Question

A nurse is reinforcing teaching for a client who is about to start therapy with alendronate to treat osteoporosis. For which of the following findings should the nurse instruct the client to monitor and report as an adverse effect of the medication? (Select all that apply.)

Answer 1

Correct Answers:

Jaw pain
Dysphagia

Rationale :

Jaw pain

💠 Osteonecrosis of the jaw (ONJ) is a rare but serious adverse effect associated with bisphosphonates such as alendronate.

💠 ONJ occurs due to suppressed bone turnover, which can impair healing after dental procedures or trauma.

💠 Clients may initially report jaw pain, swelling, loose teeth, or exposed bone, which require immediate medical evaluation.

💠 The risk is higher in clients undergoing invasive dental procedures or those with poor oral hygiene.

💠 Early reporting of jaw discomfort allows prompt intervention and can prevent progression to severe bone damage.

Dysphagia

💠 Esophageal irritation and ulceration are known adverse effects of alendronate therapy.

💠 Dysphagia may indicate esophagitis or esophageal erosion, which can become severe if untreated.

💠 Alendronate is highly irritating to the esophageal mucosa, especially if the client lies down after ingestion.

💠 The medication must be taken with a full glass of water and the client must remain upright for at least 30 minutes to reduce risk.

💠 Prompt reporting of difficulty swallowing prevents complications such as esophageal stricture or bleeding.

Tinnitus

💠 Tinnitus is not associated with the mechanism of action of bisphosphonates, which primarily affect bone resorption.

💠 Ringing in the ears is more commonly linked to ototoxic medications such as aminoglycosides or high-dose salicylates.

Drowsiness

💠 Alendronate does not act on the central nervous system, making sedation unlikely.

💠 Drowsiness is not documented as a common or serious adverse reaction in bisphosphonate therapy.

Blurred vision

💠 Visual disturbances are not typical adverse effects related to bone metabolism medications like alendronate.

💠 Blurred vision would warrant evaluation for other causes rather than being attributed to this medication.

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Answer 2

Correct Answers:

Recent vaccination

Rationale :

🔷 Etanercept is a tumor necrosis factor (TNF-α) inhibitor that suppresses immune system activity.

🔷 Because it causes immunosuppression, administration of a live vaccine while on therapy can lead to uncontrolled infection.

🔷 Live vaccines such as MMR, varicella, or intranasal influenza are contraindicated during treatment.

🔷 Clients should complete needed vaccinations before initiating etanercept therapy whenever possible.

🔷 Giving etanercept soon after or during a live vaccination increases the risk of vaccine-derived infection and poor immune response.

History of allergic rhinitis

🔷 Allergic rhinitis does not represent an immunosuppressive or infectious risk related to TNF-α inhibition.

🔷 Etanercept is not contraindicated in clients with common seasonal allergies.

History of hypertension

🔷 Hypertension is not directly affected by TNF-α blockade therapy.

🔷 Etanercept does not typically worsen blood pressure control.

History of cancer

🔷 A history of cancer requires careful evaluation but is not an absolute contraindication in all cases.

🔷 Some malignancies require risk–benefit assessment, but prior cancer alone does not automatically prohibit therapy.

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Answer 3

Correct Answers:

Drink 10 to 12 glasses of water per day.

Rationale :

🔶 Methotrexate is a folate antagonist that can cause renal toxicity, especially at higher doses or with dehydration.

🔶 Adequate hydration helps promote renal excretion of the drug, reducing the risk of nephrotoxicity and crystal formation in the kidneys.

🔶 Increased fluid intake also decreases the likelihood of bladder irritation and elevated serum drug levels.

🔶 Clients taking methotrexate are at risk for hepatotoxicity and bone marrow suppression, so maintaining hydration supports overall organ function.

🔶 Encouraging 10–12 glasses of water daily is a preventive measure to enhance drug safety and tolerance during long-term therapy.

Take NSAIDs for generalized pain such as headaches.

🔶 NSAIDs can increase the risk of methotrexate toxicity by decreasing renal clearance of the medication.

🔶 Concurrent use may elevate methotrexate levels and increase the risk of bone marrow suppression or liver toxicity.

Take this medication at the same time each day.

🔶 Methotrexate for rheumatoid arthritis is typically taken once weekly, not daily.

🔶 Taking it daily instead of weekly can lead to severe toxicity, including life-threatening bone marrow suppression.

Do not breastfeed within 2 hr of taking the medication.

🔶 Methotrexate is contraindicated during breastfeeding because it passes into breast milk and can harm the infant.

🔶 The recommendation is to avoid breastfeeding entirely, not just within a time frame after dosing.

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Answer 4

Correct Answers:

2% cottage cheese 1 cup (8 oz)

Rationale :

🟢 Calcitonin-salmon is used to treat osteoporosis by inhibiting osteoclast activity and reducing bone resorption.

🟢 Clients taking calcitonin require adequate calcium intake to support bone mineralization and maximize therapeutic effectiveness.

🟢 Cottage cheese is a rich source of calcium, providing substantial dietary calcium necessary for bone strength.

🟢 Adequate calcium intake helps prevent hypocalcemia, which can occur when calcitonin lowers serum calcium levels.

🟢 Consuming calcium-rich foods enhances the medication’s role in maintaining bone density and reducing fracture risk.

Strawberry ice-cream (4 oz)

🟢 Ice cream contains some calcium but also high amounts of sugar and saturated fat, making it a less optimal source.

🟢 It does not provide the same concentrated calcium benefit as dairy products like cottage cheese.

Peanuts (1 cup)

🟢 Peanuts are primarily a source of protein and healthy fats, not significant calcium.

🟢 They do not contribute meaningfully to bone mineral density support.

Spinach (1 cup)

🟢 Spinach contains calcium but also high levels of oxalates, which reduce calcium absorption.

🟢 The bioavailability of calcium in spinach is lower compared to dairy sources

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Answer 5

Correct Answers:

Avoid people who have infections.
Do not drink alcoholic beverages.
Report unexplained bruising to the provider.

Rationale :

Avoid people who have infections.

🔵 Methotrexate suppresses the immune system by inhibiting folate metabolism and reducing rapidly dividing immune cells.

🔵 This immunosuppressive effect increases the client’s risk for opportunistic and common infections.

🔵 Clients may not mount a strong inflammatory response, masking early signs of infection.

🔵 Exposure to individuals with contagious illnesses increases the likelihood of serious complications.

🔵 Preventive strategies such as avoiding sick contacts reduce infection-related morbidity.

Do not drink alcoholic beverages.

🔵 Methotrexate is associated with hepatotoxicity, especially with long-term therapy.

🔵 Alcohol consumption increases the risk of liver damage and elevated liver enzymes.

🔵 Combining alcohol with methotrexate significantly raises the likelihood of hepatic fibrosis or cirrhosis.

🔵 Routine monitoring of liver function tests is required during therapy.

🔵 Avoiding alcohol helps protect the liver from additive toxic effects.

Report unexplained bruising to the provider.

🔵 Methotrexate can cause bone marrow suppression, leading to thrombocytopenia.

🔵 Low platelet levels increase the risk of spontaneous bruising and bleeding.

🔵 Unexplained bruises may indicate developing pancytopenia.

🔵 Early reporting allows prompt laboratory evaluation and dose adjustment.

🔵 Monitoring complete blood counts is essential for safe therapy.

Expect to feel the medication's effects immediately.

🔵 Methotrexate does not provide immediate symptom relief in rheumatoid arthritis.

🔵 Therapeutic effects may take several weeks to become noticeable.

Take the medication daily with breakfast.

🔵 Methotrexate for rheumatoid arthritis is typically prescribed once weekly, not daily.

🔵 Daily dosing can lead to severe toxicity and life-threatening complications.

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Answer 6

Correct Answers:

Alternate nostrils each time calcitonin-salmon is inhaled.

Rationale :

🟣 Calcitonin-salmon is commonly administered as an intranasal spray for the treatment of osteoporosis.

🟣 Alternating nostrils helps prevent nasal mucosal irritation, dryness, and ulceration, which are common adverse effects.

🟣 Continuous use in one nostril increases the risk of local inflammation and epistaxis.

🟣 Proper administration technique improves medication absorption and patient tolerance.

🟣 Clients should also report persistent nasal discomfort or sores to ensure safe continuation of therapy.

Mix the liquid medication with juice and take it after meals.

🟣 Calcitonin-salmon is not typically administered orally in liquid form for osteoporosis.

🟣 The approved common route is intranasal or subcutaneous, not mixed with juice.

Watch for jerky like movements or numbness.

🟣 Jerky movements are not characteristic adverse effects of calcitonin therapy.

🟣 Numbness is more commonly associated with electrolyte imbalances, not typical intranasal calcitonin use.

Watch for skin rash and redness when applying calcitonin-salmon topically.

🟣 Calcitonin-salmon is not administered as a topical skin medication.

🟣 Skin redness would not be a standard administration-related concern for this drug form.

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Answer 7

Correct Answers:

May experience menopausal symptoms.

Rationale :

🟡 Raloxifene is a selective estrogen receptor modulator (SERM) that has estrogen-agonist effects on bone but antagonist effects on breast and uterine tissue.

🟡 Because it does not provide full systemic estrogen activity, clients may experience vasomotor symptoms such as hot flashes and sweating.

🟡 These symptoms are common adverse effects and should be anticipated rather than leading to medication discontinuation.

🟡 Raloxifene is used to prevent and treat osteoporosis in postmenopausal women and reduce the risk of invasive breast cancer.

🟡 Clients should also be taught to report signs of venous thromboembolism, as the medication increases clot risk.

Skip doses if experiencing hot flashes

🟡 Hot flashes are a known side effect and do not require skipping doses.

🟡 Skipping doses reduces therapeutic effectiveness in preventing bone loss.

Increase potassium intake

🟡 Raloxifene does not significantly affect serum potassium levels.

🟡 Potassium supplementation is not routinely required with this medication.

Crush the medication before taking

🟡 Raloxifene tablets are designed to be swallowed whole.

🟡 Crushing is unnecessary and may alter drug stability or absorption.

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Answer 8

Correct Answers:

History of venous thrombosis

Rationale :

🟠 Raloxifene increases the risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).

🟠 Clients with a history of venous thrombosis are at an increased risk for complications such as clot formation.

🟠 Raloxifene should be avoided in individuals with a history of VTE, as it can exacerbate this risk.

🟠 Caution is also needed for those who have other risk factors for clotting, such as prolonged immobility or recent surgery.

🟠 Alternative therapies may be considered for individuals with this contraindication.

Allergy to penicillin

🟠 An allergy to penicillin does not affect the use of raloxifene, as it is unrelated to penicillin or any penicillin class of antibiotics.

🟠 Penicillin allergy is not a contraindication for raloxifene therapy.

History of asthma

🟠 A history of asthma does not affect raloxifene's action or safety profile.

🟠 Asthma is not a contraindication to the use of raloxifene.

Severe kidney disease

🟠 Raloxifene is primarily metabolized in the liver, and renal dysfunction does not significantly alter the drug's safety or efficacy.

🟠 However, as with any medication, dose adjustments may be necessary for patients with severe renal impairment, but severe kidney disease is not an absolute contraindication.

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Answer 9

Correct Answers:

Avoid who have infections.
Report unexplained bruising to the provider.
Do not drink alcoholic beverages.

Rationale :

Avoid people who have infections.

🔶 Methotrexate is an immunosuppressant that can increase the risk of infections by lowering the body's ability to fight off bacteria, viruses, and fungi.

🔶 The client should be educated to avoid crowded places or people with active infections, as even minor infections can lead to serious complications.

🔶 Early intervention for any signs of infection is crucial to prevent serious illness.

Report unexplained bruising to the provider.

🔶 Methotrexate can cause bone marrow suppression, which leads to a decrease in platelet production.

🔶 This can result in thrombocytopenia, making the client more prone to easy bruising and bleeding.

🔶 The client should report unexplained bruising promptly to ensure that the platelet count is monitored and appropriate action is taken.

Do not drink alcoholic beverages.

🔶 Alcohol can exacerbate the hepatotoxicity associated with methotrexate, especially when combined with long-term therapy.

🔶 Alcohol increases the risk of liver damage, and methotrexate can also have hepatotoxic effects.

🔶 To protect the liver, clients are advised to avoid alcohol while taking methotrexate.

Expect to feel the medication's effects immediately.

🔶 Methotrexate does not provide immediate symptom relief for rheumatoid arthritis.

🔶 Therapeutic effects may take several weeks to become noticeable, as it works gradually to reduce inflammation.

Take ascorbic acid to help minimize side effects.

🔶 Ascorbic acid (vitamin C) is not necessary for minimizing side effects of methotrexate.

🔶 There is no evidence to support that taking vitamin C will reduce the toxicity or side effects of methotrexate.

🔶 It's important to discuss any supplement use with a healthcare provider, as some supplements can interact with the medication.

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Answer 10

Correct Answers:

2

Rationale :

Desired dose = 400 mg

Available dose = 200 mg per capsule

Number of capsules = Desired dose / Available dose

= 400 mg / 200 mg per capsule

= 2 capsules

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QLexNursing

1 :
A nurse is reinforcing teaching for a client who is about to start therapy with alendronate to treat osteoporosis. For which of the following findings should the nurse instruct the client to monitor and report as an adverse effect of the medication? (Select all that apply.)

2 :
What are the contraindications for the use of etanercept?

3 :
A nurse is reinforcing teaching with a female client who has rheumatoid arthritis and a prescription for methotrexate. Which of the following information should the nurse include in the teaching?

4 :
A nurse is reinforcing teaching with a client who is to start taking calcitonin-salmon. Which of the following foods should the nurse instruct the client to consume?

5 :
A nurse is reinforcing teaching with a client who is about to start therapy with methotrexate to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.)

6 :
A nurse is providing instructions to a client who has a new prescription for calcitonin-salmon. Which of the following instructions should the nurse include in the teaching

7 :
What instructions should be provided for a client taking raloxifene?

8 :
What contraindications are there for the use of raloxifene?

9 :
A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse review with the client? (Select all that apply.)

10 :
A nurse is preparing to administer celecoxib 400 mg PO. The amount available is celecoxib 200 mg/capsule. How many capsules should the nurse administer to the client with each dose? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

QLexNursing

1 : A nurse is reinforcing teaching for a client who is about to start therapy with alendronate to treat osteoporosis. For which of the following findings should the nurse instruct the client to monitor and report as an adverse effect of the medication? (Select all that apply.)

2 : What are the contraindications for the use of etanercept?

3 : A nurse is reinforcing teaching with a female client who has rheumatoid arthritis and a prescription for methotrexate. Which of the following information should the nurse include in the teaching?

4 : A nurse is reinforcing teaching with a client who is to start taking calcitonin-salmon. Which of the following foods should the nurse instruct the client to consume?

5 : A nurse is reinforcing teaching with a client who is about to start therapy with methotrexate to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.)

6 : A nurse is providing instructions to a client who has a new prescription for calcitonin-salmon. Which of the following instructions should the nurse include in the teaching

7 : What instructions should be provided for a client taking raloxifene?

8 : What contraindications are there for the use of raloxifene?

9 : A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse review with the client? (Select all that apply.)

10 : A nurse is preparing to administer celecoxib 400 mg PO. The amount available is celecoxib 200 mg/capsule. How many capsules should the nurse administer to the client with each dose? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

1 :
A nurse is reinforcing teaching for a client who is about to start therapy with alendronate to treat osteoporosis. For which of the following findings should the nurse instruct the client to monitor and report as an adverse effect of the medication? (Select all that apply.)

2 :
What are the contraindications for the use of etanercept?

3 :
A nurse is reinforcing teaching with a female client who has rheumatoid arthritis and a prescription for methotrexate. Which of the following information should the nurse include in the teaching?

4 :
A nurse is reinforcing teaching with a client who is to start taking calcitonin-salmon. Which of the following foods should the nurse instruct the client to consume?

5 :
A nurse is reinforcing teaching with a client who is about to start therapy with methotrexate to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.)

6 :
A nurse is providing instructions to a client who has a new prescription for calcitonin-salmon. Which of the following instructions should the nurse include in the teaching

7 :
What instructions should be provided for a client taking raloxifene?

8 :
What contraindications are there for the use of raloxifene?

9 :
A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse review with the client? (Select all that apply.)

10 :
A nurse is preparing to administer celecoxib 400 mg PO. The amount available is celecoxib 200 mg/capsule. How many capsules should the nurse administer to the client with each dose? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)