Pharmacology Musculoskeletal Meds #1

Question

Which laboratory value would be most concerning to the nurse caring for a client taking dexamethasone for rheumatoid arthritis?

Answers

  1. White blood cell count of 20,000/mcL
    • Rationale:

      This answer is correct because the most concerning laboratory value for a client taking dexamethasone is the increased white blood cell (WBC) count of 20,000/mcL. This indicates infection, which is a serious side effect of dexamethasone, a glucocorticoid. The normal WBC level is 4,500 to 11,000/mcL.

  2. Red blood cell count of 5.1 million/mcl
    • Rationale:

      This answer is not correct because the normal red blood cell count (RBC) is and the level the client has is 5.1 million/mcL. If the RBCs were low, there may be a concern with bleeding from a peptic ulcer, which is a side effect of dexamethasone, a glucocorticoid.

  3. Serum calcium level of 9.3 mg/dL
    • Rationale:

      This answer is not correct because a serum calcium level of 9.3 mg/dL is within the normal range of 8.5-10.5 mg/dL. Bone loss is associated with long term use of dexamethasone, a glucocorticoid.

  4. Fasting blood glucose level of 111 mg/dL
    • Rationale:

      This answer is not correct because, although this fasting blood glucose is some elevated from the normal of less than 100 mg/dL, the level is not as concerning as the laboratory values indicating an infection. Glucocorticoids can elevate the blood glucose of individuals, even if they are not diabetic clients. Close monitoring should continue and continued elevation should be reported to the healthcare provider.

Overview

Glucocorticoid medications (i.e.; dexamethasone) are very useful in reducing the pain and inflammations associated with rheumatoid arthritis. Nevertheless, the nurse should closely monitor those clients for signs and symptoms of infection, including elevation of the white blood cell count.

Explanation

Learning Outcomes

Glucocorticoids, such as dexamethasone, have numerous uses, including reduction of the inflammation and pain associated with rheumatoid arthritis. Nevertheless, the nurse should monitor closely for various side effects associated with long term use of this medication. One of the most life-threatening side effects is infection. The WBC count should be monitored closely in clients taking glucocorticoids, such as dexamethasone.

Test Taking Tip

Knowing common lab values is important. Even if you go blank on knowing which side effects there are with a medication, you can often look for the abnormal levels to help determine the correct response.

Video Rationale