The nurse is providing discharge teaching to a patient with rheumatoid arthritis (RA) who has been prescribed methotrexate. Which patient statement indicates to the nurse a need for further teaching?

Choice A reason: Monitoring the patient's absolute neutrophil count (ANC) daily and stopping medication when the ANC is greater than 20,000 cells/uL is an essential aspect of using filgrastim safely. However, this is typically managed by the healthcare provider and not the primary action for the nurse to take for patient education. The nurse's role focuses more on educating the patient about potential side effects and self-care.

Choice B reason: Teaching the patient how to administer the medication via intramuscular is not relevant for filgrastim, as it is typically administered via subcutaneous injection. Proper administration technique is crucial for ensuring the medication's effectiveness, but this choice does not accurately reflect the standard administration method for filgrastim.

Choice C reason: Ensuring the patient understands the risk of bone pain and how to manage it is crucial for promoting safe and effective use of filgrastim. Bone pain is a common side effect of filgrastim due to the stimulation of bone marrow to produce more neutrophils. Educating the patient about this potential side effect and providing strategies for managing the pain, such as using over-the-counter pain relievers, helps improve patient comfort and adherence to the medication.

Choice D reason: Administering filgrastim as needed for symptoms of infection is not appropriate. Filgrastim is used to stimulate neutrophil production and prevent infection, rather than treating active infections. The medication should be administered according to the prescribed schedule, not based on the presence of infection symptoms.

Choice A reason: Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage and underlying bone. It is not directly associated with corticosteroid treatment. Osteoarthritis develops due to wear and tear over time, and while corticosteroids are used to manage inflammation, they do not cause osteoarthritis.

Choice B reason: Osteoporosis is a potential complication of long-term corticosteroid use. Corticosteroids can interfere with bone formation and increase the rate of bone resorption, leading to decreased bone density and an increased risk of fractures. Patients on long-term corticosteroid therapy should be monitored for signs of osteoporosis, and preventive measures such as calcium and vitamin D supplementation may be recommended.

Choice C reason: Hyperglycaemia, or elevated blood glucose levels, is a common side effect of corticosteroid therapy. Corticosteroids can increase insulin resistance and promote glucose production in the liver, leading to higher blood sugar levels. Patients with diabetes or those at risk for diabetes should be closely monitored for changes in their blood glucose levels when on corticosteroid therapy.

Choice D reason: Mucositis, or inflammation of the mucous membranes, is not a typical complication of corticosteroid therapy. Mucositis is more commonly associated with chemotherapy or radiation therapy used in cancer treatment. While corticosteroids can affect the immune system, they do not directly cause mucositis.