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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Keep an oral liquid or glucose source available:
While it's essential to have a readily available source of glucose in case of hypoglycemia, ensuring consistency in meal timing is more critical for managing blood sugar levels in clients receiving insulin lispro. However, having a glucose source available is still important as a precautionary measure.
B) Check blood glucose levels every six hours:
Frequent monitoring of blood glucose levels is essential in managing diabetes, but checking levels every six hours may not be necessary for all clients. The frequency of blood glucose monitoring should be individualized based on factors such as the client's overall glycemic control, insulin regimen, meal timing, and activity level.
C) Assess for hypoglycemia between meals:
While assessing for hypoglycemia is important, especially in clients receiving insulin therapy, ensuring consistent meal timing is a more proactive measure to prevent hypoglycemia. Clients should ideally consume meals or snacks containing carbohydrates around the same time they administer rapid-acting insulins like insulin lispro to prevent blood sugar fluctuations.
D) Provide meals at the same time this insulin is given:
This is the correct intervention. Insulin lispro is a rapid-acting insulin that is typically administered just before meals to control postprandial blood sugar levels effectively. Providing meals at consistent times relative to insulin administration helps synchronize the peak action of the insulin with the rise in blood glucose that occurs after eating, minimizing the risk of hypoglycemia and hyperglycemia.
Correct Answer is ["200"]
Explanation
The nurse should program the infusion pump to deliver 200 mL/hr.
Although the medication dosage is 400 mg, the infusion pump rate is determined by the total volume of the IV fluid (including the medication) and the desired infusion time.
In this case:
Total volume of IV bag (D,W): 200 mL
Infusion time: 1 hour
Since the medication is already diluted in the 200 mL bag, the entire volume needs to be delivered over the course of the hour. Therefore, the nurse should program the pump to deliver the full 200 mL of the solution at a rate of:
200 mL / 1 hour = 200 mL/hr
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