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A nurse is teaching a client with rheumatoid arthritis (RA) who is prescribed etanercept (Enbrel). What information is most important for the nurse to teach this client?
- A. Administer the medication via subcutaneous injection twice a week
- B. Use heat on the injection site to reduce pain
- C. Avoid large crowds or people who are ill
- D. Monitor for signs of infection daily
Correct Answer: A
Rationale: Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept.
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A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The client calls the clinic reporting sedation. What response by the nurse is most appropriate?
- A. A little sedation will help you get some rest
- B. Depression often accompanies fibromyalgia
- C. Duloxetine reduces pain by increasing serotonin and norepinephrine
- D. You will have more energy after taking this drug
Correct Answer: C
Rationale: Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine, which reduces the pain from fibromyalgia. The other answers are inaccurate.
A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include?
- A. Avoid large crowds or people who are ill
- B. Stay upright for 1 hour after taking this drug
- C. This drug may cause your hair to fall out
- D. You may double the dose if pain is severe
Correct Answer: A
Rationale: This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab.
A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started acting up, especially both hips and knees. What action by the nurse is best?
- A. Assess for the presence of subcutaneous nodules or Baker's cysts
- B. Inspect the client's feet and hands for podagra and tophi on fingers and toes
- C. Assess for the correlation of osteoarthritis to weather changes
- D. Reassure the client that the problems will fade when the weather changes again
Correct Answer: A
Rationale: Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Baker's cysts. Inspecting for podagra and tophi is more relevant for gout. Reassuring the client about weather changes is inaccurate.
A client is on the postoperative unit after a total hip replacement. The client reports a sudden onset of shortness of breath, chest pain, and coughing. What action by the nurse is best?
- A. Assess neurovascular status of both legs
- B. Elevate the affected leg and apply ice
- C. Prepare to administer pain medication
- D. Try to place the affected leg in abduction
Correct Answer: A
Rationale: This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess this client.
A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the client practices good self-care when the client makes which statement?
- A. I always wear long sleeves, pants, and a hat when outdoors
- B. I try not to use concentrate that contains any type of sunblock
- C. Since I tend to sweat a lot, I use a lot of baby powder
- D. Since I can be exposed to the sun, I have been using a tanning bed
Correct Answer: A
Rationale: Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, and avoiding drying agents such as powder and tanning beds.