Question

A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

Answer 1

Correct Answers:

Avoid people who have infections.
DO not drink alcoholic beverages While taking this medication.
Report unexplained bruising to the provider.

Rationale :

💠Avoid people who have infections

💠 Methotrexate is an immunosuppressant and antimetabolite that decreases inflammation by suppressing the immune response.

💠 Because it lowers bone marrow activity, the client becomes more susceptible to infections. Even minor infections can progress rapidly in immunocompromised patients.

💠 The nurse should instruct the client to avoid crowded areas, people who are ill, and to report any fever, sore throat, or signs of infection promptly.

💠 This precaution helps prevent serious complications such as pneumonia or sepsis in immunosuppressed individuals.

💠Do not drink alcoholic beverages while taking this medication

💠 Methotrexate is hepatotoxic, meaning it can cause liver damage.

💠 Consuming alcohol while taking methotrexate significantly increases the risk of liver toxicity and potential hepatic failure.

💠 Clients should be taught to completely avoid alcohol and to report signs of liver injury such as jaundice, dark urine, or fatigue.

💠 Regular liver function tests (LFTs) should be done to monitor for hepatic damage during therapy.

💠Report unexplained bruising to the provider

💠 Unexplained bruising, petechiae, or bleeding may indicate bone marrow suppression, a serious adverse effect of methotrexate.

💠 This suppression can lead to thrombocytopenia (low platelets) or leukopenia, increasing the risk of bleeding and infection.

💠 The nurse should educate the client to report these symptoms immediately so that the provider can adjust the dose or discontinue the medication.

💠 Frequent CBC monitoring is essential to detect early signs of hematologic toxicity.

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Answer 2

Correct Answers:

4 oz skim milk

Rationale :

🩸 A blood glucose level of 48 mg/dL indicates hypoglycemia, which requires rapid-acting carbohydrates to quickly raise blood glucose.

🩸 4 oz of skim milk contains natural lactose sugar, providing approximately 15 grams of carbohydrates, which is ideal for initial hypoglycemia treatment.

🩸 After consuming, the nurse should recheck blood glucose in 15 minutes and repeat if still below 70 mg/dL, following the “15-15 rule.”

🩸 Diet soda contains artificial sweeteners and provides no glucose benefit, while 1 tsp sugar is insufficient and graham crackers act too slowly due to fat content.

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Answer 3

Correct Answers:

Avoid walking barefoot.

Rationale :

🦶 Clients with diabetic neuropathy have decreased sensation in their feet, which increases the risk of injury, burns, or infection without them realizing it.

🦶 Walking barefoot can lead to cuts, punctures, or burns, which may go unnoticed and progress to ulcers or gangrene due to poor wound healing and circulation.

🦶 The nurse should teach the client to always wear well-fitting, closed-toe shoes and inspect feet daily for redness, blisters, or open areas.

🦶 Feet should be washed in lukewarm water, dried thoroughly (especially between toes), and moisturizer applied only to dry skin—not between toes to prevent fungal growth.

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Answer 4

Correct Answers:

Hypoglycemia

Rationale :

💧 Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL, often due to excess insulin, missed meals, or increased physical activity.

💧 Classic symptoms include sweating, anxiety, tremors, irritability, confusion, and palpitations, caused by the body’s adrenergic response to low glucose levels.

💧 If untreated, it can progress to seizures, loss of consciousness, or coma, making it a medical emergency.

💧 The nurse should check blood glucose immediately and administer a rapid-acting carbohydrate such as juice, glucose tablets, or skim milk.

💧 Once stabilized, the client should be given a complex carbohydrate to prevent rebound hypoglycemia.

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Answer 5

Correct Answers:

Iron deficiency anemia

Rationale :

🩸 Hemolytic anemia results from the premature destruction of red blood cells (RBCs), leading to decreased oxygen-carrying capacity and increased bilirubin levels.

🩸 Common causes include sickle cell disease, thalassemia, and autoimmune hemolytic anemia, all of which involve abnormal RBC structure or immune-mediated destruction.

🩸 Iron deficiency anemia, however, is due to insufficient iron for hemoglobin synthesis, leading to microcytic, hypochromic RBCs, not RBC destruction.

🩸 Therefore, it is not a hemolytic process, but rather a production-related anemia caused by inadequate iron intake, absorption, or chronic blood loss.

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Answer 6

Correct Answers:

Alcohol

Rationale :

🍷 Glimepiride is a sulfonylurea that lowers blood glucose by stimulating insulin release from the pancreas.

🍷 Alcohol can cause a disulfiram-like reaction with this drug—manifesting as flushing, nausea, palpitations, headache, and vomiting—and it can also potentiate hypoglycemia by interfering with glucose production in the liver.

🍷 Clients should be instructed to avoid all forms of alcohol, including beer, wine, and cough syrups containing alcohol, while taking glimepiride.

🍷 Grapefruit juice, milk, and coffee do not cause this type of interaction or increase the risk of hypoglycemia.

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Answer 7

Correct Answers:

Increased red blood cell destruction by the immune system

Rationale :

🩸 Immune hemolytic anemia occurs when the body’s immune system mistakenly attacks and destroys its own red blood cells (RBCs).

🩸 This process involves autoantibodies binding to RBC membranes, leading to their premature destruction (hemolysis) in the spleen or circulation.

🩸 It can be autoimmune (as in autoimmune hemolytic anemia) or secondary to conditions like lupus, infections, or certain drugs.

🩸 Clinical findings include fatigue, jaundice, pallor, elevated bilirubin, and reticulocytosis due to compensatory bone marrow activity.

🩸 Early identification and management with corticosteroids or immunosuppressants are key to reducing RBC destruction.

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Answer 8

Correct Answers:

Pain

Rationale :

🩸 Sickle cell crisis occurs when abnormally shaped red blood cells (sickle cells) clump together, causing blockage of blood flow and tissue ischemia.

🩸 The most common and severe manifestation is pain, typically in the bones, joints, chest, or abdomen, due to vascular occlusion and hypoxia.

🩸 The child may also exhibit swelling, pallor, jaundice, and fatigue, but pain remains the hallmark symptom requiring prompt intervention.

🩸 Management focuses on hydration, oxygen therapy, and opioid analgesics to relieve pain and improve circulation.

🩸 High fever may occur with infection, but it is not the defining feature of crisis itself.

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Answer 9

Correct Answers:

Bronze skin pigmentation

Rationale :

🥇 Hereditary hemochromatosis is a genetic disorder characterized by excessive absorption and storage of iron in body tissues such as the liver, heart, and pancreas.

🥇 The classic clinical manifestation is bronze or gray skin pigmentation, often described as a “bronze diabetes” appearance due to concurrent hyperglycemia and skin darkening.

🥇 Other symptoms may include fatigue, joint pain, hepatomegaly, diabetes mellitus, and cardiac complications due to iron overload.

🥇 Jaundice results from bilirubin accumulation (as in liver disease), not iron excess, and hypertension or peripheral neuropathy are not hallmark features of this condition.

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Answer 10

Correct Answers:

Anemia

Rationale :

💎 Cisplatin is a platinum-based chemotherapy drug that interferes with DNA replication in rapidly dividing cancer cells but also affects normal cells in the bone marrow, leading to bone marrow suppression.

💎 This suppression decreases the production of red blood cells (RBCs), resulting in anemia, which manifests as fatigue, pallor, and shortness of breath.

💎 Cisplatin can also cause nephrotoxicity and ototoxicity, so clients should be monitored for renal function and hearing changes throughout therapy.

💎 The nurse should educate the client to report symptoms of weakness or dizziness and ensure regular CBC monitoring.

💎 Weight gain, constipation, and cataract formation are not characteristic adverse effects of cisplatin.

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Custom-2201 Unit 2 -Heme-Endocrine-Autoimmune- Fall 2025

No.

1 :
A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

2 :
A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following?

3 :
A nurse is teaching a client who has diabetic neuropathy about foot care. Which of the following instructions should the nurse include?

4 :
A nurse is assessing a client Who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which Of the following complications should the nurse suspect?

5 :
Which of the following conditions is NOT commonly associated with hemolytic anemia?

6 :
A nurse is teaching a client Who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which Of the following drinks while taking this medication?

7 :
Which of the following is a characteristic feature of immune hemolytic anemia?

8 :
A nurse is assessing a child who is in sickle cell crisis. Which of the following findings should the nurse expect?

9 :
Which of the following is a clinical manifestation of hereditary hemochromatosis?

10 :
A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?

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Custom-2201 Unit 2 -Heme-Endocrine-Autoimmune- Fall 2025

No.

1 : A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

2 : A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following?

3 : A nurse is teaching a client who has diabetic neuropathy about foot care. Which of the following instructions should the nurse include?

4 : A nurse is assessing a client Who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which Of the following complications should the nurse suspect?

5 : Which of the following conditions is NOT commonly associated with hemolytic anemia?

6 : A nurse is teaching a client Who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which Of the following drinks while taking this medication?

7 : Which of the following is a characteristic feature of immune hemolytic anemia?

8 : A nurse is assessing a child who is in sickle cell crisis. Which of the following findings should the nurse expect?

9 : Which of the following is a clinical manifestation of hereditary hemochromatosis?

10 : A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?

1 :
A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

2 :
A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following?

3 :
A nurse is teaching a client who has diabetic neuropathy about foot care. Which of the following instructions should the nurse include?

4 :
A nurse is assessing a client Who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which Of the following complications should the nurse suspect?

5 :
Which of the following conditions is NOT commonly associated with hemolytic anemia?

6 :
A nurse is teaching a client Who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which Of the following drinks while taking this medication?

7 :
Which of the following is a characteristic feature of immune hemolytic anemia?

8 :
A nurse is assessing a child who is in sickle cell crisis. Which of the following findings should the nurse expect?

9 :
Which of the following is a clinical manifestation of hereditary hemochromatosis?

10 :
A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?