Nokea
The health care provider has prescribed the following collaborative interventions for a patient who is taking azathioprine for systemic lupus erythematosus. Which of the following orders should the nurse question?
- A. Draw anti-DNA blood titre.
- B. Administer varicella vaccine.
- C. Use naproxen 200 mg BID.
- D. Take famotidine 20 mg daily.
Correct Answer: B
Rationale: Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.
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The nurse is assessing a patient who is taking hydroxychloroquine to treat rheumatoid arthritis. Which of the following findings is most important to report to the health care provider?
- A. Abdominal cramping
- B. Complaint of blurry vision
- C. Phalangeal joint tenderness
- D. Blood pressure 170/84 mm Hg
Correct Answer: B
Rationale: Plaquenil can cause retinopathy; the medication should be stopped. The other findings are not related to the medication, although they also will be reported.
The nurse is caring for a patient who has rheumatoid arthritis (RA) and is prescribed anakinra. Which of the following information should the nurse include when teaching the patient about this drug?
- A. Self-administration of subcutaneous injections
- B. Take the medication with at least 240 mL of fluid
- C. Avoid concurrently taking Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
- D. Symptoms of gastrointestinal (GI) irritation or bleeding
Correct Answer: A
Rationale: Anakinra is administered by subcutaneous injection. GI bleeding is not an adverse effect of this medication. Because the medication is injected, instructions to take it with 240 mL of fluid would not be appropriate. The patient is likely to be concurrently taking Aspirin or NSAIDs, and these should not be discontinued.
Which of the following assessment findings about a patient who has been using naproxen for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?
- A. The patient has dark-coloured stools.
- B. The patient's pain has not improved.
- C. The patient is using capsaicin cream.
- D. The patient has gained 3 pounds over 3 weeks.
Correct Answer: A
Rationale: Dark-coloured stools may indicate that the patient is experiencing gastrointestinal bleeding caused by the naproxen. The information about the patient's ongoing pain and weight gain also will be reported and may indicate a need for a different treatment or counselling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
The nurse is caring for a young adult patient with urethritis and knee pain who has been diagnosed with reactive arthritis. Which of the following medications should the nurse include in the teaching plan?
- A. Anakinra
- B. Etanercept
- C. Doxycycline
- D. Methotrexate
Correct Answer: C
Rationale: Reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and treatment with doxycycline. The other medications are used for persistent inflammatory problems such as rheumatoid arthritis.
Which of the following information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition?
- A. Exercise by taking long walks.
- B. Do daily deep-breathing exercises.
- C. Sleep on the side with hips flexed.
- D. Take frequent naps during the day.
Correct Answer: B
Rationale: Deep-breathing exercises are used to decrease the risk for pulmonary complications that may occur with the reduced chest expansion that can occur with ankylosing spondylitis (AS). Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps.