Nokea
After teaching a client receiving leflunomide, the nurse determines that the teaching was successful when the client identifies which of the following as a possible adverse reaction? Select all that apply.
- A. Alopecia
- B. Hypotension
- C. Diarrhea
- D. Nystagmus
- E. Hematuria
Correct Answer: A,C
Rationale: Adverse reactions to leflunomide include hypertension, alopecia, rash, nausea, and diarrhea.
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A client is receiving anakinra. After administering the drug, the nurse would continue to assess the client for which of the following?
- A. Constipation
- B. Abdominal pain
- C. Retinal changes
- D. Pancytopenia
Correct Answer: D
Rationale: Due to the immunosuppressive properties of DMARD drugs, pancytopenia is an adverse effect of anakinra, a DMARD, and the client should be monitored for it closely. Administration of anakinra may also cause headache and irritation at the injection site, but not constipation, abdominal pain, or retinal changes.
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 nurse caring for a client with gout should monitor the client's fluid intake and output, as increased urinary output is needed to excrete uric acid. The nurse would encourage the client to achieve an intake of how much fluid per day?
- A. 1000 mL
- B. 1500 mL
- C. 2000 mL
- D. 3000 mL
Correct Answer: D
Rationale: A client with gout is encouraged to drink at least 3000 mL of fluid per day to promote uric acid excretion.
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.
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.