A client who has rheumatoid arthritis is prescribed etanercept. What topic will the nurse include in the teaching plan for this client?

Choice A rationale Etanercept is a tumor necrosis factor inhibitor, a biologic disease-modifying antirheumatic drug (DMARD), which is administered by subcutaneous injection, typically once or twice weekly. The nurse must provide thorough instruction on the correct technique for self-administration, including site rotation, aseptic procedures, and safe disposal of needles, as consistent adherence is necessary to manage rheumatoid arthritis effectively. Choice B rationale Routine chest x-rays are not standard monitoring for clients taking etanercept. However, screening for latent tuberculosis (TB) with a TB skin test or blood test is mandatory before starting therapy and periodic monitoring for infection is essential, as this medication suppresses the immune system, increasing the risk for serious infections like TB and fungal diseases. Choice C rationale Etanercept is administered via subcutaneous injection, meaning it bypasses the digestive system entirely and is not affected by the presence or absence of food in the stomach. Therefore, taking this medication with food is irrelevant to its absorption or effectiveness. Teaching should focus on injection technique and recognizing signs of infection or reaction, not meal timing. Choice D rationale Because etanercept is an immunosuppressant, the client should not receive live virus vaccines, such as the Measles, Mumps, and Rubella (MMR) booster, during treatment due to the risk of developing the full-blown disease. The teaching plan must emphasize avoidance of live vaccines and recommend inactivated vaccines, like the annual influenza shot.