NCLEX Practice Exam for Pharmacology: Musculoskeletal Medications

EXPLANATION

✔Correct answer:

Aplastic Anemia. Aplastic anemia is a condition in which the bone marrow fails to produce enough blood cells, leading to pancytopenia (deficiency of all types of blood cells). Colchicine can cause bone marrow suppression, which can exacerbate conditions like aplastic anemia. Therefore, it is critical to use caution and closely monitor patients with this condition when prescribing Colchicine.

Colchicine is primarily used to reduce inflammation and pain in acute gout flares by inhibiting microtubule polymerization, which affects various inflammatory processes. However, its effects on rapidly dividing cells, such as those in the bone marrow, can lead to significant hematologic side effects, including bone marrow suppression.

Think of Colchicine as a potent chemical that targets certain cells. While it effectively tackles the problem (inflammation in gout), it can also damage a delicate environment (bone marrow), much like a strong cleaning agent can damage fragile surfaces.

Nurses should ensure that patients with pre-existing hematologic conditions such as aplastic anemia are carefully monitored for signs of bone marrow suppression while on Colchicine. Regular blood tests should be performed to track blood cell counts.

• Monitor complete blood counts (CBC) regularly to detect any early signs of bone marrow suppression.
• Educate patients to report any unusual bruising, bleeding, fatigue, or signs of infection promptly, as these can indicate hematologic side effects.
• Collaborate with the healthcare team to adjust dosage or discontinue Colchicine if significant hematologic side effects are observed.

✘Incorrect answer options:

Behcet disease. Colchicine can be used to treat Behcet disease due to its anti-inflammatory properties. There are no specific cautions for using Colchicine in patients with this condition beyond general monitoring.

Familial Mediterranean fever (FMF). Colchicine is actually a primary treatment for FMF and is used to prevent attacks and amyloidosis associated with the disease. Therefore, it is not contraindicated or used with special caution in FMF patients.

Amyloidosis. Colchicine is also used to treat amyloidosis secondary to FMF, as it can help reduce the formation of amyloid fibrils. There are no specific additional cautions for patients with amyloidosis beyond general monitoring.

EXPLANATION

✔Correct answer:

Tennis. When recommending physical activities for a patient taking Methotrexate (Trexall) for rheumatoid arthritis, it is important to consider activities that provide exercise benefits while minimizing the risk of injury. Tennis is a suitable recommendation as it can be played at varying intensities and can be adjusted to accommodate the patient's physical limitations and fitness level. Unlike the other options, tennis generally involves less physical contact and a lower risk of high-impact injuries, making it a safer choice for someone managing a chronic condition like rheumatoid arthritis.

Methotrexate is an immunosuppressant and anti-inflammatory medication that helps control the symptoms of rheumatoid arthritis. Patients taking Methotrexate may experience side effects such as fatigue and an increased risk of infections. Therefore, recommending physical activities that are less strenuous and involve lower injury risks is prudent.

Think of choosing an activity like selecting a gentle walk versus a challenging hike. While both offer benefits, the gentle walk (tennis) is less likely to cause strain or injury, making it a better fit for someone managing a delicate condition.

Nurse Thompson should provide guidance on safe physical activities and emphasize the importance of staying active to manage rheumatoid arthritis symptoms effectively.

• Recommend tennis as a suitable physical activity, emphasizing that it can be played at various intensities to match the patient's fitness level and comfort.
• Advise the patient to warm up properly before playing and to listen to their body, taking breaks as needed to avoid overexertion.
• Encourage the patient to maintain an overall active lifestyle, including other low-impact activities such as walking, swimming, or yoga, which can help improve joint flexibility and reduce stiffness.
• Monitor the patient's response to physical activities and adjust recommendations as necessary based on their feedback and any changes in their condition.

✘Incorrect answer options:

Ice hockey. Ice hockey is a high-contact sport with a significant risk of injury due to falls and collisions. It is not recommended for patients with rheumatoid arthritis due to the potential for exacerbating joint damage and causing other injuries.

Basketball. Basketball involves a lot of running, jumping, and physical contact, which increases the risk of joint strain and injury. It is less suitable for patients with rheumatoid arthritis who need to avoid high-impact activities.

Football. Football is a high-contact, high-impact sport with a high risk of injury. It is not appropriate for patients with rheumatoid arthritis due to the physical demands and potential for significant joint and muscle injuries.

EXPLANATION

✔Correct answer:

Taking cold or allergy medications will reduce the side effects of Methocarbamol. This statement is incorrect. Cold or allergy medications, particularly those containing antihistamines, can actually enhance the sedative effects of Methocarbamol and increase the risk of side effects such as drowsiness and dizziness.

Methocarbamol is a central muscle relaxant used to relieve muscle spasms. It works by depressing the central nervous system, leading to relaxation of the muscles.

Think of Methocarbamol as a sedative that slows down the nervous system's activity, similar to how turning down the volume on a radio makes it quieter. Combining it with cold or allergy medications is like turning down multiple radios simultaneously, which can make the environment too quiet (too sedated), causing unwanted effects.

Nurses should educate patients on the risks of combining Methocarbamol with other CNS depressants and monitor for signs of excessive sedation or adverse reactions.

• Advise patients to avoid taking over-the-counter cold or allergy medications without consulting their healthcare provider.
• Monitor patients for increased drowsiness, dizziness, or confusion when taking Methocarbamol, especially if combined with other CNS depressants.
• Educate patients on the importance of avoiding alcohol while on Methocarbamol to prevent additive CNS depression.

✘Incorrect answer options:

This medication may cause urine to change color to brown, black, or green. Methocarbamol can cause discoloration of urine, which is a benign side effect and should be explained to patients to prevent unnecessary concern.

Rapid administration of the injectable form can lead to hypotension and bradycardia. Rapid intravenous administration of Methocarbamol can indeed cause hypotension and bradycardia. Therefore, it should be administered slowly and patients should be monitored for these effects.

The injectable form should not be used in patients with liver impairment. Methocarbamol is metabolized in the liver, and the injectable form should be used with caution in patients with liver impairment to avoid potential toxicity.

EXPLANATION

✔Correct answer:

Take the medication with a glass of water after rising in the morning. Alendronate (Fosamax) is a bisphosphonate used to treat and prevent osteoporosis. It is crucial for the medication to be taken correctly to ensure proper absorption and to minimize the risk of gastrointestinal side effects, such as esophagitis. The best practice is to take Alendronate first thing in the morning, with a full glass of water, and to remain upright for at least 30 minutes after taking it. This helps the medication reach the stomach quickly and reduces the risk of esophageal irritation.

Alendronate works by inhibiting osteoclast-mediated bone resorption, thereby increasing bone mineral density. Proper administration is essential for optimal absorption and effectiveness of the medication.

Think of Alendronate as a special nutrient for your bones that needs to be delivered without any blockage. Taking it with a full glass of water on an empty stomach ensures it goes directly to where it's needed, much like pouring water directly into a funnel without any obstructions.

Nurse Stevens should provide detailed instructions to ensure the patient understands the importance of correct administration to maximize the drug’s benefits and minimize side effects.

• Instruct the patient to take Alendronate first thing in the morning, at least 30 minutes before any food, beverages, or other medications.
• Emphasize the importance of taking the medication with a full glass (6-8 ounces) of plain water.
• Advise the patient to remain upright (sitting or standing) for at least 30 minutes after taking the medication to prevent esophageal irritation and improve absorption.
• Ensure the patient understands not to lie down or eat anything for at least 30 minutes after taking Alendronate.

✘Incorrect answer options:

Take the medication 2 hours before bedtime. Taking Alendronate before bedtime is not recommended because lying down shortly after taking it can increase the risk of esophageal irritation and reflux.

Take the medication during lunch. Taking Alendronate during lunch or with any meal can significantly reduce its absorption and effectiveness. It should be taken on an empty stomach.

Take the medication in the morning with meals. Alendronate should be taken on an empty stomach, not with meals, to ensure optimal absorption. Food and beverages can interfere with its absorption and effectiveness.

EXPLANATION

✔Correct answer:

Folic Acid. Folic acid is often prescribed alongside Methotrexate to help reduce the risk of side effects such as mouth sores, gastrointestinal discomfort, and bone marrow suppression. Methotrexate inhibits the enzyme dihydrofolate reductase, which is necessary for folic acid synthesis, leading to a deficiency. Supplementing with folic acid helps to mitigate these adverse effects without interfering with the therapeutic efficacy of Methotrexate.

Methotrexate works by inhibiting dihydrofolate reductase, an enzyme involved in the production of nucleotides required for DNA synthesis and cell replication. This inhibition affects rapidly dividing cells, such as those involved in inflammation in rheumatoid arthritis but can also cause folic acid deficiency. Folic acid supplementation helps to replenish the body's stores and reduce Methotrexate toxicity.

Think of Methotrexate as a roadblock that stops unwanted traffic (inflammation). However, it also blocks some essential services (folic acid). Providing folic acid is like setting up a special pass that allows these necessary services to get through without affecting the roadblock's primary purpose.

Nurse Johnson should ensure that the patient understands the importance of taking folic acid while on Methotrexate and should monitor for any side effects of Methotrexate.

• Instruct the patient to take folic acid as prescribed, usually on days they are not taking Methotrexate, to help reduce side effects.
• Educate the patient about the potential side effects of Methotrexate and the role of folic acid in minimizing these effects.
• Monitor the patient's blood counts and liver function regularly to detect any early signs of toxicity or adverse effects from Methotrexate.

✘Incorrect answer options:

Phenytoin. Phenytoin is an anticonvulsant that can interfere with Methotrexate by displacing it from protein-binding sites and increasing its toxicity. Additionally, both medications can affect folate metabolism, potentially exacerbating side effects.

Sulfamethoxazole. Sulfamethoxazole is an antibiotic that can increase the risk of Methotrexate toxicity. Both drugs can suppress bone marrow, increasing the risk of pancytopenia, and may cause interactions that elevate Methotrexate levels in the blood.

Tetracycline. Tetracycline is an antibiotic that can interact with Methotrexate by affecting its excretion and increasing the risk of toxicity. Methotrexate can also reduce the effectiveness of Tetracycline by affecting gut flora.

EXPLANATION

✔Correct answer:

Drink at least 8-10 glasses of water daily while on Allopurinol. Allopurinol (Zyloprim) is a medication used to manage gout by reducing the production of uric acid in the body. A key piece of advice for patients taking Allopurinol is to stay well-hydrated. Drinking at least 8-10 glasses of water daily helps prevent the formation of kidney stones, a potential side effect of the medication due to the increased excretion of uric acid.

Allopurinol inhibits xanthine oxidase, an enzyme involved in the conversion of hypoxanthine and xanthine to uric acid. Adequate hydration promotes the excretion of uric acid and other waste products, reducing the risk of kidney stone formation and improving kidney function.

Think of uric acid like small pebbles that can accumulate in the kidneys, potentially forming larger stones. Drinking plenty of water is like using a strong stream of water to flush out these pebbles before they can clump together into problematic stones.

Nurses should emphasize the importance of hydration to patients on Allopurinol and educate them on recognizing signs of kidney stones or other complications.

• Advise patients to drink at least 8-10 glasses of water daily to promote urine output and prevent kidney stones.
• Monitor patients for symptoms of kidney stones, such as severe pain in the back or side, blood in the urine, and nausea or vomiting.
• Educate patients on the importance of regular follow-up appointments to monitor uric acid levels and kidney function.

✘Incorrect answer options:

Take Allopurinol on an empty stomach every morning. Allopurinol can be taken with or without food. Taking it with food may help reduce gastrointestinal upset, which can be a side effect of the medication.

Increase your intake of vitamin C while taking Allopurinol. There is no specific recommendation to increase vitamin C intake while taking Allopurinol. In fact, high doses of vitamin C can increase the risk of kidney stones in some individuals, which is a concern for patients taking Allopurinol.

Avoid eating dairy products while taking Allopurinol. There is no need to avoid dairy products while taking Allopurinol. Dairy products do not interact with the medication or affect its efficacy.

EXPLANATION

✔Correct answer:

Practice strict hand washing. Methotrexate (Trexall) is an immunosuppressant commonly used in the treatment of rheumatoid arthritis. It can significantly reduce the body's ability to fight infections. Therefore, practicing strict hand washing is crucial for patients taking Methotrexate to minimize the risk of infections.

Methotrexate works by inhibiting dihydrofolate reductase, which reduces the synthesis of DNA, RNA, and proteins, effectively suppressing the immune system. This suppression can make patients more susceptible to infections.

Think of Methotrexate as a tool that slows down the body's immune response, similar to turning down the volume on an alarm system. While it helps in reducing the overactive immune response in rheumatoid arthritis, it also lowers the body's defense against infections, making hygiene practices like hand washing essential.

Nurse Garcia should emphasize the importance of good hygiene and infection prevention practices to the patient.

• Advise the patient to practice strict hand washing and avoid close contact with people who are sick.
• Instruct the patient to monitor for signs of infection, such as fever, chills, or sore throat, and report them immediately to their healthcare provider.
• Educate the patient on the importance of regular follow-up appointments to monitor blood counts and liver function while on Methotrexate.

✘Incorrect answer options:

Ensure daily exposure to sunlight. Methotrexate can increase the skin's sensitivity to sunlight, leading to a higher risk of sunburn. Patients are generally advised to avoid excessive sun exposure and use sun protection.

Clay-colored stool is a normal response to the treatment. Clay-colored stool is not a normal response to Methotrexate treatment and could indicate a liver problem, which requires immediate medical attention. Methotrexate can cause hepatotoxicity, and any signs of liver dysfunction should be reported to a healthcare provider.

Pregnancy is not contraindicated with this medication. Methotrexate is contraindicated during pregnancy due to its teratogenic effects, which can cause serious birth defects or fetal death. Women of childbearing potential should use effective contraception while taking Methotrexate and for a period after discontinuing the medication.

EXPLANATION

✔Correct answer:

Acetaminophen (Tylenol). Acetaminophen is a safe choice for managing pain in patients taking Probenecid for gout. Probenecid is a uricosuric agent used to lower uric acid levels in gout patients, but it doesn't provide relief from acute pain. Acetaminophen is a suitable analgesic that does not interact negatively with Probenecid and does not affect uric acid levels, making it an appropriate option for pain management in gout patients.

Acetaminophen works as an analgesic and antipyretic by inhibiting the synthesis of prostaglandins in the central nervous system. It does not possess anti-inflammatory properties, but it effectively reduces pain and fever without interfering with Probenecid's mechanism of action or exacerbating gout symptoms.

Think of Probenecid as a maintenance worker who clears out the excess trash (uric acid) to keep the area clean. Acetaminophen acts like a pain reliever (like a balm) that helps soothe the pain without interfering with the maintenance work.

Nurse Lopez should ensure that the patient understands the importance of using Acetaminophen for pain relief and avoiding medications that could potentially worsen gout or interact negatively with Probenecid.

• Administer Acetaminophen as prescribed to manage acute gout pain.
• Educate the patient to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like Aspirin, as they can affect uric acid levels and potentially worsen gout.
• Monitor the patient for pain relief and any adverse reactions to the medications.

✘Incorrect answer options:

Tizanidine (Zanaflex). Tizanidine is a muscle relaxant used to treat muscle spasticity. It is not indicated for pain management in gout and does not address the acute pain associated with gout flare-ups.

Aspirin (Ecotrin). Aspirin is an NSAID that can interfere with uric acid excretion and potentially worsen gout symptoms. It is not recommended for pain management in patients with gout.

Orphenadrine (Norflex). Orphenadrine is a muscle relaxant and anticholinergic used to treat muscle pain and spasms. It is not specifically indicated for gout pain and does not address the underlying cause or acute pain associated with gout flare-ups.

EXPLANATION

✔Correct answer:

Use an effective form of birth control while on this medication. Leflunomide (Arava) is a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis. It is known to cause serious birth defects and is contraindicated during pregnancy. Therefore, it is essential for female patients of childbearing potential to use an effective form of birth control while taking this medication to prevent pregnancy.

Leflunomide works by inhibiting the enzyme dihydroorotate dehydrogenase, which is necessary for the synthesis of pyrimidine. This inhibition reduces the proliferation of activated lymphocytes, thereby decreasing inflammation. Due to its teratogenic effects, strict contraception is advised during and for some time after treatment.

Think of Leflunomide as a chemical that could harm a developing plant (fetus). To protect the plant from being harmed, you must make sure there are no seeds (pregnancy) exposed to the chemical. Using birth control is like ensuring no seeds are present during the treatment.

Nurse Taylor should emphasize the importance of effective contraception to the patient and discuss options for birth control. Additionally, she should educate the patient on the need for a drug elimination procedure if pregnancy is planned or suspected.

• Advise the patient to use an effective form of birth control during treatment and for a certain period after discontinuing Leflunomide.
• Inform the patient about the risk of severe birth defects associated with Leflunomide and the importance of preventing pregnancy.
• Discuss the possibility of using cholestyramine to accelerate the elimination of Leflunomide from the body if the patient plans to become pregnant.
• Ensure regular follow-up to monitor for any side effects and assess the effectiveness of the treatment and contraception.

✘Incorrect answer options:

Expect to see improvement within 3-5 days of starting Leflunomide. Improvement with Leflunomide usually takes several weeks to months. It is not a fast-acting medication, and patients should be informed about the expected timeline for seeing therapeutic effects.

Use cholestyramine to reduce side effects. Cholestyramine is used to rapidly clear Leflunomide from the body in cases of severe toxicity or if a patient wishes to become pregnant, not to reduce common side effects. It binds to Leflunomide and its active metabolite, facilitating their elimination.

Breastfeeding can continue during treatment. Breastfeeding is contraindicated while taking Leflunomide due to the potential for serious adverse effects on the nursing infant. Patients should be advised against breastfeeding while on this medication.

EXPLANATION

✔Correct answer:

Liver function test. Dantrolene Sodium (Dantrium) is a muscle relaxant used primarily for the treatment of malignant hyperthermia and chronic spasticity. One of the significant adverse effects of Dantrolene is hepatotoxicity, which can lead to liver damage. Monitoring liver function tests (LFTs) is essential to detect any potential liver impairment early.

Dantrolene works by interfering with the release of calcium from the sarcoplasmic reticulum in muscle cells, thereby reducing muscle contractions. However, it has been associated with liver toxicity, particularly with long-term use.

Think of Dantrolene as a medication that helps keep muscle contractions under control by managing the flow of calcium. However, this control mechanism can sometimes put stress on the liver, similar to how a heavy workload can stress out an employee. Monitoring liver function is like checking on the employee's health to ensure they are not being overworked.

Nurses should regularly monitor liver function tests for patients on Dantrolene, educate patients about the signs and symptoms of liver toxicity, and encourage them to report any symptoms promptly.

• Monitor liver function tests (ALT, AST, ALP, and bilirubin) at baseline and periodically during treatment.
• Educate patients about symptoms of liver dysfunction, such as jaundice, dark urine, fatigue, nausea, and abdominal pain.
• Advise patients to avoid alcohol and other hepatotoxic substances while taking Dantrolene.

✘Incorrect answer options:

Triglycerides level. Triglycerides are a type of fat found in the blood, and their levels are used to assess cardiovascular risk and metabolic health. Monitoring triglycerides is not directly related to the adverse effects of Dantrolene.

Creatinine level. Creatinine levels are used to assess kidney function. While it is important to monitor kidney function in many patients, the primary concern with Dantrolene is its potential hepatotoxicity, not nephrotoxicity.

Blood urea nitrogen (BUN). BUN is another marker of kidney function. Similar to creatinine, monitoring BUN is important for assessing renal health but is not specifically related to the primary adverse effects of Dantrolene.

EXPLANATION

✔Correct answer:

Ophthalmologist. Hydroxychloroquine (Plaquenil) is commonly used to treat rheumatoid arthritis and other autoimmune conditions. One of the significant potential side effects of long-term use of Hydroxychloroquine is retinal toxicity, which can lead to irreversible vision damage if not detected early. Therefore, it is essential for patients taking this medication to have regular eye examinations by an ophthalmologist.

Hydroxychloroquine works by modulating the immune system and reducing inflammation. However, it can accumulate in the retina over time, potentially causing damage to the retinal cells and resulting in conditions such as retinopathy or maculopathy.

Think of Hydroxychloroquine as a helpful tool that can clear the pathways (reduce inflammation) in the body. However, it can also leave debris (accumulate) in the eyes over time. Regular check-ups with an eye specialist ensure that any debris buildup is detected early before it causes harm.

Nurse Adams should advise the patient to have a baseline eye exam before starting Hydroxychloroquine and regular follow-up exams, typically every 6 to 12 months, to monitor for any signs of retinal toxicity.

• Recommend the patient see an ophthalmologist for a comprehensive eye exam at baseline and at regular intervals during treatment.
• Educate the patient on the importance of these regular eye exams to detect any early signs of retinal toxicity.
• Inform the patient to report any visual disturbances such as changes in vision, blurriness, or difficulty seeing to their healthcare provider immediately.

✘Incorrect answer options:

Endocrinologist. While Hydroxychloroquine is not typically associated with endocrine issues, there is no specific need for regular endocrinology follow-up for patients on this medication.

Dentist. Regular dental check-ups are important for overall health but are not specifically related to Hydroxychloroquine use. Dental issues are not a primary concern with this medication.

Pulmonologist. Hydroxychloroquine is not typically associated with pulmonary toxicity. There is no specific indication for regular pulmonology follow-up for patients taking this medication unless there are underlying respiratory conditions that require monitoring.

EXPLANATION

✔Correct answer:

Inquire about any allergy to latex. Before administering Etanercept (Enbrel), it is important to inquire about any allergy to latex. Some components of the medication's delivery system may contain latex, which could cause an allergic reaction in patients sensitive to latex. Ensuring the patient does not have a latex allergy helps prevent a potential allergic reaction.

Etanercept is a biologic medication that works by inhibiting tumor necrosis factor (TNF), a substance in the body that causes inflammation. It is used to treat autoimmune conditions such as juvenile rheumatoid arthritis by reducing inflammation and slowing disease progression.

Think of administering Etanercept like using a tool that has a rubber grip. If someone is allergic to rubber (latex), holding the tool could cause a reaction. Checking for latex allergy ensures it's safe for the patient to use the tool (receive the medication).

Nurse Roberts should perform a thorough allergy assessment, including asking about any known latex allergies, before administering Etanercept. This helps ensure patient safety and prevent allergic reactions.

• Ask the patient about any known allergies, specifically to latex, before administering Etanercept.
• If the patient has a latex allergy, use alternative delivery systems that do not contain latex.
• Monitor the patient for any signs of an allergic reaction during and after administration.
• Educate the patient and their caregivers about potential allergic reactions and how to manage them if they occur.

✘Incorrect answer options:

Advise avoiding people who have recently received an injection of Etanercept. There is no need to avoid people who have recently received Etanercept, as it is not contagious.

Suggest postponing any planned vacation trips abroad. While it is important to monitor the patient for side effects and ensure stability on the medication, there is no general need to postpone travel solely due to starting Etanercept. However, travel plans should be discussed with the healthcare provider to ensure proper management and access to medical care if needed.

Remind the client not to miss any scheduled vaccinations while on treatment. Patients receiving Etanercept should avoid live vaccines due to their immunosuppressive effects. It is important to discuss the vaccination schedule with the healthcare provider, but advising the patient not to miss vaccinations is not the most critical step before beginning the medication.

EXPLANATION

✔Correct answer:

Dimercaprol therapy. Dimercaprol is a chelating agent used to treat heavy metal poisoning, including gold salt toxicity. It works by binding to the metal ions and forming a complex that can be excreted from the body, thereby reducing the toxicity.

Dimercaprol, also known as British anti-Lewisite (BAL), is an antidote for various heavy metal poisonings, including arsenic, mercury, and gold. It has a high affinity for metal ions, which allows it to effectively neutralize and promote the excretion of these toxic substances from the body.

Think of Dimercaprol as a magnet that attracts and captures metal particles (toxic metals) in the body, allowing them to be safely removed, similar to how a vacuum cleaner picks up and removes dirt from a carpet.

Nurses should administer Dimercaprol as prescribed and monitor the patient for improvement in symptoms and any potential side effects of the therapy. It is also important to continue monitoring the patient's renal and hepatic functions during treatment.

• Administer Dimercaprol according to the prescribed dosage and schedule.
• Monitor the patient for signs of improvement in gold toxicity symptoms and for any adverse reactions to Dimercaprol.
• Conduct regular follow-up tests to assess renal and liver function during and after treatment.
• Educate the patient on the importance of adhering to follow-up appointments and laboratory tests to ensure the effectiveness of the treatment and monitor for potential side effects.

✘Incorrect answer options:

Hydroxocobalamin injections. Hydroxocobalamin is a form of vitamin B12 used to treat B12 deficiency and cyanide poisoning. It is not effective in treating gold salt toxicity.

Acetaminophen tablets. Acetaminophen is an analgesic and antipyretic used to treat pain and fever. It has no chelating properties and cannot reverse gold salt toxicity.

Calcium salt supplements. Calcium supplements are used to treat calcium deficiencies and certain conditions like hypocalcemia. They do not have the ability to chelate or neutralize gold ions and therefore are not effective for treating gold salt toxicity.

EXPLANATION

✔Correct answer:

Hair loss is temporary. Hair loss, also known as alopecia, can occur as a side effect of Azathioprine (Imuran), an immunosuppressive medication commonly used in the treatment of autoimmune diseases and to prevent organ transplant rejection. While it can be concerning to patients, it is typically a temporary side effect that resolves with time or after discontinuing the medication.

Azathioprine works by inhibiting the synthesis of DNA, RNA, and proteins, leading to a reduction in the proliferation of immune cells. This suppression of the immune system helps control autoimmune conditions but can also affect rapidly dividing cells such as hair follicles, leading to hair loss.

Think of Azathioprine as a strong windstorm that affects the entire garden (the body). Some delicate flowers (hair) might temporarily fall off due to the strong wind, but they will grow back once the storm passes.

Nurse Kim should provide reassurance to the patient that hair loss is generally temporary and offer support and resources to manage this side effect.

• Reassure the patient that hair loss is usually temporary and may resolve with continued use of the medication or after its discontinuation.
• Suggest ways to manage hair loss, such as using gentle hair care products, avoiding harsh treatments, and considering wigs or hairpieces if the hair loss is distressing.
• Encourage the patient to report any severe or persistent side effects to their healthcare provider.
• Monitor the patient for other side effects of Azathioprine and provide appropriate education and interventions as needed.

✘Incorrect answer options:

Hair loss is uncommon. While hair loss can occur with Azathioprine, it is not uncommon. Patients should be made aware that this is a possible side effect.

Hair loss is a sign of toxicity. Hair loss is not typically a sign of toxicity but rather a side effect of the medication's impact on rapidly dividing cells like hair follicles. Signs of Azathioprine toxicity are more related to bone marrow suppression and liver function abnormalities.

Hair loss is irreversible. Hair loss due to Azathioprine is generally reversible. Once the medication is stopped or the body adjusts to it, hair growth usually resumes.

EXPLANATION

✔Correct answer:

Numbness. Adalimumab (Humira) is a tumor necrosis factor (TNF) blocker used to treat various inflammatory conditions, including rheumatoid arthritis. One of the potential serious side effects of Adalimumab is neurological issues, including numbness and tingling. This can indicate demyelinating disorders, such as multiple sclerosis, which have been associated with TNF inhibitors.

Adalimumab works by binding to TNF-alpha, a pro-inflammatory cytokine, and inhibiting its interaction with TNF receptors, thereby reducing inflammation. However, TNF inhibitors can affect the nervous system, potentially leading to demyelination and neurological symptoms.

Think of TNF-alpha as an overactive signal in the body’s immune system, like an alarm that won't stop ringing. Adalimumab helps to turn off this alarm. However, if the body’s wiring (nervous system) is sensitive, turning off the alarm can sometimes cause issues in the wiring, leading to symptoms like numbness.

Nurse Williams should educate the patient about the potential neurological side effects and monitor for any signs of numbness or tingling. If these symptoms occur, it is crucial to notify the healthcare provider immediately for further evaluation and possible adjustment of therapy.

• Educate the patient to report any new or unusual neurological symptoms, such as numbness, tingling, or weakness, immediately.
• Monitor for signs of demyelinating disorders and document any reported symptoms.
• Ensure regular follow-up appointments to assess the patient’s response to the medication and check for side effects.
• Collaborate with the healthcare provider to determine the appropriate course of action if neurological symptoms develop.

✘Incorrect answer options:

Diarrhea. While diarrhea can be a side effect of various medications, it is not a common side effect of Adalimumab. Gastrointestinal symptoms are more commonly associated with other medications used to treat rheumatoid arthritis.

Weight gain. Weight gain is not typically associated with Adalimumab. Side effects more commonly include injection site reactions, infections, and allergic reactions.

Urinary retention. Urinary retention is not a known side effect of Adalimumab. It is more commonly associated with conditions affecting the prostate or medications with anticholinergic effects.

EXPLANATION

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Avoid consuming alcohol. Baclofen (Lioresal) is a muscle relaxant used to treat spasticity. It works by acting on the central nervous system (CNS) to reduce muscle stiffness. Consuming alcohol while taking Baclofen can potentiate the CNS depressant effects, leading to increased drowsiness, dizziness, and risk of severe respiratory depression. Therefore, it is crucial to avoid alcohol while on this medication.

Baclofen acts as a GABA agonist, inhibiting excitatory neurotransmission in the CNS. Alcohol also depresses the CNS, and the combination of both substances can enhance the depressant effects, posing significant risks to the patient.

Think of Baclofen as a dimmer switch for the brain’s activity, reducing excitatory signals to help with muscle relaxation. Alcohol is another dimmer switch. Using both together can dim the lights too much, leading to excessive sedation and potentially dangerous outcomes.

Nurses should provide comprehensive education to patients about the importance of avoiding alcohol and monitoring for any CNS side effects while taking Baclofen.

• Emphasize the importance of avoiding alcohol to prevent additive CNS depression.
• Educate patients about potential side effects such as drowsiness, dizziness, and weakness, and advise them to avoid activities requiring alertness until they know how the medication affects them.
• Instruct patients to take Baclofen as prescribed and not to discontinue it abruptly, as sudden withdrawal can lead to severe symptoms such as hallucinations and seizures.

✘Incorrect answer options:

Discontinue the medication if you experience diarrhea. Diarrhea is not a common side effect of Baclofen. Patients should not discontinue Baclofen without consulting their physician, as abrupt cessation can lead to withdrawal symptoms.

Reduce your fluid intake. Reducing fluid intake is not a recommended action for patients taking Baclofen. Adequate hydration is important, especially since some muscle relaxants can cause dry mouth and other anticholinergic effects.

Inform your physician if you feel weak. While it is important to report any side effects, feeling weak can be a common side effect of Baclofen. This instruction is not as critical as avoiding alcohol, which has a direct and significant interaction with the medication.

EXPLANATION

✔Correct answer:

Metallic taste. Gold Sodium Thiomalate is a disease-modifying antirheumatic drug (DMARD) used in the treatment of rheumatoid arthritis. One of the early signs of gold toxicity or overdose is a metallic taste in the mouth. This side effect is important for Nurse Brown to recognize, as it can indicate that the patient is experiencing toxicity from the medication, which requires immediate medical attention to prevent more severe complications.

Gold Sodium Thiomalate works by modulating immune responses and reducing inflammation in rheumatoid arthritis. However, it has a narrow therapeutic window, and toxicity can occur, leading to various adverse effects, including those affecting the gastrointestinal system, kidneys, and hematologic system.

Imagine taking a sip of water and tasting metal instead. This unusual taste is like an early alarm signaling that something is wrong, similar to how a metallic taste signals potential toxicity with Gold Sodium Thiomalate.

Nurses should closely monitor patients for signs of gold toxicity and educate them on the importance of reporting any unusual symptoms immediately. Prompt detection and intervention are crucial to prevent serious adverse effects.

• Monitor for early signs of gold toxicity, such as a metallic taste in the mouth, and report them to the physician immediately.
• Educate patients about the symptoms of gold toxicity and instruct them to report any unusual tastes or symptoms without delay.
• Ensure regular laboratory monitoring of renal function, liver function, and blood counts, as gold toxicity can affect these systems.

✘Incorrect answer options:

Dizziness. While dizziness can occur with various medications, it is not specifically indicative of gold toxicity. Dizziness is a nonspecific symptom that can result from many different conditions or medications.

Flushing. Flushing is not a typical sign of gold toxicity. It can be associated with other conditions or reactions but is not specific to an overdose of Gold Sodium Thiomalate.

Joint pain. Joint pain is a symptom of rheumatoid arthritis itself and is not a specific sign of gold toxicity. While it could indicate inadequate control of the disease, it is not a marker of overdose.

EXPLANATION

✔Correct answer:

Angle-closure glaucoma. Cyclobenzaprine hydrochloride (Flexeril) is a muscle relaxant used to relieve muscle spasms. It works primarily through central nervous system depression and has anticholinergic properties. Due to its anticholinergic effects, it can increase intraocular pressure, making it inappropriate for patients with angle-closure glaucoma, as it can exacerbate the condition and lead to severe complications.

Cyclobenzaprine acts at the brainstem to reduce tonic somatic motor activity, affecting both gamma and alpha motor systems. Its anticholinergic properties can cause pupil dilation, leading to increased intraocular pressure in patients with angle-closure glaucoma.

Think of angle-closure glaucoma as a blocked drain in the eye where fluid can't escape properly, causing pressure to build up. Cyclobenzaprine is like a valve that, when turned on, could further block the drain, worsening the pressure build-up.

Nurses should assess a patient's medical history for contraindications like angle-closure glaucoma before administering Cyclobenzaprine and educate patients about potential side effects related to increased intraocular pressure.

• Review patient history for any eye conditions, especially angle-closure glaucoma.
• Monitor patients for symptoms of increased intraocular pressure, such as eye pain, blurred vision, and halos around lights.
• Educate patients to report any visual changes immediately while on Cyclobenzaprine.

✘Incorrect answer options:

Urinary tract infection. A urinary tract infection does not contraindicate the use of Cyclobenzaprine. While urinary retention can be a side effect of Cyclobenzaprine due to its anticholinergic properties, it is not specifically contraindicated in UTIs.

Emphysema. Cyclobenzaprine is not specifically contraindicated in patients with emphysema. However, caution may be needed due to its sedative effects, which could potentially depress respiratory function.

Diabetes Mellitus. Diabetes mellitus does not directly contraindicate the use of Cyclobenzaprine. Patients with diabetes should be monitored for potential side effects, but the medication itself does not worsen diabetic conditions.

EXPLANATION

✔Correct answer:

If you do not feel the spray while using it, repeat the dose in the other nostril. This instruction is incorrect. Patients should not repeat the dose in the other nostril if they do not feel the spray. The correct dosing should be one spray per day into one nostril, alternating nostrils each day. Repeating the dose can lead to overmedication and potential side effects.

Salmon calcitonin (Miacalcin) is a hormone used to treat osteoporosis by inhibiting bone resorption. It is administered via a nasal spray to provide localized absorption with systemic effects. Proper administration technique is crucial to ensure effectiveness and minimize side effects.

Think of the nasal spray like watering a plant with a precise amount of water each day. Giving too much water (medication) can harm the plant (body), even if you don't see the water immediately.

Nurse Davis should provide clear instructions on the correct administration of Miacalcin nasal spray, emphasizing that the dose should not be repeated even if the patient doesn't feel the spray.

• Instruct the patient to administer one spray per day into one nostril, alternating nostrils each day.
• Emphasize that the patient should not repeat the dose in the other nostril if they do not feel the spray.
• Advise the patient on the importance of keeping track of the doses and discarding the bottle after 30 doses, as the delivery system contains enough medication for only 30 doses.
• Recommend taking additional vitamin D and calcium as part of the overall osteoporosis treatment plan, as advised by the healthcare provider.

✘Incorrect answer options:

Miacalcin is usually given as one spray per day into only one of your nostrils. This is a correct instruction. The medication should be administered as one spray per day into one nostril, alternating nostrils each day.

The delivery system contains enough medication for at least 30 doses. Discard any unused solution after 30 doses. This is also a correct instruction. The bottle should be discarded after 30 doses, even if there is some solution left, to ensure the correct dosage is administered.

Take extra vitamin D while you are using Miacalcin. This is a correct recommendation. Vitamin D supplementation is often necessary to support calcium absorption and bone health in patients with osteoporosis.

EXPLANATION

✔Correct answer:

Withhold the medication and notify the physician. Colchicine is used primarily for the treatment of acute gout flares. Common side effects of Colchicine include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. These symptoms can indicate toxicity, especially if they occur after the patient has taken several doses. It is important for the patient to stop taking the medication and inform their physician to prevent further complications and assess the appropriate next steps.

Colchicine works by reducing inflammation and decreasing the build-up of uric acid crystals in the joints. However, it has a narrow therapeutic index, meaning that the margin between an effective dose and a toxic dose is small. Gastrointestinal symptoms are often the first sign of toxicity.

Think of Colchicine like a powerful cleaning agent. While it is effective at cleaning (reducing inflammation), using too much can cause damage (toxicity). Experiencing nausea, vomiting, and diarrhea is like seeing the cleaning agent start to damage the surface you're cleaning – it's a sign to stop immediately and seek advice on how to proceed.

Nurses should educate patients about the signs of Colchicine toxicity and emphasize the importance of reporting any adverse symptoms promptly. They should also ensure patients understand not to exceed the prescribed dosage.

• Instruct patients to withhold Colchicine if they experience significant gastrointestinal symptoms and to contact their physician immediately.
• Educate patients on the importance of adhering strictly to the prescribed dose and not taking extra doses to avoid toxicity.
• Monitor for signs of Colchicine toxicity, particularly in patients with renal or hepatic impairment, as they are at higher risk.

✘Incorrect answer options:

Continue taking the medication as these symptoms will resolve. Continuing the medication despite these symptoms can lead to worsening toxicity and serious health risks. This advice is unsafe.

Skip the next dose and take the following dose as scheduled. Skipping a dose and then resuming may not adequately address the toxicity issue. The patient needs immediate assessment by a physician.

Reduce the next dose by half. Adjusting the dose without medical advice is not recommended. The patient should stop the medication and consult their physician to determine the appropriate action.