exam 2

A nurse is providing teaching for a client newly prescribed methotrexate for rheumatoid arthritis. Which statement by the client indicates a need for further teaching?

• “I’ll take my medication once a week.”

• “I’ll increase my folic acid intake while taking this medication.”

• “I can continue to drink a glass of wine each night.”

•  “I’ll call my provider if I develop a fever or sore throat.”

Answer explanation

The statement "I can continue to drink a glass of wine each night" indicates a need for further teaching. Methotrexate can interact with alcohol, increasing the risk of liver damage.

A nurse should monitor which laboratory value most closely in a client taking methotrexate?

• Hemoglobin

• Liver function tests

• Serum sodium

• Serum calcium

Answer explanation

Methotrexate can cause liver toxicity, so monitoring liver function tests is crucial to detect any potential damage early. Hemoglobin, serum sodium, and serum calcium are less directly affected by methotrexate.

A client taking hydroxychloroquine for rheumatoid arthritis should be instructed to:

• Have regular eye examinations.

• Avoid foods high in purine

• Take the medication on an empty stomach.

• Stop the medication if mild nausea occurs.

Answer explanation

Clients on hydroxychloroquine should have regular eye examinations due to the risk of retinal toxicity associated with long-term use of the medication.

Before initiating etanercept therapy for rheumatoid arthritis, which test should be completed?

• Electrocardiogram (ECG)

•  Tuberculosis (TB) screening

•  Bone density scan

•  Pregnancy test

Answer explanation

Before starting etanercept for rheumatoid arthritis, TB screening is essential due to the risk of reactivation of latent tuberculosis. This test ensures patient safety and is a standard precaution for immunosuppressive therapies.

A nurse should question a prescription for infliximab in which client?

• A client with osteoarthritis

• A client with a history of tuberculosis

• A client taking oral contraceptives

• A client with mild hypertension

Answer explanation

Infliximab is an immunosuppressant that can reactivate latent tuberculosis. Therefore, a nurse should question its prescription for a client with a history of tuberculosis due to the increased risk of infection.

A client experiencing an acute gout attack is prescribed colchicine. Which finding requires the nurse’s immediate action?

• Mild nausea

• Diarrhea

• Fatigue

• Flushed skin

Answer explanation

Diarrhea is a common side effect of colchicine and can indicate toxicity. It requires immediate action to prevent dehydration and further complications, unlike mild nausea, fatigue, or flushed skin.

A nurse is teaching a client prescribed allopurinol for chronic gout. Which statement by the client indicates understanding?

• “I should take this medication at the first sign of a gout flare."

• “I need to drink plenty of water while taking this medication.”

• “This medication is used to relieve pain during a gout attack."

• “I will take aspirin if I get a headache.

Answer explanation

The correct statement is about drinking plenty of water, which helps prevent kidney stones and supports the excretion of uric acid while on allopurinol. The other statements are incorrect regarding the medication's use.

The nurse should teach a client taking probenecid to avoid:

• Aspirin

• Dairy products

• Orange juice

• Bananas

Answer explanation

Probenecid can interact with aspirin, reducing its effectiveness and increasing the risk of side effects. Therefore, clients taking probenecid should avoid aspirin.

A client prescribed allopurinol reports a rash. What should the nurse do?

• Encourage the client to apply hydrocortisone cream.

• Tell the client this is a common, mild side effect.

•  Instruct the client to stop the medication and notify the provider.
  

• Suggest taking the medication with food.

Answer explanation

The rash may indicate a serious allergic reaction to allopurinol. The nurse should instruct the client to stop the medication and notify the provider immediately to prevent potential complications.

Which of the following lab values indicates effective therapy with allopurinol?

• Decreased serum uric acid levels

• Increased white blood cell count

• Elevated BUN levels

• Increased serum calcium levels

Answer explanation

Decreased serum uric acid levels indicate effective therapy with allopurinol, as the drug is used to lower uric acid levels in conditions like gout. The other options do not reflect the intended effect of allopurinol.