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Immune/Musculoskelet
| Question | Answer |
|---|---|
| DMARDS I med | methotrexate |
| Methotrexate (DMARDS I) action & use | slows the joint degeneration and progression of rheumatoid arthritis |
| Methotrexate (DMARDS I) complications (4) | increased risk for infection, bone marrow suppression, GI ulcers/GI bleeding, & mouth ulcers (ulcerative stomatitis) |
| What would we be on the look out for, for the increased risk for infection with methotrexate (DMARDS I)? | flu-like symptoms |
| What should patients keep in mind about social interaction while taking methotrexate (DMARDS I)? | they should stay away from people who are sick since their immune systems are compromised |
| What forms does methotrexate come in (3)? | oral, subcutaneous, & IM |
| Administration considerations for methotrexate (DMARDS I) (5) | take with food, increase fluids, use reliable contraception (since this is a pregnancy category X), avoid alcohol, & give a folic acid supplement with it |
| What labs would we monitor for a patient taking methotrexate (DMARDS I) (2) & how frequently would we monitor them? | RBC & platelets, monitor every 3-6 months |
| DMARDS II meds | etanercept or adalimumab (Humira pen) |
| What are patients at an increased risk for while they're taking etanercept (DMARDS II)? | TB & Hep B |
| Complications for etanercept (DMARDS II) (4) | injection site irritation, risk for infection, *skin rash*, & heart failure |
| What would we look for when assessing if a patient taking etanercept (DMARDS II) is experiencing heart failure (3)? | shortness of breath, jugular vein distension, & crackles in the lungs |
| Administration considerations with etanercept (DMARDS II) (1) | avoid unnecessary vaccines |
| What route are etanercept & adalimumab (DMARDS II) taken & how frequently would we give them? | subcutaneous & etanercept once or 2x a week *adalimumab every 2 weeks* |
| What should a patient avoid while taking etanercept & adalimumab (DMARDS II)? | live vaccines since they can actually make them sick, their immune system is compromised |
| DMARDS III med | cyclosporine |
| Cyclosporine use | to treat severe RA |
| Complications for cyclosporine (1) | risk for infection |
| Administration considerations for cyclosporine (3) | shouldn't be used while pregnant, avoid live virus vaccines, & avoid erythromycin (since it increases the risk for toxicity) |
| What does SERMs stand for & what does it do? | selective estrogen receptor modulators, & it mimics the effects of estrogen on the bones and bone tissue |
| SERMs med | raloxifene |
| Raloxifene use | to treat osteoporosis |
| Complications for raloxifene (3) | increased risk for PE & DVT, & hot flashes |
| What would signs of pulmonary embolism look like, as a complication for raloxifene (2)? | dyspnea upon exertion & sense of impending doom |
| What would a sign of deep vein thrombosis look like, as a complications for raloxifene (1)? | pain in the calf |
| Administration considerations for raloxifene (5) | take with no regards to food once a day, increase calcium & vitamin D, monitor bone density & serum calcium, increase weight-bearing activities, & use a reliable contraceptive |
| What lab would we monitor with a patient taking raloxifene & what range are we looking for? | serum calcium & 9-10.5 |
| Bisphosphonates med | alendronate |
| Alendronate action | increases bone mass by decreasing osteoclast activity |
| Alendronate use | to treat osteoporosis |
| Complications for alendronate (4) | esophagitis, musculoskeletal pain (muscle/joint pain), visual disturbances (blurred vision), & jaw pain |
| Administration considerations for alendronate (5) | take either once a day or once a week, take 1st thing on an empty stomach, remain upright for 30 mins, monitor bone density & serum calcium, & increase weight-bearing activities |
| What lab would we monitor with a patient taking alendronate & what range are we looking for? | serum calcium & 9-10.5 |
| Calcitonin action | increases calcium excretion |
| Calcitonin use | to treat osteoporosis & hypercalcemia |
| Complications for calcitonin (3) | hypersensitivity, hypocalcemia, & nasal irritation |
| What forms are calcitonin available in (3)? | subcutaneous injection, IM injection, & intranasal |
| What should a patient do if they are administering calcitonin themselves through the intranasal route (3)? | hold pump upright, primp the pump, & alternate nostrils |
| Administration considerations for calcitonin (2) | don't give to patients with an allergy to salmon & refrigerate after opening |
| Calcium supplements med | calcium gluconate |
| Calcium gluconate action | maintains & raises serum calcium levels |
| Calcium gluconate use | to treat hypocalcemia |
| Complications for calcium gluconate (2) | hypercalcemia & kidney stones (renal calculi) |
| What are some symptoms we can monitor for hypercalcemia, as a complication for calcium gluconate (5)? | nausea, abdominal pain, muscle weakness, confusion, & constipation |
| Administration considerations for calcium gluconate (5) | take 1 hour from glucocorticoids, take 1 hour after meals, CHEW chewable tablets THEN swallow, drink water with tablets, & no more than 600mg at a time |
| What lab would we monitor with a patient taking calcium gluconate & what range are we looking for | serum calcium & 9-10.5 |
| SNRIs med | duloxetine |
| Duloxetine action | blocks the reuptake of serotonin & norepinephrine |
| Duloxetine use | to treat fibromyalgia |
| Complications for duloxetine (1) | withdrawal syndrome (so we taper the drug) |
| Administration considerations for duloxetine (2) | administer without regard to food & swallow the capsules whole |
| Cholinesterase inhibitors med | methylsulfate (neostigmine) |
| Methylsulfate (neostigmine) action | improves muscle strength & endurance |
| Methylsulfate (neostigmine) use | to treat myasthenia gravis |
| Complications for methylsulfate (neostigmine) (1) | toxicity (use atropine) |
| What are some symptoms we would be on the lookout for with toxicity, as a complication with methylsulfate (neostigmine) (4)? | bradycardia, salivation, respiratory paralysis, & muscle weakness |
| Administration considerations for methylsulfate (neostigmine) (3) | assess swallowing ability prior to administering, assess pulse, & use caution if the patient has asthma |
| Antidote for methylsulfate (neostigmine) | atropine (AtroPen) |
| Neuromuscular blocking agents med | succinylcholine |
| Succinylcholine actions (2) | inhibits muscle contraction & promotes muscle relaxation |
| Succinylcholine use | to be used along with anesthesia |
| Complications for succinylcholine (3) | hyperkalemia, respiratory arrest, & malignant hyperthermia |
| What are some symptoms we'd be on the lookout for with malignant hyperthermia, a complication of succinylcholine (3)? | rigid muscles, tachycardia, & sudden spike in temperature |
| What route is succinylcholine available in (1)? | IV |
| Administration considerations with succinylcholine (2) | expect post-operative pain & educate the patient that the intubation is temporary |
| We'd use succinylcholine cautiously with patients who have...(3) | electrolyte imbalances, respiratory depression, & myasthenia gravis |
| What lab would we monitor for while a patient is taking succinylcholine? | serum K+ (potassium) |
| What do immunizations do? | eradicate and prevent infectious diseases |
| Contraindications with general immunizations (3) | anaphylactic reaction, severe febrile illness, & immunocompromised (w/live viruses) |
| Contraindication with varicella vaccine | sensitivity to gelatin or neomycin |
| Contraindication with influenza vaccine | sensitivity to eggs |
| Contraindication with MMR vaccine | pregnancy |
| General precautions to vaccines (1) | moderate to severe illnesses |
| Administration considerations with general vaccines (6) | obtain consent, verify proper site, minimize discomfort, provide written VIS (vaccine information statement), educate the patient, & document |
| What are the 2 vaccines women can get while they're pregnant? | Tdap & influenza |
| What is the Hep B shot? | hepatitis B vaccine |
| What is the DTap shot? | diphtheria-tetanus-pertussis vaccine |
| What is the RV shot? | rotavirus vaccine |
| What is the Hib shot? | haemophilus influenza type B vaccine |
| What is the IPV shot? | polio vaccine |
| What is the PCV shot? | pneumococcal conjugate vaccine |
| What is the MMR shot? | measles-mumps-rubella vaccine |
| What is the Hep A2 shot? | hepatitis A vaccine |
| What is the varicella shot? | chickenpox vaccine |
| What shot does a patient get at birth (1)? | Hep B |
| What shots does a patient get at 2 months old (6)? | Hep B, DTaP, RV, Hib, IPV, & PCV |
| What shots does a patient get at 4 months old (5)? | DTaP, RV, Hib, IPV, & PCV |
| What shots does a patient get at 6 months old (6-same as 2 months)? | Hep B, DTaP, RV, Hib, IPV, & PCV |
| What shots does a patient get at 12-18 months old (6)? | MMR, Hep A2, DTaP, Hib, PCV, & varicella |
| What shots does a patient get at 4-6 years old (4)? | MMR, DTaP, IPV, & varicella |
| A nurse is reinforcing teaching with a client who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client monitor? (select all that apply) Nausea Increased gout pain Stomatitis Insomnia Rash | nausea increased gout pain rash |
| Based on the route of administration of adalimumab, what should the nurse plan to monitor? | The subcutaneous site for redness following injection |
| A nurse is caring for a client who has a new diagnosis of fibromyalgia. Which of the following medications should the nurse anticipate being prescribed for this client? auranofin hydroxychloroquine colchicine duloxetine | duloxetine |
| A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. What client statement indicates understanding? | "I'll let the doctor know if I develop sores in my mouth while taking this medication." |
| Which of the following medications increases the risk of toxicity when taken concurrently with cyclosporine? rifampin erythromycin carbamazepine phenytoin | erythromycin |
| Which of the following are possible adverse effects of raloxifene? (select all that apply) swelling or redness in the calf hot flashes difficulty swallowing shortness of breath lump in breast | swelling or redness in the calf hot flashes shortness of breath |
| The nurse should monitor the client for which of the following manifestations as an indication of hypercalcemia? diarrhea abdominal pain blurred vision muscle weakness nausea | abdominal pain muscle weakness nausea |
| A nurse is caring for a client who has a new prescription for calcitonin-salmon for osteoporosis. What test should the nurse expect before beginning this medication? | skin test for allergy to the medication |
| A nurse is caring for a young adult client whose serum calcium is 8.8mg/dL. Which of the following medications should the nurse anticipate administering to this client? calcium carbonate calcitonin-salmon ibandronate zoledronic acid | calcium carbonate |
| A nurse is reinforcing teaching with a client who has a new prescription for calcitonin-salmon for postmenopausal osteoporosis. What instructions should the nurse provide? | alternate nostrils each time calcitonin-salmon is inhaled |
| A nurse in a public health clinic is caring for several clients who request seasonal influenza immunization. Which client has a contraindication to receiving the influenza immunization? | a 2-month-old who has no health problems |
| A nurse is speaking to a group of new parents about immunizations. CDC recommendations call for completion of which of the following vaccines by the first birthday? varicella meningococcal conjugate pneumococcal conjugate rotavirus | rotavirus |
| A nurse at a provider's office is preparing to administer RV, DTaP, Hib, PCV13, and IPV immunizations to a 4-month-old infant. What actions should the nurse plan to take? | give the infant his pacifier during vaccine injections & administer subcutaneous injection in the anterolateral thigh |
| What are some reactions that can occur from the MMR vaccine (select all that apply)? headache bruising swollen glands inconsolable crying rash | bruising swollen glands rash |
| The nurse should prepare to administer the varicella vaccine to which client? | 32-year-old man who has essential hypertension |
Created by:
tiffhales
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