Musculoskeletal system

A nurse is teaching a client about the adverse effects of etanercept. Which of the following statements by the client indicates understanding of teaching?

"I will need to get my blood draw 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

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.

"I will take my birth control pill everyday" 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.

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.

"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.

Goal of drug therapy for RA

-Decrease pain and inflammation -Prevent disabling deformities such as ulnar deviation.

Increase intake of calcium and vitamin D is correct. An increased intake of calcium and vitamin D helps improve the effectiveness of raloxifene and increases bone mass.

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.

Methotrexate

Antineoplastic Therapeutic use- Treatment of several types of cancer, as well as rheumatoid arthritis and psoriasis Treatment of joint inflammation and subsequent damage.

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.

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. 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.

A nurse is teaching a client about methotrexate. The nurse should inform the client to monitor for which of the following as an adverse 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.

A nurse is planning care for a client who has a new prescription of methotrexate. The nurse should plan to monitor the client for which of the following adverse effects?

Bone marrow depression The nurse should monitor the client for bone marrow depression, which is an adverse effect of folic acid analogs such as methotrexate.

A nurse is caring for a client who is taking alendronate to treat post menopausal osteoporosis. The nurse should explain to the client that alendronate increases bone mass by which of the following actions?

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.

Adverse reactions of DMARDs

Dizziness, headache, blurred vision, nausea, and vomiting. Can cause liver damage bc they are hepatotoxic. Cause bone marrow suppression- causing decrease of platelets and red& white blood cells. Cause in increased risk for infection. Gastrointestinal ulceration and pulmonary fibrosis are additional adverse effects.

The abdominal venous hum results from conditions which cause portal vein hypertension. Collateral venous channels are opened between the portal and the systemic venous channels, and the resultant flow of blood from the high-pressure portal system to the lower pressure systemic system in some way results in the hum.

Drink a minimum of 2 liters of water per day to promote the drugs 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.

Brand/ trade name for Etanercept

Enbrel

disease-modifying antirheumatic drugs (DMARDs)

Immunosuppressive drugs that that decrease joint inflammation, & as a result joint damage. Provide symptomatic relief but also delay progression of RA. Initially given with NSAIDs bc the onset of DMARDs therapeutic effect may take weeks. May end up discontinuing NSAIDs after DMARDs exert their effect and client treatment achieves good pain control.

Alendronate is contraindicated for administration to clients who have which of the following conditions?

Inability to sit up right 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 is caring for a client who has a prescription for etancept. The nurse should identify that etarnercept treats rheumatoid arthritis by which of the following actions?

Inactivation 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.

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.

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. Increase intake of calcium and vitamin D is correct. An increased intake of calcium and vitamin D helps improve the effectiveness of raloxifene and increases bone mass.

What are adverse drug reactions associated with etanercept?

Increases susceptibility to infections Dizziness Abdominal pain Pharyngitis Psoriasis Upper respiratory infections Rare occurrence of severe allergic reactions such as steven johnson syndrome (SJS), Toxic epidermal necrolysis (TEN), & Erythema multiforme Local injection site reaction Heart failure Reactivation of latent Tuberculosis (TB)

A nurse should identify that a client who has diabetes mellitus and is taking etanercept is at an increased risk for which of the following adverse effects?

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 should instruct a client who is taking alendronate to monitor for which of the following adverse effects?

Jaw pain-Alendronate can cause osteonecrosis of the jaw, and clients who develop it should report it to the provider. Blurred vision-Alendronate can cause ocular inflammation. The client should report any eye pain or blurred vision to the provider. muscle pain- Alendronate can cause musculoskeletal pain. If analgesics do not help, the client might have to stop taking alendronate.

A nurse is preparing to administer alendronate to a client who has osteoporosis. The nurse should recognize which of the following as an adverse effect of alebdronate?

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.

Which of the following is a therapeutic action of raloxifene?

Mimics the effects of estrogen on bone tissue Raloxifene mimics the effects of estrogen on bone tissue, minimizing or stopping bone loss.

calcium citrate

Mineral and electrolyte supplemnets Therapeutic use- Treatment of joint inflammation and prevention of joint damage

3 main drug types to treat RA

NSAIDs Glucocorticoids Disease modifying antirhxeumatic drugs (DMARDs)

A nurse is teaching a client about calcitonin-salmon instranasal spray to treat osteoporosis which of the following information should they nurse include?

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. 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 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 this drug?

Shortness of breath (SOB) Etanercept can cause heart failure, manifesting as shortness of breath, cough, elevated blood pressure and heart rate, and pink-tinged sputum.

A nurse is teaching a client who has a prescription for prednisone and takes 1,500mg/day calcium carbonate to reduce the risk of osteoporosis. Which of the following information should the nurse include?

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 caring for a client who is currently taking methotrexate for rheumatoid arthritis. The nurse should identify that which of the following is an adverse effect of this medication.

Thrombocytopenia Methotrexate has many adverse effects that affect the central nervous, respiratory, dermatologic, and hematology systems, such as anemia, leukopenia, and thrombocytopenia.

A nurse is caring for a client who was diagnosed with post-menopausal osteoporosis. Which of the following actions should the nurse take prior to administering calcitonin-salmon to the client for the first time?

Use skin testing to check the client for allergies 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.

A nurse is teaching a client who has a prescription for calcitonin citrate about manifestations of hypercalcemia. Which of the following manifestations should the nurse include in the teaching?

Vomiting The nurse should teach the client that hypercalcemia can occur when taking this drug. Manifestations of hypercalcemia include nausea, vomiting, flank pain, lethargy, and deep bone pain.

rhuematoid arthritis

a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked. Inflammatory systemic disorder. Primarily affects synovial joints, Cause unknown. Cause severe deformities and loss of function, stiffness, pain.

Alendronate

bone resorption inhibitor Therapeutic use- Treatment and prevention of post menopausal osteoporosis, glucocorticoid related osteoporosis, and age related osteoporosis in men.

Raloxifene (Evista)

bone resorption inhibitor Therapeutic use- Treatment of post menopausal osteoporosis, as well as to reduce the risk of estrogen receptor positive breast cancer.

Goal of drug therapy for osteoporosis

decrease possibility of fractures. medications use to increase or maintain bone strength by reducing bone reabsorption, and promoting bone formation.

Types of DMARDS

methotrexate and leflunomide- are teratogenic drugs- so contraindicated during pregnancy.

2 types DMARDs

non-biologic (Traditional) - antimetabolite drugs that exert their immunosuppressant effect by interfering w/ normal B and T lymphocytes activity. biologic

Osteoporosis

A condition in which the body's bones become weak and break easily. Lose of bone density Cause severe deformities and loss of function

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 to this drug?

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.

A nurse is caring for a client who has a prescription for methotrexate. Which of the following drugs would likely be prescribed in conjunction during the initial treatment for rheumatoid arthritis?

Ibuprofen 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.

Calcitonin-Salmon

Mineral and electrolyte supplements Therapeutic use- Treatment of hypocalcemia and gastric hyperacidity.

A nurse is teaching a client who is taking etanercept for rheumatoid arthritis. The nurse should instruct the client to monitor which of the following indications of an adverse reaction to this drug?

Skin rash Etanercept can cause serious skin infections. Clients should immediately report any skin rashes or blisters, because an infection can cause a serious reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.