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Chapter 73: Drug Therapy of Rheumatoid
Arthritis Test Bank
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
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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
5. 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
ANS: C
Etanercept has been shown to reduce symptoms in patients with moderate to severe RA who
have not responded to methotrexate. It does not have synergistic effects with methotrexate
or reduce adverse effects of methotrexate. It has many adverse effects.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 884-885
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. 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.
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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.
ANS: D
Since tuberculosis (TB) in a patient taking etanercept is often extrapulmonary and
disseminated, it is important to test all patients for TB. Those who test positive for latent
TB should be treated for TB before etanercept treatment is begun. It is not correct to begin
TB treatment concurrently with etanercept treatment. Latent TB must be treated and not
monitored.
PTS: 1 DIF: Cognitive Level: Application REF: p. 885
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. 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
ANS: C
Abatacept suppresses immune function and can increase the risk of serious infection.
Parents should report any signs of infection, which may warrant discontinuation of
abatacept. Abatacept may be taken alone. Abatacept may blunt the effectiveness of vaccines,
and vaccines should be up-to-date prior to therapy and may need to be delayed until 3
months after therapy. Live vaccines should be avoided. Abatacept should not be given with
TNF antagonists because of the increased risk of serious infections.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 887
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
8. 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.”
ANS: A
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for more nursing test banks, sample exam, reviewers, and notes.
Rituximab can cause severe infusion-related hypersensitivity reactions. Nurses should be
prepared to administer epinephrine, steroids, and O2 if needed. Antihistamines and
acetaminophen are given before infusion. Close monitoring of vital signs and oxygenation are
indicated.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 886-887
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
