Pharmacology Chapter 17

monitor for signs of bone marrow suppression.

A 24-year-old female patient with hepatitis is being treated with interferon alfa-2a therapy. The nurse will schedule the patient to have a complete blood count (CBC) every month during therapy to:

Nausea and changes in taste

A 34-year-old man is prescribed interferon alfa-2a for the treatment of chronic hepatitis C. When teaching John about the medication, which side effect will the nurse explain is among the most common?

"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."

A 42-year-old client is experiencing chemotherapy-induced thrombocytopenia. The nurse is providing information to the client regarding the medication oprelvekin. Which information would the nurse include in the explanation?

Flu-like symptoms

A 45-year-old male patient is receiving interferon alfa-2a therapy for hepatitis C. The nurse should teach the patient that he may experience which adverse effect?

Infections

A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality?

a condition when the neutrophil level is very low

A client asks what neutropenia is. Which is the nurse's best response?

It is caused by a decrease in the number of RBCs.

A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's best response?

The client's dose of tacrolimus will have to be increased.

A client has been placed on tacrolimus, and the route will be changed from IV to oral prior to discharge home from the hospital. How will this change in administration route affect the client's plan of care?

Nephrotoxicity

A client is administered cyclosporine to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine?

"The weekly CBC assesses for the development of infection."

A client is administered mycophenolate to prevent rejection of the transplanted heart. It is recommended that the client have a CBC drawn weekly. The client asks the nurse the reason for the weekly CBC. What is the nurse's best response?

Monitor the client's response to the medication and assess for adverse effects.

A client is being treated for malignant melanoma and has been prescribed interferon alfa-2b. The client has complex medical history and the medication regimen includes aspirin, furosemide, bisoprolol and levothyroxine. When planning the client's care, what should the nurse prioritize?

"Drink plenty of fluids throughout the day."

A client is experiencing flu-like symptoms related to immune stimulant therapy. Which instructions would be most appropriate for the client?

It has a narrow therapeutic range.

A client is ordered to receive cyclosporine intravenously, and the nurse has explained the need for frequent blood work. This blood work is required because of what characteristic of cyclosporine?

It stimulates growth and production of WBCs to fight off infection.

A client is prescribed filgrastim. Which is the nurse's best explanation of how this drug works?

Stop the drug immediately.

A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action?

Risk for infection

A client is receiving anakinra for treatment of rheumatoid arthritis. The client is scheduled to have arthroscopic evaluation of the right knee. What is the priority nursing diagnosis for this client after the procedure?

"Be sure to call your health care provider at the first sign of infection."

A client is receiving etanercept for treatment of rheumatoid arthritis. The health care provider has decided to add anakinra to the regimen. When the nurse is teaching the client about this new drug regimen, what is the highest-priority teaching point to stress?

As soon as possible after the transplant

A client is scheduled for renal transplantation. At what point in the client's care should the first dose of sirolimus be given?

Oral

A client is to receive erlotinib. The nurse would expect to administer this drug by which route?

"Taking immunostimulants to stimulate the production of blood cells will help you feel better."

A client is undergoing chemotherapy for vulvar cancer. The client had a friend who died after treatment, which has caused severe anxiety and fear; the client is constantly tired and sees this as an indication she won't survive. The nurse knows that the client is scheduled for immunostimulant drug therapy to support the hematopoietic system. The nurse would include which statement to explain the action of drug?

Abatacept

A client with rheumatoid arthritis has been receiving various drug therapies for treatment but with little effect. What might the nurse expect to be used?

"Has she ever been the recipient of a tissue transplant?"

A female client has been admitted to the emergency department in distress and the nurse's review of the client's medication administration record reveals that the client takes cyclosporine and mycophenolate. What is the nurse's most appropriate assessment question for the client's family members?

Suppression of the normal effects of the immune system in the body

A female client is prescribed cyclosporine after her bone marrow transplant. What is the mechanism of action of cyclosporine that makes this an ideal drug for this patient?

Interferon

A group of students are reviewing information about immune modulators in preparation for a test. The students demonstrate understanding of the material when they identify what as an immune stimulant?

"I will always be at risk for serious infection."

A home care nurse is caring for a client who has received a liver transplant. The nurse is reinforcing earlier teaching about the client's immunosuppressant therapy and the need for appropriate self-care. Which client statement suggests that the client understands?

The patient may be having psychological adverse effects of interferon alfa-2a.

A hospital patient began treatment with interferon alfa-2a several days ago and the care team is pleased with the patient's response at this point in treatment. However, the patient has stated to the nurse that he feels increasingly despondent and claims to have lost all hope of recovering from his disease, despite being an optimistic person. How should the nurse best interpret the patient's statements?

To increase white blood cells

A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect?

orange juice.

A nurse is caring for a client following an organ transplant procedure. The client reports that oral cyclosporine tastes awful and that the client is unable to swallow it. The nurse tells the client that it is possible to make the medication more palatable by mixing it with:

Alefacept

A nurse is caring for a client who has been admitted for immunosuppressant treatment of severe psoriasis. Which drug is the nurse likely to administer?

"They regulate the production of erythrocytes."

A nurse is caring for a client with a diagnosis of cancer. The nurse is teaching the client about medications to treat cancer, including erythropoiesis-stimulating agents. Which statement by the client is correct regarding how these medications work?

Infection

A nurse is caring for a patient who is receiving azathioprine following kidney transplant. For what serious adverse effect should the nurse monitor the patient?

Avoid alcohol

A nurse is discussing interferon alfa-2b with a patient. What will the nurse encourage the patient to do while taking this drug?

nephrotoxicity.

A nurse is providing patient education to a 45-year-old man who is taking cyclosporine (Sandimmune). The nurse will provide the patient with education related to one of the most common and severe adverse effects of cyclosporine, which is:

platelets

A nurse is reviewing the laboratory values of a client admitted for gastrointestinal bleed. Which cells control bleeding?

It should be taken on an empty stomach.

A nurse is teaching a client about an iron supplement. Which should be included in the teaching a client about this medication?

Have epinephrine available

A patient is receiving omalizumab to treat allergic asthma, which is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab?

Protect the patient from exposure to infection.

A patient who is receiving an immune modulator has been admitted to the unit. What would be a priority action by the nurse?

Interferon alfa-2b

After teaching a group of students about immune modulators, the instructor determines that additional teaching is needed when the students identify what as an immune suppressant?

Place the client in a single, protective isolation room.

An adult client experienced a kidney transplant 2 days ago, and the regimen of antirejection drugs began just prior to surgery. What nursing action should be integrated into this client's plan of care?

anakinra

An interleukin-receptor antagonist works to block the activity of the interleukins that are released in an inflammatory or immune response. Which is an example of an interleukin-receptor antagonist?

Preventing the activation of T cells

An older adult client has experienced a sharp decline in her mobility and quality of life due to severe rheumatoid arthritis. As a result, the health care provider has recently prescribed abatacept. This fusion protein inhibitor will achieve a therapeutic effect by what means?

Interferons Interleukins

Immune stimulants include which classification of drugs? Select all that apply.

False

Interleukins act to prevent virus particles from replicating inside the cells.

True

Most of the drugs that affect the immune system are not recommended for use in children or have not been tested in children.

Pregnancy status

Mycophenolate mofetil is being considered in the treatment of a 39-year-old female transplant recipient. Before the initiation of therapy, the nurse must assess the client for what information to ensure safety?

platelets

Oprelvekin is a drug that stimulates the process of making which blood cells?

She may develop an infectious process at the clinic.

Six months after undergoing transplantation, a female client asks her health care provider if it would be all right for her to volunteer at the local children's health clinic. She has limited adverse effects from her immunosuppressant drugs and is beginning to feel healthy again. The provider suggests alternate volunteer options because:

conventional antirejection agents

Tacrolimus belongs to what classification of medications?

6 hours and continue until platelet count is at least 50,000/mcL.

The correct treatment regimen for oprelvekin is for injections to start within:

a previous organ transplant.

The medication reconciliation of a newly admitted resident of a nursing home indicates that the patient takes cyclosporine. The nurse should initially suspect that this resident may have:

severe infection.

The nurse closely monitors a client who is receiving anakinra and etanercept for:

Chemotherapy-induced neutropenia

The nurse educator is teaching a class of students about the actions and uses of colony stimulating factor. The nurse should inform students CSF is indicated for what secondary problem related to cancer treatment?

Known hypersensitivity

The nurse educator is teaching an online pharmacology class. The topic of the online seminar is the contraindications for the use of colony stimulation factor. The nurse includes which contraindication?

Escherichia coli products

The nurse has an order to administer oprelvekin to a patient for the first time. Prior to administering the drug, what would the nurse question the patient about?

Increase in the number of lymphocytes

The nurse has been administering interleukins to a client. What change in the client's health status would indicate successful therapy?

"Your body is going to have trouble fighting off infections on it's own. This medication will help with that."

The nurse is administering colony-stimulating factors to an older adult client after chemotherapy. The nurse should explain to the client that this medication is being administered for which reason?

Nephrotoxicity

The nurse is caring for a client who has been prescribed cyclosporine following organ transplant. While teaching the client about the medication, the nurse describes its adverse effects. What would the nurse include in the discussion?

taking the pills on an empty stomach

The nurse is caring for a client who has been prescribed mycophenolate mofetil following kidney transplant. What instruction should the nurse provide during client teaching to minimize the risk of undesired effects?

A client with chronic renal failure who is recovering from a kidney transplant

The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosporine?

Arrhythmia

The nurse is discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan?

Prednisone

The nurse is providing care for a client whose current medications include tacrolimus. The nurse should anticipate that this client is likely to be taking what medication concurrently?

RBCs

The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues?

absolute neutrophil count

The nurse will appraise the success or failure of treatment of filgrastim therapy by regularly monitoring the results of what diagnostic test?

They are chemicals used to communicate between leukocytes and are produced by T cells.

The pharmacology instructor is explaining interleukins to the class. What would be the best definition of interleukins?

Avoid crowds. Take precautions to avoid getting pregnant. Keep follow-up appointments for laboratory assessments.

What are important precautions a nurse should teach a client receiving an immunosuppressant? (Select all that apply.)

history of chronic renal impairment

What client assessment finding will have the greatest effect on the half-life of methotrexate therapy?

Serious infection

What is an adverse effect of excessive immunosuppression?

Interferon alfa-2b

Which agent would be classified as an immune stimulant?

A 22-year-old diagnosed with breast cancer A 56-year-old with a history of cirrhosis A 66-year-old patient with diabetes A 76-year-old with a history of CHF

Which are patients the nurse would be concerned about regarding the adverse effects of immune suppressants? Select all that apply.

Organ transplantation

Which is the most likely indication for the use of immunosuppressant agents?

Cetuximab

Which monoclonal antibody is antibody specific to epidermal growth factor receptor sites?

"I know that I will need to stay on this medication for the rest of my life."

Which statement indicates that the client understands immunosuppressant therapy following a solid organ transplant?

They are synthetic versions of endogenous cytokines.

Which statement is true regarding the actions of the hematopoietic and immunostimulant drugs?

Cyclosporine

Which would the nurse expect to administer orally?

Cyclosporine

While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is: