait 30 minutes before taking calcium or an antacid that might reduce the absorption of alendronate. Following dosage, the patient should sit or stand upright for at least 30 minutes to reduce the risk of esophagitis. Patients should wait 30 minutes before taking calcium or an antacid that may reduce absorption of alendronate. Alendronate should be taken with a full glass of water to reduce the risk of esophagitis.

A patient is prescribed etanercept (Enbrel) to treat rheumatoid arthritis. Prior to beginning the treatment, the patient should be tested for which of the following? Pancreatitis Hepatitis Tuberculosis Gastritis

Tuberculosis ​Patients should be tested for tuberculosis prior to treatment with etanercept. Tuberculosis in patients taking etanercept may spread to other organs and be difficult to treat. Patients should be monitored for the development of tuberculosis during etanercept therapy as well.

When administering succinylcholine (Anectine) for relaxation during a surgical procedure, you should remember that succinylcholine provides analgesia. causes sedation. blocks respiratory muscles. reduces anxiety.

blocks respiratory muscles. ​Succinylcholine does not provide analgesia. A sedative should be administered to sedate the patient. Succinylcholine blocks both skeletal and respiratory muscles, making it essential to provide the patient with mechanical ventilation. Succinylcholine does not reduce anxiety.

You are admitting a patient who is awake postoperatively but shows signs of muscle weakness. The patient was given pancuronium in the surgical suite. You should prepare to administer which of the following drugs to reverse the effects of pancuronium? Naloxone Neostigmine (Prostigmin) Succinylcholine (Anectine) Dantrolene (Dantrium)

Neostigmine (Prostigmin) Neostigmine, a cholinesterase inhibitor, is given to reverse the effects of pancuronium, a nondepolarizing neuromuscular blocking agent. Naloxone is an opioid antagonist given to reverse the effects of opioids. Succinylcholine is a depolarizing neuromuscular blocking agent and will cause increased muscle relaxation. Dantrolene is a skeletal muscle relaxant given to treat malignant hyperthermia and spasticity.

The health care provider explains to the patient that there may be a drug interaction between the glucocorticoid and the calcium supplement. Which of the following may occur? The glucocorticoid may cause reduced absorption of the calcium supplement. The glucocorticoid may potentiate the effects of the calcium supplement. The calcium supplement used with the glucocorticoid may cause bradycardia. The calcium supplement may increase the risk for peptic ulcer disease.

The glucocorticoid may cause reduced absorption of the calcium supplement. Because the glucocorticoid can reduce the absorption of calcium, patients should take the calcium supplement 1 hr before or 1 to 2 hr after they take the glucocorticoid. Glucocorticoids can increase potassium loss, but they are unlikely to affect calcium levels without supplements. Parenteral calcium given to patients who are on digoxin (Lanoxin) can cause severe bradycardia. The calcium supplement should not increase the risk for peptic ulcer disease; however, it can increase the risk for renal calculi (kidney stones).

The primary care provider prescribes calcitonin salmon (Miacalcin) for a patient. Knowing the adverse effects of calcitonin, you should instruct the patient to do which of the following? Increase fluid intake. Rise slowly from a reclinining position. Increase calcium intake. Wear sunscreen and protective clothing.

increase calcium intake. ​Calcitonin may cause hypocalcemia due to increased excretion of calcium. Instruct the patient to increase calcium intake and monitor for indications of hypocalcemia, such as muscle cramps and numbness in the fingers or toes. Calcitonin is not known to cause orthostatic hypotension or photosensitivity. Drinking water will not reduce the adverse effects of calcitonin.

Calcium supplements

raise calcium levels and also help neutralize gastric acid.

Bisphosphonates

treat age-related and glucocorticoid-related osteoporosis by reducing the number of osteoclasts

Selective estrogen receptor modulators (SERMs)

treat postmenopausal osteoporosis by mimicking the effects of estrogen on the bones.