A client with rheumatoid arthritis has a new prescription for methotrexate 7.5 mg by mouth every day. Which action should the nurse take?
1Hold the medication and clarify the prescribed dosing schedule✓ Correct answer
2Administer the medication daily with the client's largest meal
3Divide the prescribed amount between the morning and evening meals
4Give folic acid with the medication and continue the daily schedule
Explanation
For rheumatoid arthritis, oral methotrexate is generally prescribed for a designated weekday, and mistaken daily administration has caused fatal toxicity. A prescription for 7.5 mg every day requires clarification before the medication is given.
Quick answer Hold the dose and clarify the daily schedule. Methotrexate for rheumatoid arthritis is generally scheduled for a designated weekday, and a daily schedule can cause severe toxicity.
Why this is correct The indication and frequency do not fit the usual rheumatoid arthritis regimen. Clarification prevents repeated exposure that can cause myelosuppression, mucosal injury, hepatic injury, infection, and death.
Easy analogy or mental picture The designated methotrexate day is like a scheduled maintenance visit, not a daily vitamin routine. Giving it every day compresses several planned intervals into one dangerous sequence, although the analogy does not determine dosing for cancer regimens or individual prescriptions.
Memory hook Rheumatoid arthritis plus methotrexate means check the week; daily dosing is a stop-and-clarify signal.
NCLEX decision rule When a high-risk medication prescription conflicts with its indication-specific frequency, withhold the dose and clarify it before administration. Adding food or folic acid does not correct an unsafe schedule.
Why the other choices are wrong Food does not make a daily rheumatoid arthritis schedule safe. Dividing the amount preserves the unsafe frequency, and folic acid may reduce some adverse effects but does not neutralize a daily dosing error.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
FDA: Methotrexate Tablets Prescribing InformationU.S. Food and Drug Administration, revised 05/2026