The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and receives a prescription for adalimumab. Which instructions should the nurse provide the client?
Avoid crowds and people who are sick.
Undergo annual eye examinations.
Obtain routine vaccinations as scheduled.
Have a chest x-ray prior to your first dose.
The Correct Answer is A
Choice A reason:
Avoiding crowds and people who are sick is crucial for clients taking methotrexate and adalimumab. Both medications suppress the immune system, increasing the risk of infections. Methotrexate is an immunosuppressant that can reduce the body’s ability to fight infections. Adalimumab, a TNF inhibitor, also lowers the immune response, making clients more susceptible to infections. Therefore, avoiding exposure to potential sources of infection is essential to prevent serious health complications.
Choice B reason:
While undergoing annual eye examinations is important for overall health, it is not directly related to the use of methotrexate and adalimumab. Methotrexate can cause ocular side effects, but these are relatively rare. Regular eye exams are a good practice but not the most critical instruction in this context.
Choice C reason:
Obtaining routine vaccinations is generally recommended for clients on immunosuppressive therapy. However, live vaccines should be avoided as they can cause infections in immunocompromised individuals. Non-live vaccines, such as the flu shot, are safe and should be administered according to the vaccination schedule. This instruction is important but secondary to avoiding exposure to infections.
Choice D reason:
Having a chest x-ray prior to the first dose of adalimumab is necessary to check for latent tuberculosis (TB). Adalimumab can reactivate latent TB, so screening is essential before starting the medication. However, this is a one-time requirement and not an ongoing instruction like avoiding crowds and sick people.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Sodium polystyrene sulfonate is used to treat hyperkalemia (high potassium levels) by exchanging sodium ions for potassium ions in the intestines, which are then excreted in the stool. A serum potassium level of 3.8 mEq/L is within the normal range (3.5 to 5 mEq/L), indicating that the medication has effectively reduced the potassium level to a safe range. Monitoring potassium levels is crucial in clients with AKI to prevent complications such as cardiac arrhythmias.
Choice B Reason:
A hemoglobin level of 13.3 g/dL is slightly below the normal range for adults (14 to 18 g/dL for males and 12 to 16 g/dL for females). While it is important to monitor hemoglobin levels, this value does not directly indicate the effectiveness of sodium polystyrene sulfonate, which is specifically used to manage potassium levels.
Choice C Reason:
A serum ammonia level of 30 µg/dL is within the normal range (10 to 80 µg/dL). However, this value does not reflect the effectiveness of sodium polystyrene sulfonate, as the medication is not used to manage ammonia levels. Ammonia levels are more relevant in conditions affecting liver function, such as hepatic encephalopathy.
Choice D Reason:
A serum glucose level of 100 mg/dL is within the normal range (74 to 106 mg/dL). While it is important to monitor glucose levels, this value does not indicate the effectiveness of sodium polystyrene sulfonate. The medication’s primary function is to reduce potassium levels, not to manage glucose levels.
Correct Answer is B
Explanation
Choice A Reason:
Inquiring about perceived anxiety is important because anxiety can contribute to sleep difficulties. However, in the context of a client taking dextroamphetamine-amphetamine, the timing of the medication is more directly related to sleep disturbances. While anxiety should be assessed, it is not the most critical factor in this scenario.
Choice B Reason:
Determining what time the dose is taken is crucial because dextroamphetamine-amphetamine is a stimulant that can interfere with sleep if taken too late in the day. Extended-release formulations are designed to provide a steady release of medication throughout the day, but taking the dose too late can lead to insomnia. Adjusting the timing of the dose can help mitigate sleep disturbances.
Choice C Reason:
Determining daily caffeine intake is relevant because caffeine is a stimulant that can also contribute to sleep difficulties. However, the primary concern in this scenario is the timing of the dextroamphetamine-amphetamine dose. While caffeine intake should be assessed, it is secondary to the medication timing.
Choice D Reason:
Asking about the client’s bedtime routine is important for understanding overall sleep hygiene. Good sleep hygiene practices can help improve sleep quality. However, in this context, the timing of the stimulant medication is more directly related to the reported sleep difficulties. Therefore, while bedtime routine is important, it is not the most critical assessment.
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