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?

Undergo annual eye examinations.

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

Avoid crowds and people who are sick.

Obtain routine vaccinations as scheduled.

Answer and Explanation

The Correct Answer is C

A) Undergo annual eye examinations:
While methotrexate and adalimumab can both have potential ocular side effects, such as blurred vision or eye pain, the need for annual eye examinations is more commonly associated with methotrexate therapy. Methotrexate can cause ocular toxicity, including retinopathy and optic neuropathy, which necessitates regular monitoring by an ophthalmologist. However, adalimumab is not typically associated with annual eye examinations, so this instruction is not directly relevant to the addition of adalimumab to the client’s regimen.

B) Have a chest x-ray prior to your first dose:
A chest x-ray is not routinely required before initiating adalimumab therapy. While screening for tuberculosis (TB) may be necessary in clients starting adalimumab due to its immunosuppressive effects, a chest x-ray is not always indicated for this purpose. Instead, TB screening usually involves a thorough history, physical examination, and possibly tuberculin skin testing or interferon-gamma release assays. Therefore, this instruction is not specifically related to the addition of adalimumab to the client’s treatment regimen.

C) Avoid crowds and people who are sick:
Adalimumab is a biologic disease-modifying antirheumatic drug (DMARD) that suppresses the immune system’s inflammatory response by targeting tumor necrosis factor-alpha (TNF-alpha). As a result, clients taking adalimumab are at increased risk of infections, including bacterial, viral, and fungal infections. Therefore, instructing the client to avoid crowds and individuals who are sick helps reduce the risk of exposure to infectious pathogens and minimize the likelihood of developing infections while on adalimumab therapy.

D) Obtain routine vaccinations as scheduled:
While maintaining up-to-date vaccinations is important for overall health and immunity, clients receiving biologic DMARDs like adalimumab may have a reduced response to vaccines due to immunosuppression. Therefore, it is generally recommended to administer necessary vaccinations before starting adalimumab therapy whenever possible. However, the decision to administer vaccines should be individualized, and certain live vaccines may be contraindicated while receiving adalimumab. Nonetheless, this instruction is not directly related to the addition of adalimumab to the client’s medication regimen.

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Correct Answer is A

Explanation

A) Positive guaiac of stool:
A positive guaiac test indicates the presence of occult (hidden) blood in the stool, which may suggest gastrointestinal bleeding. Given the client’s history of heartburn, indigestion, and self-treatment with ibuprofen and antacids, gastrointestinal irritation or ulceration may be occurring, leading to bleeding. Gastrointestinal bleeding can cause fatigue, dizziness, and other symptoms. Therefore, it is essential to report this finding immediately to the healthcare provider for further evaluation and management.

B) Hematocrit 42% (0.42 volume fraction):
A hematocrit level within the reference range (42% to 52%) is considered normal. While a slight decrease in hematocrit may indicate anemia, it is not an urgent finding that requires immediate reporting. The client’s hematocrit level of 42% is within the normal range, so it does not warrant immediate concern.

C) Gastric pH 2.0:
A gastric pH of 2.0 falls within the normal range (1.5 to 3.5) for gastric acid pH. This finding indicates normal gastric acidity and does not suggest an acute problem that requires immediate reporting to the healthcare provider.

D) Hemoglobin 13 g/dL (130 g/L):
A hemoglobin level of 13 g/dL is slightly below the lower end of the reference range (14 to 18 g/dL) but does not indicate a critical condition requiring immediate intervention. While it may suggest mild anemia, it is not an urgent finding that necessitates immediate reporting to the healthcare provider.

A. Monitor for any signs of sexual dysfunction. B. Decrease cigarette use to a pack per day. C. Notify the healthcare provider of lethargy. D. Take the medication an hour after antacids.

Correct Answer is B

Explanation

A) Monitoring blood pressure: Tamsulosin is an alpha-adrenergic blocker used to relax the muscles in the prostate and bladder neck, improving urinary flow in benign prostatic hyperplasia (BPH). Monitoring blood pressure is important because tamsulosin can cause orthostatic hypotension, especially when starting the medication or increasing the dose.
B) Assessing urine output: This is the correct answer. Tamsulosin can cause urinary retention, especially in patients with bladder outlet obstruction. Monitoring urine output helps assess for any signs of urinary retention or decreased urinary flow.
C) Obtaining daily weights: This is not typically necessary for monitoring the effects of tamsulosin. Changes in weight may occur due to other factors and are not directly related to the medication.
D) Performing a bladder scan: While performing a bladder scan may be indicated if there are specific concerns about urinary retention, assessing urine output is a more direct and immediate way to monitor for this adverse reaction.

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