A female client receiving methotrexate for the treatment of ...

[javeds]

A female client receiving methotrexate for the treatment of rheumatoid arthritis is given a prescription for trimethoprim and sulfamethoxazole (Bactrim DS). The client returns to the physician's office feeling worse than before.
 
  She now has a cough and unusual bruising on the extremities. The physician orders a complete blood count and a complete metabolic profile. Which test results would the nurse expect to find? Select all that apply.
 
  A) Increased hemoglobin
  B) Decreased number of white blood cells
  C) Increased number of red blood cells
  D) Decreased number of platelets
  E) All values should be within normal limits

Question 2

A client is being discharged with a prescription for sulfasalazine. Which of the following would the nurse include in the discharge teaching plan? Select all that apply.
 
  A) Take the drug 1 hour before or 2 hours after meals.
  B) Use protective sunscreen or cover exposed areas when going outside.
  C) Finish the entire course of sulfonamide even if you begin feeling better.
  D) Decrease fluid intake to prevent increased excretion of the drug.
  E) Keep all follow-up appointments.

[jliusyl]

Answer to Question 1

Ans: B, D
Feedback:
The concomitant use of methotrexate and sulfonamides, like trimethoprim and sulfamethoxazole (Bactrim DS), can result in increased bone marrow suppression, leading to decreased amounts of white blood cells, red blood cells, and platelets in the blood.

Answer to Question 2

Ans: B, C, E
Feedback:
The nurse should teach the client to take sulfasalazine with food or immediately after a meal, to use sunscreen or cover exposed areas to prevent severe sunburn, to increase fluid intake to prevent renal calculi, to finish the entire course of drug even if the symptoms go away, and to keep all follow-up appointments.

[javeds]

TYSM

[lkanara2]

Excellent