A nurse is reviewing the medical record of a client who is taking epoetin alfa. Which of the following laboratory tests should the nurse monitor to determine the effectiveness of the medication? (Select all that apply.)

When providing teaching to a client with chronic rheumatoid arthritis who is starting a new prescription for hydroxychloroquine, the nurse should instruct the client to obtain routine eye examinations. Hydroxychloroquine is an antimalarial and immunosuppressive medication commonly used to treat rheumatoid arthritis and other autoimmune conditions.

One of the potential side effects of hydroxychloroquine is ocular toxicity, particularly affecting the retina. Retinal toxicity can lead to vision changes or, in severe cases, irreversible damage to the eyes. Therefore, regular eye examinations are necessary to monitor for any signs of retinal toxicity and detect any visual changes early to prevent further complications.

The American Academy of Ophthalmology recommends that patients taking hydroxychloroquine undergo a baseline eye examination before starting the medication and annual eye examinations thereafter, especially after five years of continuous use.

Let's go through the other options:

B. Chest x-ray: A chest x-ray is not routinely required for monitoring clients taking hydroxychloroquine for rheumatoid arthritis. Hydroxychloroquine is not known to cause significant respiratory or pulmonary side effects.

C. Pancreatic enzyme levels: Monitoring pancreatic enzyme levels is not specifically related to hydroxychloroquine therapy. Pancreatic enzyme level testing is typically used to assess the function of the pancreas in conditions like pancreatitis or pancreatic insufficiency.

D. Urinalysis screening: While regular monitoring of kidney function is important for clients on long-term medication therapy, routine urinalysis screening is not specifically related to hydroxychloroquine use in clients with rheumatoid arthritis. Regular eye examinations are of higher priority due to the potential ocular toxicity associated with this medication.

To calculate the rate at which the IV pump should be set to deliver dopamine, we need to determine the total amount of dopamine in the infusion and divide it by the desired dose per minute.

Given:

Dopamine concentration: 400 mg in 250 mL

Desired dose: 5 mcg/kg/min

Patient weight: 220 lb

First, we need to convert the patient's weight from pounds to kilograms:

220 lb ÷ 2.2 = 100 kg

Next, we need to calculate the total amount of dopamine needed per minute:

5 mcg/kg/min × 100 kg = 500 mcg/min

Now, we need to convert the dopamine dose from mcg to mg:

500 mcg/min ÷ 1000 = 0.5 mg/min

To determine the infusion rate in mL/hr, we divide the dose in mg/min by the dopamine concentration in the infusion solution:

0.5 mg/min ÷ 250 mL = 0.002 mL/min

Finally, we convert the infusion rate from mL/min to mL/hr by multiplying by 60:

0.002 mL/min × 60 min = 0.12 mL/hr

Therefore, the nurse should set the IV pump to deliver 0.12 mL/hr.