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A nurse is monitoring the laboratory values of a client who has rheumatoid arthritis and is taking methotrexate. Which of the following values should the nurse identify as an adverse effect of the medication?

Positive Rheumatoid factor

WBC count 2.000/mm3

Hemoglobin 14.8 g/dL

Erythrocyte sedimentation rate 24 mm/hr

Answer and Explanation

The Correct Answer is B

Choice A rationale:

A positive Rheumatoid factor is associated with rheumatoid arthritis and is not an adverse effect of methotrexate.

Choice B rationale:

A low WBC count (leukopenia) is an adverse effect of methotrexate and can increase the risk of infection.

Choice C rationale:

A hemoglobin level of 14.8 g/dL is within a normal range and is not an adverse effect of methotrexate.

Choice D rationale:

An erythrocyte sedimentation rate (ESR) of 24 mm/hr is within a normal range and is not an adverse effect of methotrexate.

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Correct Answer is B

Explanation

Choice A rationale:

Frequent cervical examinations may increase the risk of introducing infection or causing additional bleeding. Cervical examinations are not a priority in managing placental abruption.

Choice B rationale:

Placental abruption can lead to significant blood loss, and the client may require intravenous fluids and blood products to maintain hemodynamic stability. Initiating an IV with an 18-gauge catheter allows for rapid administration of fluids and blood products if needed.

Choice C rationale:

Monitoring fetal heart rate hourly is important, but addressing the mother's hemodynamic stability with IV fluids takes priority.

Choice D rationale:

Vital signs should be obtained more frequently than every 4 hours due to the risk of ongoing blood loss.

A. Client report of back pain of 7 on a 0 to 10 scale B. Excoriated folds of the client's panniculus C. Hypoactive bowel sounds upon auscultation D. urine output of 80 mL in the past hour

Correct Answer is A

Explanation

Choice A rationale:

Postoperative pain management is crucial for the client's comfort and recovery.

Choice B rationale:

Excoriated folds of the client's panniculus might be related to skin irritation and can be addressed without immediate provider notification.

Choice C rationale:

Hypoactive bowel sounds can be expected after surgery and might not require immediate reporting.

Choice D rationale:

Urine output of 80 mL in the past hour might be influenced by various factors and is not as high a priority as severe pain.

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A nurse is monitoring the laboratory values of a client who has rheumatoid arthritis and is taking methotrexate. Which of the following values should the nurse identify as an adverse effect of the medication?

Nursing Test Bank

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