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 B
Explanation
Choice A rationale
Pruritus, or itching, is not a typical manifestation of Parkinson's disease. Parkinson's primarily affects the motor system due to degeneration of dopaminergic neurons in the substantia nigra, leading to movement disorders rather than dermatological symptoms.
Choice B rationale
Bradykinesia, characterized by slowness of movement, is a cardinal manifestation of Parkinson's disease. It results from reduced dopamine levels, impairing the basal ganglia's ability to facilitate smooth and rapid motor control, making daily activities challenging.
Choice C rationale
Hypertension, or high blood pressure, is not a direct or consistent manifestation of Parkinson's disease. While some autonomic dysregulation can occur, it typically leads to orthostatic hypotension rather than sustained hypertension, especially in later stages. Normal blood pressure is typically below 120/80 mmHg.
Choice D rationale
Xerostomia, or dry mouth, is not a primary manifestation of Parkinson's disease. It can be a side effect of some medications used to treat Parkinson's, such as anticholinergics, but it is not a direct symptom of the disease itself.
Correct Answer is D
Explanation
Choice A rationale
Pulse oximetry measures the oxygen saturation of hemoglobin in peripheral blood, which is an indirect and less accurate measure of oxygen concentration in the blood, especially in patients with respiratory compromise or poor peripheral perfusion. It is non-invasive and provides an estimate (normal range 95-100%).
Choice B rationale
A capillary blood sample, typically obtained from a fingertip, provides information on blood glucose or lactate, but it is not the most accurate method for assessing arterial oxygen concentration due to its mixed venous and arterial components and potential for air exposure.
Choice C rationale
Assessment of the patient's nail beds provides a visual, qualitative assessment of peripheral perfusion and oxygenation (e.g., cyanosis), but it is subjective and not a precise or scientific measurement of the actual oxygen concentration in the blood.
Choice D rationale
An arterial blood gas (ABG) study directly measures the partial pressure of oxygen in arterial blood ($PaO_2$), along with carbon dioxide, pH, and bicarbonate. This provides the most accurate and precise assessment of oxygenation status and acid-base balance in the patient's blood. Normal $PaO_2$ is 80-100 mmHg.
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