A nurse is teaching a client who is starting to take methotrexate to treat rheumatoid arthritis.
Which of the following instructions should the nurse include in the teaching?
Avoid eating foods high in vitamin K.
Drink at least 2 liters of water daily.
Take the medication daily.
Use an alcohol-based mouthwash after each meal.
The Correct Answer is B
Choice A rationale
Methotrexate does not have a significant interaction with vitamin K. Methotrexate's primary mechanism of action involves inhibiting dihydrofolate reductase, thereby interfering with folate metabolism and DNA synthesis. Vitamin K is crucial for blood clotting factors. There is no contraindication for vitamin K rich foods.
Choice B rationale
Methotrexate excretion is primarily renal, and adequate hydration is critical to prevent nephrotoxicity and facilitate drug elimination. Drinking at least 2 liters of water daily helps maintain good kidney function, ensuring that methotrexate and its metabolites are efficiently cleared from the body, thus minimizing the risk of drug accumulation and associated toxicities.
Choice C rationale
Methotrexate for rheumatoid arthritis is typically administered once weekly, not daily, to mitigate severe adverse effects such as bone marrow suppression, hepatotoxicity, and gastrointestinal complications. Daily dosing would lead to rapid accumulation and dangerously high systemic concentrations, overwhelming the body's detoxification pathways.
Choice D rationale
Alcohol-based mouthwashes should be avoided when taking methotrexate because alcohol can cause mucosal irritation and increase the risk of oral mucositis, a common side effect of methotrexate. Additionally, alcohol can exacerbate hepatotoxicity, a significant concern with methotrexate therapy, by increasing metabolic burden on the liver.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Third-degree AV block, also known as complete heart block, is characterized by a complete dissociation between atrial and ventricular activity, meaning P waves and QRS complexes occur independently without any consistent relationship. This rhythm does not exhibit such complete dissociation.
Choice B rationale
First-degree AV block is indicated by a prolonged PR interval (greater than 0.20 seconds) with every P wave followed by a QRS complex. The rhythm strip shows a progressive lengthening of the PR interval before a dropped QRS, which is not characteristic of first-degree block.
Choice C rationale
Second-degree AV block Mobitz type 1 (Wenckebach) is characterized by a progressive lengthening of the PR interval over several beats, eventually culminating in a P wave that is not followed by a QRS complex (a dropped beat), after which the cycle repeats. This is exactly what is shown in the telemetry strip.
Choice D rationale
Second-degree AV block Mobitz type 2 is characterized by a constant PR interval for conducted beats, but with intermittent dropped QRS complexes without prior PR interval prolongation. This differs from the progressive PR lengthening seen in the provided rhythm strip.
Correct Answer is B
Explanation
Choice A rationale
Quadriplegia, or tetraplegia, involves paralysis affecting all four limbs and the torso, typically occurring with spinal cord injuries at the cervical level (C1-C8). A T2-T3 injury is below the cervical spine, so it would not result in quadriplegia.
Choice B rationale
Paraplegia involves paralysis that affects the lower half of the body, including both legs, and typically results from spinal cord injuries at the thoracic (T1-T12) or lumbar (L1-L5) levels. A T2-T3 injury would spare upper limb function but impair sensation and movement in the trunk and lower extremities.
Choice C rationale
Paresthesia refers to abnormal sensations such as tingling, prickling, or numbness, without actual paralysis. While paresthesia can be present with a spinal cord injury, it describes a sensory disturbance, not the type of motor disability, which is the primary focus of this question.
Choice D rationale
Hemiplegia is paralysis affecting one side of the body and is typically associated with brain injuries like stroke, rather than spinal cord injuries. Spinal cord injuries generally cause bilateral deficits below the level of the lesion.
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