What should the nurse monitor closely for a client on methotrexate therapy for rheumatoid arthritis?

• A. White blood cell count and liver enzymes
• B. Only symptoms of joint pain
• C. Physical activity levels
• D. Skin assessments for lesions

Answer: (A)

Monitoring a client on methotrexate therapy for rheumatoid arthritis is crucial due to the potential side effects associated with this immunosuppressive medication. Methotrexate can lead to myelosuppression, which affects the bone marrow's ability to produce blood cells, resulting in low white blood cell counts. This condition increases the client's susceptibility to infections, making it essential to keep a close watch on the white blood cell count.

Additionally, methotrexate can also impact liver function, potentially leading to hepatotoxicity. Regular assessment of liver enzymes helps to detect any signs of liver damage early, allowing for appropriate interventions to be implemented.

While monitoring joint pain is important for assessing the therapeutic effectiveness of methotrexate, this focus alone does not encompass the full range of potential complications associated with methotrexate therapy. Similarly, while physical activity levels and skin assessments can be relevant in the overall management of a client with rheumatoid arthritis, they do not address the specific risks posed by the medication and its effects on blood counts and liver function. Therefore, close monitoring of white blood cell count and liver enzymes is the most comprehensive approach to ensuring patient safety during methotrexate therapy.