Saunders NCLEX-PN PHARM – Musculoskeletal Questions & Answers 2023

The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data? The white blood cell and platelet counts Rationale: Infection and suppression can occur as a result of etanercept. Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell and platelet counts can alert the nurse to a potentially lifethreatening infection or potential bleeding. Injection site itching and edema are common occurrences following administration. A metallic taste and loss of appetite are not associated with this medication. Fatigue and joint pain occur with rheumatoid arthritis. Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions for the administration of the medication. Which instruction should the nurse reinforce? Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal side/adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication. The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect? Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects. During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings should the nurse interpret as acceptable responses? Select all that apply. Symptom control during periods of emotional stress Normal white blood cell, platelet, and neutrophil counts Radiological findings that show nonprogression of joint degeneration An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection. A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? "Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication. The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication? Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the primary health care provider (PHCP)? A seizure disorder Rationale: Clients with a seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication Cyclobenzaprine is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the primary health care provider (PHCP) regarding the administration of this medication? Glaucoma Rationale: Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy. Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication? Acts directly on the skeletal muscle to relieve spasticity Rationale: Dantrolene acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. The nurse is reinforcing discharge instructions to a client receiving baclofen. Which should the nurse include in the instructions? Avoid the use of alcohol. Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Constipation rather than diarrhea is an adverse effect of baclofen. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the PHCP if fatigue occurs. A client receives a prescription for methocarbamol, and the nurse reinforces instructions to the client regarding the medication. Which client statement should indicate a need for further teaching? "If my vision becomes blurred, I don't need to be concerned about it." Rationale: There is a need for further teaching when the client says that if my vision becomes blurred, I don't need to be concerned. The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that if these adverse effects occur, the primary health care provider needs to be notified. The medication is used to relieve muscle spasms. The client has been on treatment for rheumatoid arthritis for 3 weeks. Which is most important for the nurse to check during the administration of etanercept? The white blood cell counts and platelet counts Rationale: When the client is taking etanercept, it is most important for the nurse to check the client's white blood cell count. Infection and pancytopenia are adverse effects of etanercept. Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication. The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect should the nurse monitor? Bradycardia Rationale: Intravenous administration of methocarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these adverse effects. The nurse prepares to reinforce instructions to a client who is taking allopurinol. The nurse should include which instruction in the plan? Instruct the client to drink 3000 mL of fluid per day. Rationale: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. Allopurinol is an antigout medication used to decrease uric acid levels. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the primary health care provider because this may indicate hypersensitivity. Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? Renal failure Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic, or cardiac disorders, or those with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication would be used with caution in clients with impaired hepatic function, older clients, and debilitated clients. The nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide. During data collection, the nurse asks which question to determine if the medication is effective? "Do you have any joint pain?" Rationale: Asking the client, "do you have any joint pain?" is the question to ask to determine if the medication is effective. Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other questions are unrelated to medication effectiveness. A client is receiving baclofen for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which is a side effect of this medication? Slurred speech Rationale: Slurred speech is a one of the side effects of baclofen. Other side effects include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. The other side effects are not related to this medication. A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which data would indicate that the client is experiencing a side effect related to this medication? Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication. The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan? Avoid the use of alcohol. Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the PHCP about fatigue.