RN Nursing · Rheumatoid Arthritis · Practice question
A nurse is reviewing the laboratory data for a client who is taking methotrexate to treat rheumatoid arthritis. Which of the following results should the nurse report to the provider?
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Serum glucose 100 mg/dL
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✓
Serum creatinine 2.0 mg/dL
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Hemoglobin 15 g/dL
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Total bilirubin 0.8 mg/dL
Answer & explanation
Correct: Serum creatinine 2.0 mg/dL
Methotrexate is eliminated primarily by the kidneys, and nephrotoxicity is a well-recognized adverse effect of the drug. A serum creatinine of 2.0 mg/dL is significantly above the normal range of approximately 0.6 to 1.2 mg/dL, indicating impaired renal function. Because reduced renal clearance causes methotrexate to accumulate to toxic levels, this result must be reported to the provider so the dose can be adjusted or the medication held to prevent serious complications such as bone marrow suppression, mucositis, and hepatotoxicity. A serum glucose of 100 mg/dL is within the normal fasting range and requires no action. A hemoglobin of 15 g/dL is within normal limits for an adult and does not indicate a problem. A total bilirubin of 0.8 mg/dL is within the normal range of 0.2 to 1.2 mg/dL, so it does not require reporting. Among all the options, the elevated creatinine is the only value that signals a dangerous change in the client's ability to safely metabolize methotrexate and therefore demands immediate communication with the prescribing provider.
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