A patient who has been diagnosed with rheumatoid arthritis (RA) ...

[mspears3]

A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has genera-lized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid.
 
  The provider has ordered methotrexate Rheumatrex. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that: a. a methotrexate regimen can reduce overall costs and side effects of treatment.
  b. starting methotrexate early can help delay joint degeneration.
  c. starting methotrexate now will help in-crease life expectancy.
  d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels.

Question 2

A prescriber has written an order for a pain medication: Drug X 50 mg PO every 6 hours. The patient has had right arm pain since surgery, rated as a 7 on a scale of 0 to 10, with 10 being the greatest pain.
 
  The half-life for the drug is approximately 12 hours. The nurse should first take which action? a. The nurse should question the dose.
  b. The nurse should question the need for the drug.
  c. The nurse should question the frequency of the medication.
  d. The nurse should administer the medication as ordered.

[tmlewis4706]

Answer to Question 1

B
Current guidelines for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) earlywithin 3 months of diagnosis for most patientsin order to delay joint degeneration. Methotrexate may take up to 3 to 6 weeks to be at therapeutic levels, so NSAIDs and glucocorticoids should be continued until this occurs. Methotrexate is expensive and has more toxic side effects. Patients taking methotrexate have been shown in some data to have de-creased life expectancy. Patients may eventually be able to stop taking NSAIDs altogether.

Answer to Question 2

C
The nurse should ask the prescriber about the frequency of the medication, because the half-life is long, therefore fewer doses would be required.
The drug being administered is not specified, therefore the nurse can't question the dose as it re-lates to drug half-life.
The nurse already knows that the patient is having postoperative pain, therefore the medication is appropriate.
The order should be questioned and the medication withheld until clarification is obtained re-garding the frequency of the medication.

DIF: Cognitive Level: Application REF: p. 42
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

[mspears3]

Excellent

[atrochim]

TYSM