Nokea
A client is prescribed probenecid and several other medications. When reviewing the client's medication record, the nurse determines that the client is at risk for possible toxicity if which of the following is also prescribed? Select all that apply.
- A. Phenobarbital (Luminal)
- B. Valproic acid (Depakote)
- C. Diazepam (Valium)
- D. Diclofenac (Voltaren)
- E. Acyclovir (Zovirax)
Correct Answer: A,C,D,E
Rationale: Probenecid (Benemid) increases the serum levels of the following medications, placing the client at risk for toxicity: penicillins, cephalosporins, acyclovir, rifampin, sulfonamides, barbiturates (phenobarbital), benzodiazepines (diazepam), and NSAIDs (diclofenac).
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A group of nursing students are reviewing information about drug therapy for rheumatoid arthritis. The students demonstrate understanding of the information when they identify which of the following as an example of a DMARD? Select all that apply.
- A. Infliximab
- B. Etanercept
- C. Ibandronate
- D. Zoledronic acid
- E. Carisoprodol
Correct Answer: A,B
Rationale: Infliximab and etanercept are examples of DMARDs. Ibandronate and zoledronic acid are examples of bone resorption inhibitors (bisphosphonates). Carisoprodol is a skeletal muscle relaxant.
A nurse is caring for a client who is receiving cyclobenzaprine. The nurse would expect to assess which of the following as indicating the therapeutic effect of the drug?
- A. Reduction of muscle spasm
- B. Prevention of convulsion
- C. Relief from anxiety
- D. Relief from nervous disorder
Correct Answer: A
Rationale: Cyclobenzaprine affects muscle tone, thereby causing reduction of muscle spasm. Administration of cyclobenzaprine does not result in prevention of convulsion, relief from anxiety, or relief from nervous disorder.
A client with gout has not responded to the usual medications. The primary health care provider prescribes a pegloticase infusion. Based on the nurse's understanding of this drug, which nursing diagnosis would be most appropriate?
- A. Risk for Injury
- B. Acute Pain
- C. Impaired Comfort: Gastric Distress
- D. Risk for Allergic Response
Correct Answer: D
Rationale: When first-line treatments for gout are not successful, sometimes drugs that are more toxic may be prescribed, such as the pegloticase infusion. During the infusion the patient is closely monitored for the development of adverse reactions, in particular anaphylaxis. Should an anaphylactic reaction occur, the infusion center staff members are prepared to start resuscitative measures as emergency personnel are notified.
A client is receiving hydroxychloroquine for a musculoskeletal disorder. Which of the following adverse reactions is irreversible and needs to be reported by the nurse?
- A. Easy bruising
- B. Skin rash
- C. Fever
- D. Visual changes
Correct Answer: D
Rationale: The nurse needs to report complaints of visual changes in a client receiving hydroxychloroquine, because irreversible retinal damage may occur. Although easy bruising, skin rash, and fever are adverse reactions of the drug, they are not irreversible.
A client tells the nurse that she takes her prescribed medication immediately upon arising each morning and does not eat or drink anything for 30 minutes while she stays in an upright sitting position. The nurse determines that the client is adhering to the medication regimen because which drug has been prescribed?
- A. Methotrexate
- B. Allopurinol
- C. Risedronate
- D. Baclofen
Correct Answer: C
Rationale: The client is taking a bisphosphonate, which requires that it be taken upon arising in the morning with 6 to 8 ounces of water, with the client remaining in an upright position. Methotrexate (a DMARD), allopurinol (uric acid inhibitor), and baclofen (skeletal muscle relaxant) are taken with or immediately after meals to minimize gastric distress.