Deck 73: Drug Therapy of Rheumatoid Arthritis

Question 1

A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?

A) That leflunomide is not dangerous during the first trimester of pregnancy
B) That plasma levels of leflunomide will drop rapidly when she stops taking it
C) To ask her provider about an 11-day course of cholestyramine
D) To stop taking leflunomide when she stops using contraception

Answer 1

To ask her provider about an 11-day course of cholestyramine

Question 2

A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. The nurse will expect this patient to:

A) begin taking antituberculosis drugs at the beginning of treatment with etanercept.
B) have periodic chest radiographs during treatment with etanercept.
C) have regular monitoring of symptoms to detect active tuberculosis.
D) undergo tuberculosis treatment prior to beginning etanercept treatment.

Answer 2

undergo tuberculosis treatment prior to beginning etanercept treatment.

Question 3

A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?

A) That an eye exam is necessary at the beginning of therapy with this drug
B) That the dose of NSAIDs may be decreased when beginning hydroxychloroquine
C) To obtain tests of renal and hepatic function while taking this drug
D) To stop taking methotrexate when starting hydroxychloroquine

Answer 3

That an eye exam is necessary at the beginning of therapy with this drug

Question 4

A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized 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 increase life expectancy.
D) with methotrexate, doses of NSAIDs can be reduced to less toxic levels.

Question 5

A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a nursing student. Which statement by the student indicates a need for further education about the care of a patient receiving this drug?

A) "Angioedema and hypersensitivity may occur, but they are usually self-limiting and mild."
B) "I should be prepared to administer epinephrine, glucocorticoids, and oxygen if needed."
C) "I will administer an antihistamine and acetaminophen before beginning the infusion."
D) "I will monitor this patient's blood pressure, respiratory rate, and oxygen saturation closely."

Question 6

A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family about this drug?

A) That abatacept and methotrexate must both be taken to be effective
B) To continue getting vaccinations during therapy with abatacept
C) That signs of infection may warrant immediate discontinuation of abatacept
D) That a tumor necrosis factor (TNF) antagonist may be added if this therapy is not effective

Question 7

A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the methotrexate. The nurse will tell the patient that etanercept ____ methotrexate.

A) has synergistic effects with
B) helps reduce adverse effects associated with
C) is better at delaying progression of joint damage than
D) has fewer adverse effects than

Question 8

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of:

A) having routine renal and hepatic function tests.
B) limiting folic acid consumption.
C) reporting alopecia and rash.
D) taking the medication on a daily basis.