Pharmacology - Musculoskeletal System

A nurse is caring for a client who has a new prescription for etanercept. Which of the following actions should the nurse take? 1. administer a tuberculin skin test prior to starting the medication 2. teach the client that fevers are common while taking this medication 3. determine if the client has chronic HTN 4. mix the medication with methotrexate prior to administration

Administer a TB skin test prior to starting the medication ; etanercept is contraindicated for clients who have a history of exposure to tuberculosis.

A nurse is teaching a client about raloxifene therapy to prevent osteoporosis. the nurse should instruct the client to monitor for which of the following indications of an adverse reaction? 1. loss of hair 2. numbness of the fingertips 3. calf pain 4. blisters on mucous membranes

Calf pain ; Raloxifene can increase the risk of DVT. Clients should avoid long periods of inactivity and report any pain, redness, or swelling in the calf.

Etanercept treats rheumatoid arthritis by which of the following actions? 1. inactivation of tumor necrosis factor 2. inhibition of osteoclast activity 3. decreased the reuptake of serotonin 4. interference with the production of lymphocytes

Inactivation of tumor necrosis factor ; this prevents the autoimmune response and subsequent inflammation of the joints.

Which of the following is a manifestation of hypercalcemia? 1. muscle twitching 2. laryngospasm 3. paresthesia 4. vomiting

Vomiting ; other manifestations of hypercalcemia include nausea, vomiting, flank pain, lethargy, and deep bone pain.

Alendronate is contraindicated for administration to clients who have which of the following conditions? 1. heart failure 2. fish protein allergy 3. inability to sit upright 4. tuberculosis

Inability to sit upright ; clients should drink 8oz of water after taking the drug and sit upright or stand for at least 30 min to prevent esophagitis.

The nurse should explain that alendronate increases bone mass by which of the following actions? 1. decreases activity of osteoclasts 2. increases calcium excretion 3. promotes intestinal absorption of calcium and phosphorus 4. reduces action of osteoblasts

Decreases activity of osteoclasts ; osteoclasts cause bone resorption or bone loss.

A nurse is teaching about self-administering methotrexate to a client who has rheumatoid arthritis. Which of the following statements should be include? 1. use an NSAID to reduce toxicity 2. if you miss a dose, take it with the next scheduled dose 3. drink a minimum of 2 liters of water per day to promote excretion 4. take it in the morning to prevent insomnia.

Drink a minimum of 2 liters of water per day to promote excretion ; methotrexate can cause kidney damage. Clients can also take sodium bicarbonate tablets to increase urine alkalinity and reduce the drug precipitation.

Which of the following would likely be prescribed in conjunction with methotrexate during the initial treatment for rheumatoid arthritis? 1. aspirin 2. salicylates 3. sulfonylureas 4. ibuprofen

Ibuprofen ; NSAIDs are often prescribed with methotrexate during the initial course of treatment because it can take weeks for DMARDs to reach therapeutic levels. Aspirin, salicylates, and sulfonylureas can cause methotrexate toxicity.

Which of the following should be included in teaching about raloxifene? SATA - perform a breast self-exam twice per month - increase physical activity by taking walks - use a contraceptive if there is any possibility of pregnancy - take the drug on an empty stomach - increase intake of calcium and vitamin D

Increase physical activity by taking walks, Use a contraceptive if there is any possibility of pregnancy, Increase intake of calcium and vitamin D ; raloxifene is pregnancy category X drug.

The nurse should instruct a client who is taking alendronate to monitor for which of the following adverse effects? SATA - jaw pain - drowsiness - blurred vision - tinnitus - muscle pain

Jaw pain, Blurred vision, Muscle pain

Which of the following is an adverse effect of alendronate? 1. venous thromboemboli 2. ventricular dysrhythmias 3. breast cancer 4. joint pain

Joint pain ; alendronate can cause joint and muscle pain. This can be treated with analgesics. Other adverse effects include nausea, visual disturbances, and esophagitis.

Which of the following is a therapeutic action of raloxifene? 1. blocks the effects of estrogen on endometrial tissue 2. mimics the effects of estrogen on bone tissue 3. stimulates secretion of parathyroid hormone 4. stimulates menstruation

Mimics the effects of estrogen on bone tissue

A nurse is teaching a client about calcitonin-salmon intranasal spray to treat osteoporosis. Which of the following information should the nurse include? SATA - report rash or itching - deliver two sprays to each nostril - prime the pump before the first dose - report nasal irritation - hold the pump horizontally

Report rash or itching, Prime the pump before the first dose, Report nasal irritation ; the medication should by sprayed once in one nostril each day. The nasal should be held upright to deliver spray intranasally.

A nurse is caring for a client who is taking etanercept for rheumatoid arthritis. The nurse should monitor the client for which of the following indications of a serious adverse reaction to the drug? 1. excessive salivation 2. increased thirst 3. blood in the urine 4. shortness of breath

Shortness of breath ; etanercept can cause heart failure which manifest as SOB, cough, elevated blood pressure and heart rate, and pink-tinged sputum. Etanercept is likely to cause blood in stools, not urine, r/t GI hemorrhage.

Which of the following is an adverse reaction to etanercept? 1. skin rash 2. tinnitus 3. diarrhea 4. dysphagia

Skin rash