Nokea
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.
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A nurse is caring for a client with a musculoskeletal disorder who is experiencing a significant impairment in the ability to ambulate due to pain. As a result, the client spends a majority of time in bed. Which of the following would the nurse most likely include in the client's plan of care?
- A. Changing the client's position every 2 hours
- B. Changing the bed linens every hour
- C. Encouraging the client to walk with assistance
- D. Encouraging the client to exercise with assistance
Correct Answer: A
Rationale: The nurse should change the client's position every 2 hours and inspect pressure sites for skin breakdown. The nurse need not change linens every hour. Once the client's condition improves, then encouraging ambulation with assistance and exercises would be appropriate.
Before administering dantrolene to a client, the nurse checks the client's medical history for possible contraindications for use. Which condition would the nurse identify as problematic? Select all that apply.
- A. Hypertension
- B. Atrial fibrillation
- C. Hepatic disease
- D. Diabetes
- E. Lactation
Correct Answer: C,E
Rationale: The use of dantrolene is contraindicated during lactation and in clients with active hepatic disease and muscle spasm caused by rheumatic disorders.
A client is receiving alendronate for osteoporosis. The client has informed the nurse that she has also been taking aspirin. Which of the following interactions should the nurse monitor for in this client?
- A. Increased risk of GI bleeding
- B. Decreased effects of bisphosphonate
- C. Increased level of sedation
- D. Increased risk of rash
Correct Answer: A
Rationale: Interaction of aspirin with a bisphosphonate drug causes increased risk of GI bleeding, which requires monitoring. Interaction of a uric acid inhibitor with barbiturates and benzodiazepines causes an increased level of sedation. Interaction of a uric acid inhibitor with ampicillin causes increased risk of rash. Interaction of calcium supplements or antacids with bisphosphonates decreases the effects of bisphosphonates.
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 would monitor a client closely for increased CNS depressant effects when a skeletal muscle relaxant is used concomitantly with which of the following? Select all that apply.
- A. Antihistamine
- B. Oral contraceptives
- C. Alcohol
- D. Opiates
- E. Antidiabetic medications
Correct Answer: A,C,D
Rationale: The concomitant use of skeletal muscle relaxants and antihistamines, alcohol, opiates, or sedatives can result in increased CNS depressant effects.