NCLEX-PN Musculoskeletal
1. 1.The white blood cell and platelet counts: The client has been taking medica-tion for
rheumatoid arthritis for 3 weeks. During the administration of etanercept, itis most important
for the nurse to collect which data?
1. The white blood cell and platelet counts
2. A metallic taste in the mouth, with a loss of appetite
3.Whether the client is experiencing fatigue and joint pain
4.Whether the client is experiencing itching and edema at the injection site
2. 4.Take the medication with a full glass of water after rising in the morning.(This medication
can cause esophageal irritation)
Rationale: Precautions need to be taken with the administration of alendronateto prevent
gastrointestinal side/adverse effects (especially esophageal irrita-tion) 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 shouldnot eat or drink anything for 30 minutes following
administration and shouldnot lie down after taking the medication.: Alendronate is prescribed
for a client with osteoporosis and the nurse is providing instructions for the administration of
themedication. Which instruction should the nurse reinforce?
1. Take the medication at bedtime.
2. Take the medication in the morning with breakfast.
3.Lie down for 30 minutes after taking the medication.
4.Take the medication with a full glass of water after rising in the morning.
3. 3.Drowsiness
(baclofen is a CNS depressant used to treat muscle spasticity)
Rationale: Baclofen is a central nervous system (CNS) depressant and fre- quently causes
drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and
urinary retention. Clients should be warnedabout the possible reactions. Options 1, 2, and 4 are
not side effects.: The nurseis monitoring a client receiving baclofen for side effects related to
the medication.
Which should indicate that the client is experiencing a side effect?
1.Polyuria 2.Diarrhea 3.Drowsiness
,4.Muscular excitability
4. 1.Symptom control during periods of emotional stress2.Normal white blood cell, platelet,
and neutrophil counts
3.Radiological findings that show nonprogression of joint degeneration 4.An increased range
of motion in the affected joints 3 months into therapy
Rationale: Because emotional stress frequently exacerbates the symptoms ofrheumatoid
arthritis, the absence of symptoms is a positive finding. DMARDsare given to slow
progression of joint degeneration. In addition, the improve-ment in the range of motion after 3
months of therapy with normal blood workis a positive finding. Temperature elevation and
inflammation and irritation atthe medication injection site could indicate signs of infection.:
During the mon-itoring of a client's response to disease-modifying antirheumatic drugs
(DMARDs),which findings should the nurse interpret as acceptable responses? Select all that
apply.
1.Symptom control during periods of emotional stress 2.Normal white blood cell, platelet, and
neutrophil counts
3.Radiological findings that show nonprogression of joint degeneration 4.An increased range
of motion in the affected joints 3 months into therapy
5. Inflammation and irritation at the injection site 3 days after injection is given
6. A low-grade temperature when rising in the morning that remains throughout theday
5. 4."Weakness and fatigue commonly occur and will diminish with continuedmedication 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 neverto withdraw or stop the medication abruptly because
abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best
for thenurse to inform the client that these symptoms will subside and encourage the client to
continue the use of the medication.: 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 discontinuingthe medication. The nurse should make which
appropriate response to the client?
1. "You should never stop the medication."
2. "It is best that you taper the dose if you intend to stop the medication."
3. "It is okay to stop the medication if you think that you can tolerate the muscle
, spasms."
4. "Weakness and fatigue commonly occur and will diminish with continued medica-tion use."
6. 2.Liver function tests
(recall that this medication affects liver function.)
Rationale: Dose-related liver damage is the most serious adverse effect ofdantrolene. 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 timenecessary.
Options 1 and 3 are tests that assess kidney function.: 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 administrationof this medication?
1. Creatinine
2. Liver function tests 3.Blood urea nitrogen
4.Hematological function tests
7. 1.A seizure disorder
(Remember, a lowered seizure threshold can occur when baclofen is admin-istered.)
Rationale: Clients with a seizure disorders may have a lowered seizure thresh-old when baclofen
is administered. Concurrent therapy may require an in- crease in the anticonvulsive
medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking
baclofen.: The nurse is reviewing therecord of a client who has been prescribed baclofen.
Which disorder should alert the nurse to contact the primary health care provider (PHCP)?
1.A seizure disorder 2.Hyperthyroidism 3.Diabetes mellitus 4.Coronary artery disease
8. 1.Glaucoma
(Recalling that this medication has anticholinergic effects)
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 hydrochlo- ride should be
1. 1.The white blood cell and platelet counts: The client has been taking medica-tion for
rheumatoid arthritis for 3 weeks. During the administration of etanercept, itis most important
for the nurse to collect which data?
1. The white blood cell and platelet counts
2. A metallic taste in the mouth, with a loss of appetite
3.Whether the client is experiencing fatigue and joint pain
4.Whether the client is experiencing itching and edema at the injection site
2. 4.Take the medication with a full glass of water after rising in the morning.(This medication
can cause esophageal irritation)
Rationale: Precautions need to be taken with the administration of alendronateto prevent
gastrointestinal side/adverse effects (especially esophageal irrita-tion) 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 shouldnot eat or drink anything for 30 minutes following
administration and shouldnot lie down after taking the medication.: Alendronate is prescribed
for a client with osteoporosis and the nurse is providing instructions for the administration of
themedication. Which instruction should the nurse reinforce?
1. Take the medication at bedtime.
2. Take the medication in the morning with breakfast.
3.Lie down for 30 minutes after taking the medication.
4.Take the medication with a full glass of water after rising in the morning.
3. 3.Drowsiness
(baclofen is a CNS depressant used to treat muscle spasticity)
Rationale: Baclofen is a central nervous system (CNS) depressant and fre- quently causes
drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and
urinary retention. Clients should be warnedabout the possible reactions. Options 1, 2, and 4 are
not side effects.: The nurseis monitoring a client receiving baclofen for side effects related to
the medication.
Which should indicate that the client is experiencing a side effect?
1.Polyuria 2.Diarrhea 3.Drowsiness
,4.Muscular excitability
4. 1.Symptom control during periods of emotional stress2.Normal white blood cell, platelet,
and neutrophil counts
3.Radiological findings that show nonprogression of joint degeneration 4.An increased range
of motion in the affected joints 3 months into therapy
Rationale: Because emotional stress frequently exacerbates the symptoms ofrheumatoid
arthritis, the absence of symptoms is a positive finding. DMARDsare given to slow
progression of joint degeneration. In addition, the improve-ment in the range of motion after 3
months of therapy with normal blood workis a positive finding. Temperature elevation and
inflammation and irritation atthe medication injection site could indicate signs of infection.:
During the mon-itoring of a client's response to disease-modifying antirheumatic drugs
(DMARDs),which findings should the nurse interpret as acceptable responses? Select all that
apply.
1.Symptom control during periods of emotional stress 2.Normal white blood cell, platelet, and
neutrophil counts
3.Radiological findings that show nonprogression of joint degeneration 4.An increased range
of motion in the affected joints 3 months into therapy
5. Inflammation and irritation at the injection site 3 days after injection is given
6. A low-grade temperature when rising in the morning that remains throughout theday
5. 4."Weakness and fatigue commonly occur and will diminish with continuedmedication 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 neverto withdraw or stop the medication abruptly because
abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best
for thenurse to inform the client that these symptoms will subside and encourage the client to
continue the use of the medication.: 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 discontinuingthe medication. The nurse should make which
appropriate response to the client?
1. "You should never stop the medication."
2. "It is best that you taper the dose if you intend to stop the medication."
3. "It is okay to stop the medication if you think that you can tolerate the muscle
, spasms."
4. "Weakness and fatigue commonly occur and will diminish with continued medica-tion use."
6. 2.Liver function tests
(recall that this medication affects liver function.)
Rationale: Dose-related liver damage is the most serious adverse effect ofdantrolene. 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 timenecessary.
Options 1 and 3 are tests that assess kidney function.: 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 administrationof this medication?
1. Creatinine
2. Liver function tests 3.Blood urea nitrogen
4.Hematological function tests
7. 1.A seizure disorder
(Remember, a lowered seizure threshold can occur when baclofen is admin-istered.)
Rationale: Clients with a seizure disorders may have a lowered seizure thresh-old when baclofen
is administered. Concurrent therapy may require an in- crease in the anticonvulsive
medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking
baclofen.: The nurse is reviewing therecord of a client who has been prescribed baclofen.
Which disorder should alert the nurse to contact the primary health care provider (PHCP)?
1.A seizure disorder 2.Hyperthyroidism 3.Diabetes mellitus 4.Coronary artery disease
8. 1.Glaucoma
(Recalling that this medication has anticholinergic effects)
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 hydrochlo- ride should be
