What instruction for oral administration of methotrexate should the nurse include when teaching a client diagnosed with rheumatoid arthritis?

Use an antiemetic one hour following administration.

Drink 2-3 liters of water per day.

Rinse mouth twice per day with an alcohol-based mouthwash.

Take the medication with an NSAID.

Answer and Explanation

The Correct Answer is D

Choice A Reason
Using an antiemetic one hour after administration of methotrexate is not a standard recommendation. Antiemetics are typically used to prevent nausea and vomiting associated with chemotherapy and are taken before or at the time of methotrexate administration, not afterward.

Choice B Reason
Drinking 2-3 liters of water per day is important for patients taking methotrexate to prevent kidney damage by ensuring adequate hydration and facilitating the excretion of the drug¹. Methotrexate can be nephrotoxic, and proper hydration helps to mitigate this risk.

Choice C Reason
Rinsing the mouth with an alcohol-based mouthwash is not recommended for patients taking methotrexate. Alcohol can cause drying and irritation, which might exacerbate any mouth sores caused by methotrexate. Instead, patients should use a gentle, non-alcoholic mouthwash to maintain oral hygiene.

Choice D Reason
Taking methotrexate with an NSAID is not advised without specific medical guidance. NSAIDs can increase the toxicity of methotrexate by displacing it from protein-binding sites and reducing its renal clearance, potentially leading to increased side effects.

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Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A Reason:
A blood glucose level of 80 mg/dL before eating falls within the normal fasting blood glucose range, which is between 70 mg/dL to 110 mg/dL. Therefore, this finding is not a priority concern for a client taking prednisone.

Choice B Reason:
Gaining 5 pounds over 7 months is not typically a priority concern unless it is sudden or unexplained. Prednisone can cause fluid retention and weight gain as a common side effect, but this gradual weight change does not indicate an immediate health risk.

Choice C Reason:
Waking up with a fever is a priority finding as it may indicate an infection. Patients on prednisone are at increased risk of infections due to its immunosuppressive effects¹. Fever could also signify an exacerbation of inflammatory bowel disease or other complications.

Choice D Reason:
While insomnia is a common side effect of prednisone and can impact quality of life, it is not typically a priority over signs that could indicate infection or exacerbation of the underlying condition

A. An increase in urine output. B. Less dyspnea with activity. C. A blood pressure of 120/80 mmHg. D. A heart rate of 65 per minute.

Correct Answer is D

Explanation

Choice a reason:
An increase in urine output can be a sign of improved kidney function or the effect of medications, but it is not a direct indicator of reduced cardiac workload. Atenolol, a beta-blocker, primarily reduces the heart rate and myocardial oxygen demand, not urine output.

Choice b reason:
Less dyspnea with activity suggests improved cardiovascular efficiency, but it is not a specific measure of cardiac workload. Dyspnea can be influenced by respiratory conditions and is not solely determined by cardiac function.

Choice c reason:
A blood pressure of 120/80 mmHg is considered optimal for most adults and indicates good control of hypertension. However, it does not specifically reflect the cardiac workload, which is more directly affected by heart rate and myocardial oxygen demand.

Choice d reason:
A heart rate of 65 per minute is a clear indicator that atenolol is effective in reducing cardiac workload. Atenolol decreases the heart rate, which in turn reduces myocardial oxygen demand and the overall workload on the heart. This is particularly important for patients with unstable angina, where reducing the heart's workload can prevent angina attacks and potential myocardial infarction.

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What instruction for oral administration of methotrexate should the nurse include when teaching a client diagnosed with rheumatoid arthritis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. Which finding should the nurse recognize as the priority? The client reports:

Correct Answer is C

Explanation

The nurse identifies that the goal of decreasing the cardiac workload for a client receiving atenolol 25 mg PO BID for unstable angina is met when the client has:

Correct Answer is D

Explanation

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