The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and receives a prescription for adalimumab. Which instructions should the nurse provide the client?

Avoid crowds and people who are sick.

Undergo annual eye examinations.

Obtain routine vaccinations as scheduled.

Have a chest x-ray prior to your first dose.

Answer and Explanation

The Correct Answer is A

Choice A reason:

Avoiding crowds and people who are sick is crucial for clients taking methotrexate and adalimumab. Both medications suppress the immune system, increasing the risk of infections. Methotrexate is an immunosuppressant that can reduce the body’s ability to fight infections. Adalimumab, a TNF inhibitor, also lowers the immune response, making clients more susceptible to infections. Therefore, avoiding exposure to potential sources of infection is essential to prevent serious health complications.

Choice B reason:

While undergoing annual eye examinations is important for overall health, it is not directly related to the use of methotrexate and adalimumab. Methotrexate can cause ocular side effects, but these are relatively rare. Regular eye exams are a good practice but not the most critical instruction in this context.

Choice C reason:

Obtaining routine vaccinations is generally recommended for clients on immunosuppressive therapy. However, live vaccines should be avoided as they can cause infections in immunocompromised individuals. Non-live vaccines, such as the flu shot, are safe and should be administered according to the vaccination schedule. This instruction is important but secondary to avoiding exposure to infections.

Choice D reason:

Having a chest x-ray prior to the first dose of adalimumab is necessary to check for latent tuberculosis (TB). Adalimumab can reactivate latent TB, so screening is essential before starting the medication. However, this is a one-time requirement and not an ongoing instruction like avoiding crowds and sick people.

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Correct Answer is A

Explanation

Choice A reason:

Measuring the client’s blood pressure is the most direct and effective way to assess the effectiveness of amlodipine. Amlodipine is a calcium channel blocker primarily used to treat hypertension and angina. Its main action is to relax the blood vessels, which lowers blood pressure. Regular monitoring of blood pressure helps determine if the medication is achieving its intended effect.

Choice B reason:

Monitoring the client’s serum electrolytes is important for overall health, but it is not the primary method to assess the effectiveness of amlodipine. Amlodipine does not significantly affect serum electrolyte levels, so this action would not provide specific information about the drug’s effectiveness.

Choice C reason:

Noting the client’s serum calcium levels is not necessary for assessing the effectiveness of amlodipine. Amlodipine does not alter serum calcium levels, as its mechanism of action involves blocking calcium channels in the blood vessels, not affecting calcium levels in the blood.

Choice D reason:

Reviewing the client’s intake and output can be useful for monitoring fluid balance and kidney function, but it is not the primary method to assess the effectiveness of amlodipine. This action does not directly measure the drug’s impact on blood pressure.

A. Are you taking any supplements? B. Have you experienced itching or hives? C. Have you noticed that your skin is dry? D. Have you noticed the need to urinate less often? E. Do you use any salt substitutes? F. Have you experienced urgency to urinate?

Correct Answer is ["A"]

Explanation

Choice A reason:

Asking if the client is taking any supplements is important because certain supplements can affect blood urea nitrogen (BUN) levels. For example, high protein supplements can increase BUN levels, while others might interact with medications or affect kidney function.

Choice B reason:

Inquiring about itching or hives is relevant for identifying potential allergic reactions or side effects from medications or supplements. However, it is not directly related to the BUN levels.

Choice C reason:

Dry skin can be a symptom of various conditions, including dehydration or kidney issues. While it is a useful question, it does not directly address the BUN levels.

Choice D reason:

Asking if the client has noticed the need to urinate less often is crucial for assessing kidney function. Reduced urine output can indicate kidney dysfunction, which can affect BUN levels.

Choice E reason:

Using salt substitutes is relevant because some contain potassium, which can affect kidney function and electrolyte balance. This question helps assess potential dietary influences on BUN levels.

Choice F reason:

Experiencing urgency to urinate can be a symptom of urinary tract issues or other conditions. While it is important to know, it is not directly related to the BUN levels.

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The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and receives a prescription for adalimumab. Which instructions should the nurse provide the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which action should the nurse implement to assess the effectiveness of amlodipine?

Correct Answer is A

Explanation

The nurse reviews the laboratory values. What question(s) can the nurse ask the client based on the laboratory results? Select all that apply.

Correct Answer is ["A"]

Explanation

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