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Before administering cyclobenzaprine, a nurse reviews a client's medical record. Which condition if found would alert the nurse to a possible contraindication for this drug? Select all that apply.
- A. Recent myocardial infarction
- B. Diabetes
- C. Hepatic disease
- D. Hypertension
- E. Hyperthyroidism
Correct Answer: A,E
Rationale: The use of cyclobenzaprine (Flexeril) is contraindicated in clients with a recent myocardial infarction, cardiac conduction disorders, hyperthyroidism, and known hypersensitivity to the drug and within 14 days of the administration of an MAOI.
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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).
A nurse reviews a client's medical history for conditions that would contraindicate use of methotrexate. Which of the following would the nurse identify as a possible contraindication? Select all that apply.
- A. Hypertension
- B. Folate deficiency
- C. Vitamin B12 deficiency
- D. Diabetes
- E. Liver disease
Correct Answer: B,E
Rationale: The use of methotrexate is contraindicated in clients with known hypersensitivity to the drug and clients with renal insufficiency, liver disease, alcohol abuse, pancytopenia, or folate deficiency.
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.
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.
After teaching a group of nursing students about the various drugs used to treat musculoskeletal conditions, the instructor determines that the teaching was successful when the students identify which of the following as being used to treat osteoporosis?
- A. DMARDs
- B. Bone resorption inhibitors
- C. Skeletal muscle relaxants
- D. Uric acid inhibitors
Correct Answer: B
Rationale: Bone resorption inhibitors are used to treat osteoporosis. Disease-modifying antirheumatic drugs (DMARDs) are used to treat rheumatoid arthritis. Uric acid inhibitors are used to treat gout. Skeletal muscle relaxants are used to alleviate muscle spasms and cramping.