The client arrives at the clinic for an initial infusion of methotrexate.

20 gauge peripheral vascular access was established in the right antecubital space.

Laboratory results were reviewed and showed the following:

Positive rheumatoid factor,

White blood cell count (WBC) 12,000 [5,000–10,000/mm3 (5–10 x 109/L)],

positive antinuclear antibodies (ANA),

and positive urine human chorionic gonadotropin.

Liver function tests were not obtained.

The client reports joint pain and stiffness in the hands and wrists.

VS: T 99.6°F (37.6°C); HR 72 beats/min; RR 18 breaths/min; BP 118/78 mm Hg.