Nokea
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.
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A client is receiving medication for gout. The nurse would include instructions about which of the following during the course of treatment?
- A. Taking drug on an empty stomach
- B. Using protection against sunlight
- C. Reporting any skin rash
- D. Wearing a brace to get out of bed
Correct Answer: C
Rationale: The nurse should instruct the client to report any skin rash. A rash should be monitored carefully because it may precede a serious adverse reaction, such as Stevens-Johnson syndrome. The nurse need not instruct the client to take the drug on an empty stomach, use protection against sunlight, or wear a brace to get out of bed. Clients with osteoporosis are asked to wear a brace to get out of bed. Clients taking medications for gout are asked to take it with food. These clients are also instructed to avoid driving or performing other hazardous tasks.
A client in the initial phase of gout is prescribed colchicine. After administering the drug, the nurse would continue to monitor the client for which of the following?
- A. Stomatitis
- B. Stevens-Johnson syndrome
- C. Bone marrow depression
- D. Exfoliative dermatitis
Correct Answer: C
Rationale: The nurse needs to closely monitor the client for bone marrow depression, an adverse reaction of colchicine. Stomatitis, Stevens-Johnson syndrome, and exfoliative dermatitis are not adverse reactions of colchicine. Stomatitis is an adverse reaction of immunosuppressive drugs. Stevens-Johnson syndrome and exfoliative dermatitis are adverse reactions of allopurinol.
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 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.
Which of the following would be most important for the nurse to assess when administering a bisphosphonate to a client with Paget's disease?
- A. Altered renal function
- B. Increased skin rashes
- C. Serum calcium levels
- D. Hematology function
Correct Answer: C
Rationale: The nurse should monitor the serum levels of calcium before, during, and after bisphosphonate therapy, because bisphosphonates act primarily on the bone by inhibiting normal and abnormal bone resorption. These drugs are used cautiously in clients with renal function impairment but do not alter renal function. The nurse should monitor the client's renal function when allopurinol is administered and hematology function when methotrexate is administered.