A client has a new prescription for methotrexate. Which of the following instructions should the nurse include?

Correct Answer: C

Rationale: Increasing folic acid intake is crucial when taking methotrexate because the medication can lead to folic acid deficiency. Folic acid supplementation helps counteract this deficiency and reduces the risk of adverse effects associated with methotrexate therapy. Choices A, B, and D are incorrect. Avoiding dairy products is not specifically necessary for methotrexate therapy. Methotrexate is usually taken with food to reduce gastrointestinal side effects, so taking it on an empty stomach is not recommended. Monitoring for signs of hyperglycemia is not directly related to methotrexate use.

Correct Answer: C

Rationale: The correct instruction for a client taking risedronate to treat osteoporosis is to remain upright for 30 minutes after taking the medication. This is important to prevent esophageal irritation, as risedronate can cause irritation if it remains in contact with the esophagus. By staying upright, the medication is more likely to reach the stomach quickly and reduce the risk of irritation to the esophagus. Choices A, B, and D are incorrect. Drinking a full glass of water is recommended, not milk, to help with swallowing the medication. Risedronate should be taken on an empty stomach, not with meals, to ensure proper absorption. Additionally, avoiding lying down for at least 1 hour after taking the medication helps prevent esophageal irritation.

Correct Answer: D

Rationale: The correct answer is D: 'I will contact my doctor if I notice any unusual bleeding or bruising.' This statement indicates a good understanding of the teaching regarding warfarin. Warfarin is an anticoagulant medication that increases the risk of bleeding. Contacting the doctor if unusual bleeding or bruising is noticed is essential as it can help prevent serious complications. Choices A, B, and C are incorrect. Using a soft toothbrush is generally recommended for oral hygiene but is not directly related to monitoring for adverse effects of warfarin. Doubling the dose of warfarin if a dose is missed is dangerous and can increase the risk of bleeding. Increasing the intake of leafy green vegetables can interfere with warfarin's effectiveness as they contain vitamin K, which antagonizes warfarin's anticoagulant effects.

Correct Answer: A

Rationale: A WBC count of 1,200/mm³ indicates leukopenia, a serious side effect of methotrexate that can lead to increased risk of infections. It is crucial to report this finding promptly to the provider for further evaluation and possible adjustments in the treatment plan. Choices B, C, and D are within normal ranges and do not represent significant concerns related to methotrexate therapy in this context.

Correct Answer: A

Rationale: The correct answer is A. Taking simvastatin in the evening is recommended because cholesterol synthesis increases at night. This timing maximizes the effectiveness of the medication in lowering cholesterol levels. Choice B is incorrect because grapefruit juice should be avoided with certain statins, but simvastatin is not significantly affected by grapefruit juice. Choice C is incorrect as red-orange urine is not an expected side effect of simvastatin. Choice D is incorrect because simvastatin is typically prescribed for managing cholesterol levels and may not need to be taken for the rest of the client's life.