A nurse is administering the disease-modifying anti-rheumatic medication hydroxychloroquine to a client who has rheumatoid arthritis.
Which of the following potential health conditions should the nurse inform the client may occur?
Weight fluctuations.
Eye problems.
Development of ulcers.
High cholesterol.
The Correct Answer is B
Choice A rationale
Hydroxychloroquine (HCQ) is an anti-malarial and disease-modifying anti-rheumatic drug (DMARD). While it can have gastrointestinal side effects, significant weight fluctuations are not a common or primary reported adverse effect requiring specific client monitoring or education. The main concern with this medication involves toxicity to sensory organs.
Choice B rationale
HCQ can cause irreversible retinal damage, known as retinopathy, which is a cumulative dose-dependent toxicity. The drug concentrates in melanin-containing tissues, leading to bull's eye maculopathy that can cause vision loss. Because of this serious potential for eye problems, baseline and subsequent annual ophthalmologic examinations are mandatory for safe use.
Choice C rationale
HCQ generally has a favorable gastrointestinal profile compared to other DMARDs. Although some patients may experience mild nausea or diarrhea, the development of severe gastric or peptic ulcers is not a characteristic or prominent adverse effect of hydroxychloroquine, unlike non-steroidal anti-inflammatory drugs (NSAIDs).
Choice D rationale
Hydroxychloroquine actually has a beneficial side effect of improving the lipid profile by lowering total cholesterol and low-density lipoprotein (LDL) levels, rather than causing high cholesterol. Therefore, informing the client about high cholesterol as a potential problem would be scientifically inaccurate.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
The human immunodeficiency virus (HIV) targets CD4+ T-lymphocytes, compromising the immune system, leading to AIDS which is associated with chronic inflammation and opportunistic infections. This prolonged state often results in anemia due to bone marrow suppression, chronic disease effects on erythropoiesis, or nutritional deficiencies. Therefore, decreased hemoglobin, not increased (normal male: 14-18 g/dL; female: 12-16 g/dL), is expected in advanced HIV/AIDS.
Choice B rationale
The primary characteristic of advanced HIV/AIDS is a significant destruction of CD4+ T-lymphocytes, which are a type of white blood cell (WBC). While some opportunistic infections may cause an initial increase, the hallmark of disease progression to AIDS is severe immunosuppression and a decreased CD4+ count (below 200 cells/mm) and often leukopenia or a low total WBC count (normal: 4,500-11,000 cells/mm).
Choice C rationale
Night sweats are a common systemic symptom in clients with advanced HIV infection or AIDS, often classified as a B symptom. This constitutional symptom is frequently associated with the viremia and the immune system's response to the persistent viral replication or underlying opportunistic infections, such as Mycobacterium avium complex (MAC) or tuberculosis, which are prevalent in the setting of severe immunosuppression.
Choice D rationale
Wasting syndrome is a critical defining diagnosis of AIDS, characterized by involuntary loss of greater than 10.
Correct Answer is A
Explanation
Choice A rationale
A sudden decline in status with a large increase in viral load in an HIV-positive client often indicates treatment failure. The most common reason for a sudden, significant increase in viral load and clinical decline while on antiretroviral therapy (ART) is non-adherence to the prescribed drug regimen, which leads to drug levels too low to suppress viral replication and can foster drug resistance.
Choice B rationale
While international travel could increase exposure to new or resistant pathogens, non-adherence to ART is a far more immediate and common cause of sudden viral load increase and clinical decline. Assessing adherence addresses the primary, modifiable factor within the client's direct control regarding their treatment effectiveness, making it the most immediate and impactful action.
Choice C rationale
New sexual partners primarily relate to the transmission risk of HIV, not the immediate reason for a sudden increase in the existing client's viral load. A change in viral load in a client already diagnosed and on therapy is highly correlated with the effectiveness of their current treatment, making adherence a more pertinent initial focus than sexual behavior changes.
Choice D rationale
Changes in environment or new pets are relevant for assessing exposure to opportunistic infections like Toxoplasma gondii (from cat feces) or certain fungi, which can exacerbate the disease. However, the most direct cause of a sharp increase in viral load is a breakdown in effective antiretroviral suppression, making adherence the priority assessment.
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