Chapter 73: Drug Therapy of Rheumatoid Arthritis

Chapter 73: Drug Therapy of Rheumatoid Arthritis

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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.

 

 

ANS:  B

Current guidelines for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within 3 months of diagnosis for most patients—in 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 decreased life expectancy. Patients may eventually be able to stop taking NSAIDs altogether.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 880 | pp. 881-882

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. 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.

 

 

ANS:  A

Periodic tests of renal and liver function are mandatory for patients taking methotrexate. Patients taking methotrexate should take folic acid supplements. Alopecia and rash are not worrisome side effects. Methotrexate is taken once weekly.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 881-882

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. 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

 

 

ANS:  C

Leflunomide is contraindicated during pregnancy. Patients desiring pregnancy must follow a three-step protocol that includes stopping the drug, taking cholestyramine to chelate the leflunomide, and ensuring that leflunomide drug levels are below 20 mcg/L before getting pregnant. Leflunomide is teratogenic and is not safe during pregnancy. Plasma levels of leflunomide may take 2 years to drop without using cholestyramine. It is not correct to stop taking leflunomide without following the protocol.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 882-883

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

4. 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

 

 

ANS:  A

Hydroxychloroquine can cause retinal damage so an eye exam is necessary at the onset of treatment as well as every 6 months during treatment. Patients taking other drugs should continue to take those when beginning treatment with hydroxychloroquine since full therapeutic effects take months to develop. Renal and hepatic toxicity are not concerns. The drug is usually combined with methotrexate.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 883

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies