Nokea
The primary health care provider prescribes adalimumab. The nurse would prepare to administer this drug by which route?
- A. Orally
- B. Intramuscularly
- C. Subcutaneously
- D. Intravenously
Correct Answer: C
Rationale: Adalimumab, a DMARD, is administered by subcutaneous injection. Abatacept and infliximab are examples of DMARDs that are administered IV. Methotrexate, sulfasalazine, and leflunomide are examples of DMARDs that can be given orally.
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A client is receiving allopurinol. Which of the following would be most important for the nurse to include in the client's plan of care?
- A. Liberal fluid intake
- B. Moderate exercise
- C. Use of a brace or corset
- D. Avoidance of direct sunlight
Correct Answer: A
Rationale: When using uric acid inhibitors, such as allopurinol, the nurse should encourage liberal fluid intake and measure the client's intake and output. The client does not need to exercise or use braces or corsets; clients with osteoporosis may require a brace or corset when out of bed. The client need not avoid sunlight as uric acid inhibitors do not cause photosensitivity.
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).
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 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.
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.