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 D
Explanation
Choice A Reason:
Nausea is a common side effect of many medications, including metoclopramide. While it is important to monitor, it is not the most critical adverse effect to report. Metoclopramide is often prescribed to manage nausea, so experiencing this symptom may indicate the need for dosage adjustment or additional supportive care, but it is not an emergency.
Choice B Reason:
Diarrhea is another common side effect of metoclopramide. It can be uncomfortable and may require management, but it is not typically life-threatening. The nurse should monitor the client and provide supportive care, but this side effect does not necessitate immediate reporting unless it becomes severe or persistent.
Choice C Reason:
Unusual irritability can occur with metoclopramide use. While it is important to note changes in mood or behavior, this symptom is not as critical as some other potential adverse effects. The nurse should monitor the client and consider discussing this symptom with the healthcare provider, but it is not the most urgent concern.
Choice D Reason:
Involuntary movements, such as those seen in tardive dyskinesia, are a serious adverse effect of metoclopramide. Tardive dyskinesia is a potentially irreversible condition characterized by repetitive, involuntary movements, often of the face and tongue. This side effect is significant and requires immediate reporting to the healthcare provider, as it may necessitate discontinuation of the medication and further evaluation.
Correct Answer is C
Explanation
Choice A Reason:
Reports of increased energy levels and decreased fatigue are subjective indicators of improvement in anemia symptoms. While these reports are important and suggest that the client is feeling better, they do not provide objective evidence of the effectiveness of epoetin alfa. Hemoglobin levels are a more precise measure of the medication’s impact on anemia.
Choice B Reason:
A food diary showing increased consumption of iron-rich foods indicates that the client is making dietary changes to support their anemia treatment. However, this does not directly measure the effectiveness of epoetin alfa. The medication’s primary goal is to stimulate red blood cell production, which is best assessed through hemoglobin levels.
Choice C Reason:
An increase in hemoglobin level to 12 g/dL (7.45 mmol/L) is an objective indicator that epoetin alfa is effective. Hemoglobin levels are a direct measure of the red blood cell count and oxygen-carrying capacity of the blood. An increase in hemoglobin levels indicates that the medication is successfully treating the anemia associated with CKD.
Choice D Reason:
Taking concurrent iron therapy without adverse effects is important for overall treatment adherence and minimizing side effects. However, it does not directly indicate the effectiveness of epoetin alfa. The primary measure of effectiveness is the improvement in hemoglobin levels.
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