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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Free Nursing Study Resources

Correct Answer is ["1.7"]

Explanation

To find out how many mL the nurse should administer:

We can set up a proportion to solve for the unknown.

Given:

The prescription is for 1,000,000 units of penicillin G.

The available medication is 1,200,000 units/2 mL.

We can set up the proportion as follows:

1,000,000units/ xmL = 1,200,000units/2mL

Solving for x gives us the volume in mL that the nurse should administer.

Cross-multiplying and solving for x:

X = 1,000,000units×2mL/1,200,000units

After performing the calculation, we find that x equals 1.67 mL.

So, the nurse should administer 1.7 mL (rounded to the nearest tenth) of the medication.

A. Expresses that they cannot get enough air to breathe. B. Respiratory rate of 7 breaths/minute. C. Bilateral wheezing on auscultation. D. Pulse oximeter reading of 89% on room air.

Correct Answer is B

Explanation

A) Expresses that they cannot get enough air to breathe: While this statement suggests respiratory distress, it is not as objective an assessment finding as a respiratory rate of 7 breaths/minute. Objective measurements are typically more reliable indicators for initiating interventions.
B) Respiratory rate of 7 breaths/minute: A respiratory rate of 7 breaths/minute is indicative of respiratory depression, which is a potential side effect of opioid analgesics like morphine sulfate. Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression. Administering a prescribed PRN dose of naloxone is appropriate to counteract the respiratory depression and prevent further complications.
C) Bilateral wheezing on auscultation: Wheezing is more commonly associated with bronchoconstriction or airway obstruction rather than opioid-induced respiratory depression. Naloxone is not indicated for wheezing unless there is concurrent opioid-induced respiratory depression.
D) Pulse oximeter reading of 89% on room air: While a pulse oximeter reading of 89% indicates hypoxemia, it may not be solely due to opioid-induced respiratory depression. Other factors, such as hypoventilation, ventilation-perfusion (V/Q) mismatch, or lung disease, could contribute to decreased oxygen saturation. Administering naloxone solely based on pulse oximetry readings may not address the underlying cause adequately. It is essential to assess the client comprehensively, considering clinical signs and symptoms along with objective data.

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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

A client receives a prescription for penicillin G 1,000,000 units intramuscular (IM) daily. The medication is available in 1,200,000 units/2 mL syringe. How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

Correct Answer is ["1.7"]

Explanation

A client is receiving morphine sulfate via a patient controlled analgesic (PCA) pump postoperatively. Which assessment finding should prompt the nurse to administer a prescribed PRN dose of naloxone?

Correct Answer is B

Explanation

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