Musculoskeletal Meds
teaching about A/V effects of etanercept. which of the following statements by the pt. indicates understanding of the teaching? -"I will need to get my blood drawn periodically while on this medication." -"I may lose part or all of my hair." -"I may wake up with a very dry mouth." -"I will leave the needle cap off during the time the medication comes to room temperature."
"I will need to get my blood drawn periodically while on this medication." Etanercept places the client at risk for systemic fungal infections and other opportunistic infections. Therefore, the client will need to have their CBC monitored periodically while on this medication.
teaching about methotrexate for RA. which of the following statements indicates understanding of teaching? "I will take a birth control pill every day." "Methotrexate decreases my chances of developing an infection." "I take methotrexate every day with breakfast." "I will aim to drink five 8-ounce glasses of water per day." "You will need to receive a MMR vaccine 1 month after starting this medication."
"I will take a birth control pill every day." Methotrexate is teratogenic to a fetus and is contraindicated during pregnancy. Therefore, a client of childbearing age should use birth control while on this medication.
teaching client about new RX for etanercept, what statement should the nurse make?
"You should report signs of infection to your provider immediately." The nurse should teach the client that they are susceptible to infections when taking DMARD II medications such as etanercept. The client should report symptoms of infection, such as fever, cough, malaise, weight loss, and dyspnea, to the provider immediately to prevent further complications.
nurse is teaching about self-administering methotrexate to client with RA. which statement should the nurse make?
-"Drink 2 to 3 liters of water per day to promote the drug's excretion." Methotrexate can cause kidney damage. Adequate hydration optimizes drug excretion and helps prevent kidney damage. Clients can also take sodium bicarbonate tablets to increase urine alkalinity and reduce the drug precipitation that can lead to kidney damage.
teaching about methotrexate for RA. what should the nurse include? SELECT ALL THAT APPLY -Avoid being near people who are sick with a communicable illness. -Periodic laboratory tests are required. -The drug's effects are immediate. -Report bruising or petechiae. -Avoid drinking alcohol.
-Avoid being near people who are sick with a communicable illness. -Periodic laboratory tests are required. -Report bruising or petechiae. -Avoid drinking alcohol. Avoid being near people who are sick with a communicable illness is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Clients taking the drug should avoid contact with large crowds or people who are sick with a communicable illness. Periodic laboratory tests are required is correct. Periodic laboratory tests help the provider monitor for kidney and liver damage. It is important to assess for jaundice and abdominal pain because these findings can indicate liver damage. The drug's effects are immediate is incorrect. It can take 3 to 6 weeks to achieve the drug's therapeutic effects. Report bruising or petechiae is correct. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae, because these findings indicate a low platelet count. The nurse should monitor the client's laboratory values for a decrease in platelets and red and white blood cells. Avoid drinking alcohol is correct. Alcohol ingestion can increase the risk of liver damage. Clients who are taking methotrexate should avoid drinking alcohol.
Nurse is teaching client about RX for prednisone and who takes 1,500mg/day of Ca+ carbonate to reduce the risk of osteoporosis. what info should you include? SELECT ALL THAT APPLY -Take the calcium tablets with food. -Drink 240 mL (8 oz) of water with the calcium tablets. -Chew calcium tablets before swallowing them. -Take the drugs 1 hr apart. -Divide the daily dosage of calcium into three 500-mg doses.
-Drink 240 mL (8 oz) of water with the calcium tablets. -Chew calcium tablets before swallowing them. -Take the drugs 1 hr apart. -Divide the daily dosage of calcium into three 500-mg doses. Take the calcium tablets with food is incorrect. It is not necessary to take calcium carbonate tablets with food when using them for calcium supplementation. Drink 240 mL (8 oz) of water with the calcium tablets is correct. Clients should drink 240 mL (8 oz) of water after taking the calcium carbonate to ensure complete passage of the drug and to maintain hydration. Chew calcium tablets before swallowing them is correct. Clients should chew the tablets before swallowing them to increase bioavailability. Clients should not swallow chewable tablets whole. Take the drugs 1 hr apart is correct. Glucocorticoids, such as prednisone, reduce the absorption of calcium carbonate. Clients should allow 1 hr in between the two to ensure optimal absorption. Divide the daily dosage of calcium into three 500-mg doses is correct. Clients should not take more than 600 mg of calcium carbonate at one time. Clients should divide the daily dosage into three doses to increase absorption of the calcium carbonate.
A nurse is teaching about raloxifene. What info should she include? SELECT ALLT THAT APPLY -Perform a breast self-examination 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 physical activity by taking walks is correct. Clients who take raloxifene should avoid long periods of inactivity to prevent deep-vein thrombosis. Furthermore, walking, and other weight-bearing exercises, can help increase bone density. Use a contraceptive if there is any possibility of pregnancy is correct. Raloxifene is a pregnancy category X drug and can cause severe fetal harm. Women who are pregnant, breastfeeding, or might become pregnant should not take the drug.
teaching pt. about calcitonin-salmon intranasal spray to treat osteoporosis. what info should the nurse include? SELECT ALL THAT APPLY -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. Report rash or itching is correct. The nurse should tell the client to stop using the drug and seek medical attention if any swelling or rash develops. Deliver two sprays to each nostril is incorrect. The client should spray calcitonin-salmon once in one nostril each day. The client should use alternate nostrils to avoid irritation. Prime the pump before the first dose is correct. The client should prime the pump before using the spray for the first time to ensure proper dosage. Report nasal irritation is correct. The client should report any nasal irritation or bleeding. The client might require parenteral administration if there is severe nasal irritation. Hold the pump horizontally is incorrect. The client should hold the nasal pump upright to deliver the spray intranasally.
a nurse is caring for a client taking etanercept for RA. the nurse should monitor for which of the following indications of a serious A/V reaction?
-SOB Etanercept can cause heart failure, manifesting as shortness of breath, cough, elevated blood pressure and heart rate, and pink-tinged sputum.
The nurse us teaching a client about methotrexate. A/V effect of this drug?
-black, tarry stools Methotrexate can cause gastric intestinal ulceration, which can lead to perforation and bleeding. The client should monitor for blood in stools or emesis and report either to the provider immediately.
match the drug to treat osteoporosis with its expected pharmacologic action Calcitonin-
-increases the excreation of Ca+
a nurse is preparing to give alendronate to client with osteoporosis. A/V effect?
-joint pain Alendronate can cause joint and muscle pain. Clients can treat joint pain with analgesics. Other adverse effects of this drug include nausea, visual disturbances, and esophagitis.
match the drug to treat osteoporosis with its expected pharmacologic action selective estrogen receptor modulators-
-mimics the effects of estrogen on the bones
match the drug to treat osteoporosis with its expected pharmacologic action calcium supplements- Calcitonin- Bisphosphonates- selective estrogen receptor modulators-
-raises Ca+ level
match the drug to treat osteoporosis with its expected pharmacologic action Bisphosphonates-
-reduces the number of osteoclasts
caring for pt. with new RX for etanercept. which of the following actions should the nurse take? SELCT ONE -Administer a tuberculin skin test prior to starting the medication. -Teach the client that fevers are common while taking this medication. -Determine if the client has chronic hypertension. -Mix the medication with methotrexate prior to administration.
Administer a tuberculin skin test prior to starting the medication. Etanercept is contraindicated for administration to clients who have a history of exposure to tuberculosis. Therefore, the nurse should administer a tuberculin skin test prior to starting the medication.
teaching about raloxifene therapy to prevent osteoporosis. the nurse should instruct pt. to monitor for what A/V reaction?
CALF PAIN Raloxifene can increase the risk of deep-vein thrombosis, which can lead to a pulmonary embolism or cerebrovascular accident. Clients should avoid long periods of inactivity and report any pain, redness, or swelling in the calf.
nurse is caring for client who is taking alendronate to treat postmenopausal osteoporosis. the nurse should explain to the client that alendronate increases bone mass by which of the following actions? SELECT ONE -Decreases activity of osteoclasts -Increases calcium excretion -Promotes intestinal absorption of calcium and phosphorus -Reduces action of osteoblasts
Decreases activity of osteoclasts Osteoclasts are cells that cause bone resorption or bone loss. Alendronate reduces the activity of osteoclasts, reducing bone loss and increasing bone mass.
rx for methotrexate, which of the following drugs would likely ne prescribed in conjunction during the initial treatment for RA?
IBUPROPHEN NSAID analgesics, such as ibuprofen, are often prescribed along with methotrexate during the initial course of treatment for rheumatoid arthritis. It can take weeks for DMARDs to reach therapeutic levels and begin relieving joint inflammation and pain, so ibuprofen can be administered concurrently to help make the client more comfortable while waiting for methotrexate's therapeutic effects.
alendronate is contraindicated for administration to clients who have what? SELECT ONE Heart failure Fish protein allergy Inability to sit upright Tuberculosis
INABILITY TO SIT UP Alendronate is contraindicated for administration to a client who cannot sit upright or stand for 30 min. Clients should drink 240 mL (8 oz) of water after taking the drug and sit upright or stand for at least 30 min to prevent esophagitis.
a nurse should instruct pt taking alendronate to monitor for which of the following A/V effects? SELECT ALL THAT APPLY Jaw pain Drowsiness Blurred vision Tinnitus Muscle pain
Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, and clients who develop it should report it to the provider. Drowsiness is incorrect. Alendronate is unlikely to cause drowsiness. It can cause a headache. Blurred vision is correct. Alendronate can cause ocular inflammation. The client should report any eye pain or blurred vision to the provider. Tinnitus is incorrect. Alendronate is unlikely to cause tinnitus. Salicylate toxicity can cause tinnitus. Muscle pain is correct. Alendronate can cause musculoskeletal pain. If analgesics do not help, the client might have to stop taking alendronate.
therapeutic action of raloxifene?
Raloxifene mimics the effects of estrogen on bone tissue, minimizing or stopping bone loss.
a nurse is teaching a client on etanercept for RA. the nurse should instruct the client to monitor for which of the following A/V reactions?
SKIN RASH it can cause a serious reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.
nurse is caring for pt. who is diagnosed with postmenopausal osteoporosis. which of the following actions should the nurse take prior to administering calcitonin-salmon to the client for the 1st time? SELECT ONE -Check the client's urine for sedimentation. -Assess the client's liver function. -Use skin testing to check the client for allergies. -Evaluate the client's breath sounds.
SKIN TESTING Calcitonin-salmon is developed using salmon. The nurse should perform skin testing to check for an allergy to salmon or fish protein, and have epinephrine, antihistamines, and resuscitation equipment available.
PCP orders etanercept to treat RA, prior to beginning the TX, the client requires testing for?
TB
caring for client taking methotrexate for RA, what is an A/V reaction for this med? SELECT ONE Hypertension Thrombocytopenia Glaucoma Edema
Thrombocytopenia Methotrexate has many adverse effects that affect the central nervous, respiratory, dermatologic, and hematology systems, such as anemia, leukopenia, and thrombocytopenia.
which of the following drugs are effective in disease prevention as well as Tx for osteoporosis? (select all that apply) alendronate raloxifene calcitonin-salmon NSAIDS
alendronate raloxifene
prior to starting alendronate, you should assess which of the following in the client? (select all that apply) baseline vison absence of nasal dryness the clients ability to lay flat ability to swallow
baseline vison ability to swallow
planning care for patient with ne RX for methotrexate. monitor for which of the following A/V reactions?
bone marrow depression, which is an adverse effect of folic acid analogs such as methotrexate.
a nurse is caring for pt. with new RX for etanercept, the nurse should identify that etanercept treats RA by which of the following actions? SELECT ONE -Deactivation of tumor necrosis factor -Inhibition of osteoclast activity -Decreasing the reuptake of serotonin -Interference with the production of lymphocytes
deactivation of tumor necrosis factor Etanercept directly binds to the tumor necrosis factor (TNF), preventing the attachment of TNF onto the cell's surface. This prevents the autoimmune response and subsequent inflammation of the joints.
client who has RA is taking methotrexate. which of the following reduces toxicity from the drug?
folic acid
a clients is about to start taking raloxifene to treat osteoporosis. you advise the pt. to watch for which of the following A/V reactions?
hot flashes
the PCP prescribes calcitonin-salmon for a post-menopausal client. knowing the A/V reactions, you instruct the client to....
increase Ca+ and Vit-D intake
a nurse should identify that a client with diabetes on etanercept is at and increase risk of what?
infection Etanercept increases the risk of developing a serious infection. Providers should not prescribe etanercept for clients who have an existing infection and should use it cautiously with clients who have diabetes mellitus because the disease itself already causes an increased risk for infection.
a nurse is caring for a client taking etanercept. which of the following A/V reactions is most important to mention when educating this client?
injection site reactions can occur
a client who is menopausal is taking Ca+ supplement to prevent osteoporosis. you instruct the pt. to watch for which of the following indications of hypercalcemia?
nausea
a client is about to start therapy with methotrexate for RA, knowing the A/V effects of it, you advise the pt. to watch for which of the following?
sore throat
a nurse is teaching a client who has a RX for calcitonin-salmon about manifestations of hypercalcemia. Which should the nurse include in the teaching?
vomiting The nurse should teach the client that rebound hypercalcemia can occur when taking this drug. Manifestations of hypercalcemia include nausea, vomiting, flank pain, lethargy, and deep bone pain.
