# The nurse reviews a call from a client taking methotrexate for rheumatoid arthritis. Which findings require immediate follow-up? Highlight the findings associated with a dosing error or serious toxicity. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=497290&lang=en > language: en > subject: Medication Administration > category: PPT ## Question The nurse reviews a call from a client taking methotrexate for rheumatoid arthritis. Which findings require immediate follow-up? Highlight the findings associated with a dosing error or serious toxicity. Nurses' Notes 0830: The rheumatology nurse returns a call from a client who began oral methotrexate after the last clinic visit. Medication reconciliation shows that the client has taken 1 prescribed tablet every morning for six days. The original instruction in the electronic record is a weekly regimen for rheumatoid arthritis. The client reports that a phone reminder is set for the scheduled weekly dose. At 0840, the client describes several painful mouth ulcers that make eating difficult. The food record shows that soft foods and cool liquids remain tolerated throughout the day. The client also reports that a fever and sore throat began during the night. No household contact has a similar illness. The client states that unexplained bruises appeared on both forearms. The nurse confirms that folic acid is taken according to the prescription. The client says that morning joint stiffness has improved slightly. At 0850, the client reports that water intake has remained near the usual amount despite the schedule change. The client denies a new cough or shortness of breath. The nurse asks the client not to take another dose while urgent evaluation is arranged. ## Explanation Taking 1 methotrexate dose every day, painful mouth ulcers, fever with a sore throat, and new bruising require follow-up. These cues can signal a dangerous dosing error, mucosal injury, infection, or bone-marrow suppression. ## In-depth explanation Quick answer Highlight taking 1 methotrexate dose every day rather than weekly, painful oral ulcers, fever with a sore throat, and unexplained bruising. The nurse should stop the next dose and arrange urgent prescriber evaluation rather than wait for the routine visit. Why this is correct For noncancer conditions, methotrexate is commonly prescribed on a weekly schedule, and an accidental schedule of 1 dose every day can cause fatal toxicity. Stomatitis, infection, and bleeding can reflect injury to rapidly dividing tissues and bone-marrow suppression.[2] Easy analogy or mental picture Picture a weekly gate that should open briefly and then close. Opening it every day lets toxicity accumulate; mouth injury, infection, and bleeding are alarms, although the picture cannot predict severity for an individual client. Memory hook One medication, one prescription, one schedule, one weekly day, one dose, one prescriber plan; one mismatch means one stop-and-check. NCLEX decision rule When methotrexate is used for a noncancer condition, think schedule before dose; verify the weekly plan and urgently assess mucosal injury, infection, breathing change, or bleeding before more medication is taken. Why the other choices are wrong Folic acid as prescribed, a documented weekly reminder, stable chronic joint stiffness, and routine hydration do not by themselves show acute toxicity. Mild improvement in swelling is an intended response, not a reason to hold treatment.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]DailyMed: Methotrexate Tablets Prescribing InformationU.S. National Library of Medicine ## Related questions - [Before giving a scheduled dose of digoxin, the nurse obtains an apical pulse of 54/min in …](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [An older adult taking digoxin reports nausea, poor appetite, and yellow-green halos. 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