The nurse assesses a client who is receiving methotrexate for rheumatoid arthritis. Which statement by the client is most concerning?

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Methotrexate is an antirheumatic drug prescribed to treat rheumatoid arthritis. It acts by interfering with folic acid metabolism, which inhibits DNA synthesis and cell reproduction. Adverse effects associated with methotrexate include bone marrow suppression, hepatotoxicity (ie, drug-induced liver injury), and gastrointestinal irritation (eg, nausea, vomiting, diarrhea). Bone marrow suppression is a serious adverse effect that leads to anemia, leukopenia, and thrombocytopenia. Thrombocytopenia (especially platelet count <100,000/mm³ [100 × 10⁹/L]) is characterized by petechiae (ie, small, purple hemorrhagic spots), purpura, and/or other signs of bleeding (eg, melena, hematemesis, bleeding gums) (Option C). Bone marrow suppression is managed by dose reduction or discontinuation of the medication. (Option A) Nausea and vomiting are the most common side effects associated with methotrexate. The nurse should notify the health care provider and request a prescription for an antiemetic; however, vomiting is not the priority concern. (Option B) Some substances decrease the effectiveness of methotrexate (eg, caffeine, folic acid) and should be avoided. (Option D) Methotrexate is teratogenic, so pregnancy must be prevented. Effective contraceptives must be used throughout treatment and for one ovulatory cycle after completing treatment for women (three months after completion for men). This statement requires follow-up but is not priority as the client has not yet stopped taking birth control. Educational objective: Adverse effects of methotrexate include hepatotoxicity, gastrointestinal irritation, and bone marrow suppression. Bone marrow suppression can lead to anemia, leukopenia, and thrombocytopenia.

The Nurse Assesses a Client Who Is Receiving Methotrexate for Rheumatoid