A nurse is teaching a client with rheumatoid arthritis about the use of methotrexate. Which statement by the client indicates a correct understanding of the safety precautions associated with methotrexate therapy?
I will return to the clinic once a year to have my blood drawn.
I should stop taking oral contraceptives while on methotrexate.
I'll let the doctor know if I develop sores in my mouth.
I can receive MMR, varicella vaccines while on methotrexate.
The Correct Answer is C
Rationale:
A. Methotrexate has the potential to cause serious toxicities, including bone marrow suppression, liver toxicity, and renal impairment. Because of these risks, patients require frequent monitoring of complete blood count (CBC), liver function tests (LFTs), and renal function. Initially, labs are typically checked every 4–8 weeks when starting or adjusting therapy, and periodically thereafter. Waiting an entire year to have labs drawn would be unsafe and could delay the detection of life-threatening complications.
B. Methotrexate is teratogenic and can cause severe fetal abnormalities. Clients of childbearing age must use effective contraception throughout therapy. Stopping oral contraceptives would increase the risk of pregnancy, which is contraindicated while taking methotrexate. Patient education must emphasize consistent contraceptive use during treatment.
C. Mouth sores, also called stomatitis or mucositis, are an early sign of methotrexate toxicity, often related to bone marrow suppression or mucosal irritation. Reporting these symptoms promptly allows the healthcare provider to adjust the dose, provide supportive care, or intervene before more serious complications occur, such as infection, severe anemia, or bleeding. This demonstrates that the client understands the importance of monitoring for early signs of adverse effects.
D. Methotrexate is immunosuppressive, so live vaccines (including MMR, varicella, and some others) are contraindicated during therapy because they can cause vaccine-related infection. Patients should receive non-live vaccines as appropriate and consult their provider before vaccination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Follow-up is essential after radioactive iodine therapy to monitor thyroid hormone levels and detect potential hypothyroidism or residual hyperthyroidism. Patients typically require periodic blood tests for months to years after treatment.
B. Radioactive iodine-131 selectively destroys overactive thyroid tissue, which decreases the production of thyroid hormones. This mechanism is why it is effective for treating hyperthyroidism, especially in conditions like Graves’ disease or toxic nodular goiter.
C. Radioactive iodine-131 is contraindicated during pregnancy and breastfeeding because it can cross the placenta and damage fetal thyroid tissue, potentially causing congenital hypothyroidism.
D. Antithyroid medications, such as methimazole or propylthiouracil, are often first-line therapy, especially in younger clients or those who are pregnant. Radioactive iodine is typically used when medication fails, is not tolerated, or as definitive therapy in adults.
Correct Answer is C
Explanation
Rationale:
A. These are common side effects of opioid use, not withdrawal. During withdrawal, gastrointestinal motility increases and alertness rises, leading to diarrhea, insomnia, and agitation rather than constipation and drowsiness.
B. While mild autonomic changes can occur, hypotension is not a hallmark of opioid withdrawal. Hyperactivity may be present in terms of restlessness, but this option does not capture the key constellation of withdrawal symptoms.
C. These are classic opioid withdrawal symptoms. Rhinitis (runny nose), yawning, lacrimation, abdominal cramping, diarrhea, restlessness, and agitation are signs of the sympathetic nervous system overactivity that occurs when opioids are abruptly discontinued or doses are missed. These symptoms guide nursing monitoring and support.
D. These are common effects of opioid overdose, not withdrawal. Withdrawal typically causes tachycardia, hypertension, and increased respiratory rate, reflecting sympathetic activation
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