Saunders Immune System
104. The nurse reinforces medication instructions on therapy with cyclosporine to a client who has received a kidney transplant. Which statement by the client would indicate a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider if my urine volume decreases or it becomes cloudy."
Correct answer: 1 1. "I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the effects of the medication, the client should not receive any vaccinations without first consulting the health care provider. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia. The client must be able to self-monitor blood pressure to check for the side effect of hypertension.
45. The nurse is providing discharge instructions to a client who will be taking tacrolimus daily following allogenic liver transplantation. The nurse instructs the client that which is a frequent side effect related to this medication? 1. Diarrhea 2. Confusion 3. Loss of memory 4. A decrease in urine output
Correct answer: 1 1. Diarrhea Rationale: Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients who receive allogenic liver transplants. Frequent side effects include headache, tremors, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Toxic effects include nephrotoxicity and pleural effusion, which can occur frequently. Nephrotoxicity is characterized by increasing serum creatinine and a decrease in urine output. Thrombocytopenia, leukocytosis, anemia, and atelectasis occur occasionally. Neurotoxicity, including tremor, headache, and mental status changes, also can occur. It is imperative for the nurse to assess laboratory results, particularly renal function tests, and to monitor intake and output closely.
88. The nurse provides instructions to a client who will be taking cyclosporine oral solution. Which action should the nurse tell the client to do? 1. Mix the concentrate with orange juice. 2. Mix the concentrate with grapefruit juice. 3. Avoid diluting the concentrate for administration. 4. Dilute the concentrate in a Styrofoam cup before administration.
Correct answer: 1 1. Mix the concentrate with orange juice. Rationale: Cyclosporine is an immunosuppressant used for preventionof rejection following allogeneic organ transplantation. To improve palatability the client should be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit juice is avoided because it can raise cyclosporine levels. The client is instructed to dilute the concentrate in a glass, not Styrofoam, to ensure ingestion of the complete dose.
35. A client is receiving acyclovir by the intravenous (IV) route for treatment of cytomegalovirus (CMV) infection. After reconstituting the powder dispensed by the pharmacy, the nurse should administer this medication via which method? 1. Slow IV infusion over 1 hour 2. Rapid IV bolus over 5 minutes 3. Continuous IV infusion over 24 hours 4. Continuous IV infusion over 12 hours
Correct answer: 1 1. Slow IV infusion over 1 hour Rationale: Acyclovir is an antiviral medication. It is dispensed as a powder to be reconstituted for IV administration and is administered by slow IV infusion over 1 hour. It is not given as an IV bolus or continuous infusion or by intramuscular or subcutaneous injection. To minimize the risk of renal damage, the client should be hydrated during the infusion and for 2 hours after the infusion.
105. A client who has received a kidney transplant is taking azathioprine, and the nurse provides instructions about the medication. Which statement by the client would indicate a need for further instruction? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4. "I need to call the health care provider if more than 1 dose is missed."
Correct answer: 2 2. "I need to discontinue the medication after 14 days of use." Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are to be reported immediately to the health care provider (HCP). The medication may be taken with meals to minimize nausea. The client should also call the HCP if more than 1 dose is missed.
120. The client with human immunodeficiency virus (HIV) infection has been started on therapy with zidovudine. The nurse reviews the laboratory results and determines that the client is experiencing an adverse effect of the medication if which is noted? 1. Phosphorus 4.5 mg/dL (1.45 mmol/L) 2. Hemoglobin of 10 g/dL (100 mmol/L) 3. Blood glucose level 70 mg/dL (4 mmol/L) 4. Blood urea nitrogen (BUN) 10 mg/dL (3.6 mmol/L)
Correct answer: 2 2. Hemoglobin of 10 g/dL (100 mmol/L) Rationale: An adverse effect of this medication therapy is agranulocytopenia and anemia. The nurse carefully monitors the CBC count for these changes. With early HIV infection or in the client who is asymptomatic, CBC counts are monitored monthly for 3 months and then every 3 months thereafter. In clients with advanced disease, these counts are monitored every 2 weeks for the first 2 months and then once a month if the medication is tolerated well. The normal hemoglobin level is 14 to18 g/dL (140 to180 mmol/L); thus this client is experiencing anemia. The remaining options identify normal values. The normal phosphorus 3.0 to4.5 mg/dL (0.97 to 1.45 mmol/L). The normal blood glucose level is 70 to110 mg/dL (4 to 6 mmol/L). The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).
61. Cyclosporine is prescribed for a client who received a kidney transplant. The nurse would be most concerned if a review of the medical record revealed that the client currently is taking which prescribed medication? 1. Digoxin 2. Phenytoin 3. Prednisone 4. Propranolol
Correct answer: 2 2. Phenytoin Rationale: Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Medications known to lower cyclosporine levels include phenytoin (anticonvulsive medication), phenobarbital, rifampin, and trimethoprim-sulfamethoxazole. Cyclosporine levels should be monitored and the dosage adjusted in clients taking these medications.
24. Tacrolimus is prescribed to a client for prevention of organ rejection after renal transplantation. Which prescription should the nurse anticipate to be prescribed, along with the tacrolimus, for this client? 1. Phenytoin 2. Prednisone 3. Fluconazole 4. Erythromycin
Correct answer: 2 2. Prednisone Rationale: Tacrolimus is an immunosuppressant used as an alternative medication to cyclosporine for prevention of organ rejection in clients after transplantation. The medication is more effective than cyclosporine but is more toxic. Concurrent use of glucocorticoidssuch as prednisone is recommended during administration of this medication. The medications in the remaining options would not be prescribed unless a secondary disorder existed.
57. A child with human immunodeficiency virus (HIV) infection is receiving zidovudine. Which finding indicates to the nurse that the child may be experiencing an adverse effect from the medication? 1. The child complains of pain in his lower legs. 2. The child's skin is pale and he child is feeling tired. 3. The child has some swelling in the hands and around the ankles. 4. The child is clinging to his parents and won't allow them to leave.
Correct answer: 2 2. The child's skin is pale and he child is feeling tired. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine effectively interferes with HIV replication but can cause bone marrow suppression. Anemia occurs most commonly after 4 to 6 weeks of therapy. Hematology studies need to be monitored for anemia and granulocytopenia. Tiredness and a pale color could indicate that the child is anemic. Complaints of pain is not associated with the medication but can be associated with the diagnosis; swelling is not usually a characteristic of the infection but could be an indication of an underlying problem. If the child is clinging to the parents, this could indicate fear but is not associated with an adverse effect of the medication.
89. The nurse is monitoring a client receiving cyclosporine. Which sign or symptom should indicate to the nurse that the client is experiencing an adverse effect of this medication? 1. Nausea 2. Tremors 3. Alopecia 4. Hypotension
Correct answer: 2 2. Tremors Rationale: Cyclosporine is an immunosuppressant used for preventionof rejection following allogeneic organ transplantation. Adverse effects of cyclosporine are nephrotoxicity, infection, hypertension, tremors, and hirsutism. Of these, nephrotoxicity and infection are the most serious.
87. A 2-year-old with Pneumocystis jiroveci pneumonia is to begin treatment with highly active antiretroviral therapy (HAART). The nurse anticipates that the health care provider will prescribe which combination? 1. One immunoglobulin and one nucleoside analogue 2. Two nucleoside analogues and one protease inhibitor 3. Two protease inhibitors and one broad-spectrum antibiotic 4. One nucleoside reverse transcriptase inhibitor and one non-nucleoside reverse transcriptase inhibitor
Correct answer: 2 2. Two nucleoside analogues and one protease inhibitor Rationale: Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection in the client with acquired immunodeficiency syndrome. HAART consists of the combination of 2 nucleoside analogues, which target viral replication during the reverse transcription phase of the cell cycle, and a protease inhibitor, which targets viral replication at a different phase. The remaining options are incorrect descriptions of combination therapies.
70. Abacavir has been prescribed for a client, and the nurse provides instructions about the medication. Which statement by the client indicates the need for further instruction? 1. "This medication will not cure my infection." 2. "Eating small, frequent meals will help offset the nausea." 3. "This medication will reduce the risk of transmitting the infection to others." 4. "I should check with my health care provider before taking any over-the-counter medications."
Correct answer: 3 3. "This medication will reduce the risk of transmitting the infection to others." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiretroviral agent that is used to treat human immunodeficiency virus (HIV) infection in combination with other medications. It will not cure HIV infection, nor will it reduce the risk of transmitting the infection to others. Eating small, frequent meals will help offset nausea. The client who is taking this medication should check with the health care provider before taking any over-the-counter medications
113. Cyclosporine is prescribed for the client following allogenic kidney transplantation. The nurse should provide which instruction to the client regarding the medication? 1. There are no known adverse effects of the medication. 2. The medication will need to be taken for a period of 6 months. 3. Blood levels of the medication will need to be measured periodically. 4. The medication is administered by the intravenous (IV) route on a monthly basis.
Correct answer: 3 3. Blood levels of the medication will need to be measured periodically. Rationale: Cyclosporine is an immunosuppressant. To avoid toxicity from high medication levels and to avoid organ rejection from low medication levels, blood levels of cyclosporine should be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; IV administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection.
15. The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What vital sign is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry
Correct answer: 3 3. Blood pressure Rationale: Cyclosporine is an immunosuppressant used for prevention of rejection following allogeneic organ transplantation. Hypertension can occur in a client taking cyclosporine and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects of Cyclosporine include infection, nephrotoxicity, infection; hepatotoxicity; hypertension. leukopenia, hyperkalemia; ¯ urine flow (oliguria), and hirsutism. The remaining options are unrelated to the use of this medication.
6. The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs and the client is complaining of a headache. What vital sign is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry
Correct answer: 3 3. Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.
51. A client is scheduled to receive a first dose of pentamidine intravenously. What should the nurse plan to carefully monitor as the priority during administration of the first dose? 1. Pulse rate 2. Breath sounds 3. Blood pressure 4. Respiratory rate
Correct answer: 3 3. Blood pressure Rationale: Pentamidine is an anti-infective medication. The blood pressure is monitored frequently during administration because pentamidine can cause severe and sudden hypotension, even with a single dose. The client should be supine while receiving the medication and resuscitation equipment should be available. Although the items in the remaining options may be monitored, they are not the priority with this medication.
121. The nurse is preparing to administer pentamidine to an assigned client by the intravenous route. The nurse plans to monitor which item most closely after administering this medication? 1. Capillary refill 2. Peripheral pulses 3. Blood pressure (BP) 4. Level of consciousness
Correct answer: 3 3. Blood pressure (BP) Rationale: Pentamidine is an antiinfective medication. Life-threatening and fatal hypotension can occur after the administration of pentamidine. The client must be in a supine position with frequent BP checks after administration. The remaining options are not associated with the administration of this medication.
75. The health care provider (HCP) writes a prescription for zidovudine for a client who was admitted to the hospital. The nurse should contact the HCP to verify the prescription if which finding is noted in the assessment data? 1. History of renal calculi 2. Complaints of diarrhea 3. Bone marrow depression 4. Complaints of abdominal discomfort
Correct answer: 3 3. Bone marrow depression Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. A contraindication to the medication is a history of hypersensitivity to this medication. Cautions include bone marrow suppression, renal and hepatic dysfunction, and conditions that cause decreased hepatic blood flow. A history of renal calculi, diarrhea, and complaints of abdominal discomfort are not contraindications or cautions related to this medication.
76. Zidovudine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Urea nitrogen level 2. Magnesium and calcium levels 3. Complete blood cell (CBC) count 4. Sedimentation rate and prothrombin time
Correct answer: 3 3. Complete blood cell (CBC) count Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Because anemia and granulocytopenia can occur with this medication, a CBC count will be done periodically. A urea nitrogen level tests kidney function. A magnesium level and calcium level check electrolyte and mineral balance. A sedimentation rate and prothrombin time assessed for the presence of inflammation and coagulation ability.
64. The nurse is preparing to administer a prescribed dose of cyclosporine by intravenous (IV) administration. Which priority item would the nurse have available during administration of this medication? 1. A code cart 2. Oral airway 3. Epinephrine 4. A suction catheter
Correct answer: 3 3. Epinephrine Rationale: Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Because of the risk of anaphylaxis during administration of cyclosporine by the IV route, epinephrine and oxygen must be immediately available for use. An oral airway or a suction machine is not the priority item. A code cart should be available, but it is not the priority item.
77. Zidovudine has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that which is a common side effect of this medication? 1. Lethargy 2. Weakness 3. Headache 4. Constipation
Correct answer: 3 3. Headache Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infection. Common side effects include nausea and headache. Lethargy, weakness, and constipation are not side effects of this medication.
26. Azathioprine is prescribed for a client to suppress rejection of a renal transplant. In planning for administration of the medication, the nurse understands that which description is the mechanism of action of this medication? 1. It crosslinks DNA. 2. It blocks all T cell functions. 3. It inhibits the proliferation of B and T lymphocytes. 4. It decreases the activity of thymus-derived lymphocytes.
Correct answer: 3 3. It inhibits the proliferation of B and T lymphocytes. Rationale: Azathioprine is an immunosuppressant; it suppresses cell-mediated and humoral immune responses by inhibiting the proliferation of B and T lymphocytes. It generally is used as an adjunct to cyclosporine and glucocorticoids to help suppress transplant rejection. The remaining options are incorrect mechanisms of action.
78. A client admitted to the hospital is taking zidovudine. The nurse monitors the client for which adverse effect of the medication? 1. Colitis 2. Ototoxicity 3. Neurotoxicity 4. Visual disturbances
Correct answer: 3 3. Neurotoxicity Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat human immunodeficiency virus (HIV) infections. Adverse effects include anemia, granulocytopenia, and neurotoxicity as evidenced by ataxia, fatigue, lethargy, and nystagmus. Seizures can also occur. Colitis, ototoxicity, and visual disturbances are not adverse effects of this medication.
79. Zidovudine has been prescribed for a client, and the nurse provides instructions to the client about expected effects with this medication. Which statement by the client indicates the need for further instruction? 1. "I need to monitor my temperature." 2. "This medication can cause some nausea." 3. "I will have to have blood tests done periodically." 4. "If I experience diarrhea, I need to contact my health care provider."
Correct answer: 4 4. "If I experience diarrhea, I need to contact my health care provider." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other retroviral agents to treat human immunodeficiency virus (HIV) infection. Diarrhea is an occasional side effect of the medication and does not warrant notification of the health care provider. Monitoring temperature, knowing that nausea can occur, and understanding the need for periodic blood tests reflect an understanding of the medication instructions.
110. A client is receiving tacrolimus to prevent organ rejection. Which is a nursing consideration associated with this medication? 1. Give with cyclosporine. 2. Assess for hypoglycemia. 3. Give with grapefruit juice. 4. Assess platelet count for thrombocytopenia.
Correct answer: 4 4. Assess platelet count for thrombocytopenia. Rationale: Tacrolimus is an immunosuppressant and is an alternative to cyclosporine for prevention of organ rejection in clients receiving an organ transplant. It should never be given with cyclosporine because of its toxic effects on the kidney. This medication will cause hyperglycemia (not hypoglycemia). Grapefruit juice can increase tacrolimus levels, so it should be avoided to prevent toxicity. Tacrolimus suppresses the bone marrow, so it can cause anemia, thrombocytopenia, and neutropenia.
114. Blood work has been drawn on a client who has been taking cyclosporine following allogenic liver transplantation. The nurse should check the results of which test to determine the presence of an adverse effect related to this medication? 1. Hematocrit level 2. Cholesterol level 3. Hemoglobin level 4. Blood urea nitrogen (BUN) level
Correct answer: 4 4. Blood urea nitrogen (BUN) level Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity is one of the most common adverse effects of cyclosporine. Nephrotoxicity is evaluated by monitoring the BUN and creatinine levels. The laboratory tests in the remaining options are unrelated to the adverse effects associated with the administration of this medication.
36. The nurse is monitoring a client with herpes simplex virus (HSV) who is receiving intravenous (IV) acyclovir. Which laboratory result would be of concern as a possible adverse effect of this medication? 1. Platelet count of 300,000 mm3 (300 × 109/L) 2. Prothrombin time of 12 seconds (12 seconds) 3. White blood cell count of 6000 mm3 (6 × 109/L) 4. Blood urea nitrogen (BUN) of 36 mg/dL (12.9 mmol/L)
Correct answer: 4 4. Blood urea nitrogen (BUN) of 36 mg/dL (12.9 mmol/L) Rationale: Acyclovir is an antiviral medication. Although the most common side and adverse reactions with this medication are phlebitis and inflammation at the IV site, reversible nephrotoxicity, evidenced by elevated serum creatinine and BUN levels, can occur in some clients. The cause of nephrotoxicity is deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and the use of other nephrotoxic medications. The laboratory values identified in the remaining options are within normal limits.
112. The nurse is collecting data from a client with a history of renal transplantation. The nurse understands that which medication is the medication of choice for preventing organ rejection? 1. Probenecid 2. Prednisone 3. Indomethacin 4. Cyclosporine
Correct answer: 4 4. Cyclosporine Rationale: Cyclosporine is a powerful immunosuppressant and is the medication of choice for preventing organ rejection following allogenic transplantation. Prednisone is a glucocorticoid and may be administered concurrently with the cyclosporine. Probenecid is a uricosuric agent used to treat hyperuricemia. Indomethacin is a nonsteroidal antiinflammatory agent.
94. A client with a severe allergic reaction is prescribed intravenous corticosteroids. The nurse should expect that which desired effect will be achieved? 1. Pain relief 2. Enhanced immunity 3. Increased serum glucose 4. Decreased inflammation
Correct answer: 4 4. Decreased inflammation Rationale: A corticosteroid acts as an antiinflammatory. Although reduction of inflammation may relieve pain, this is not the indication of the use of corticosteroids in the allergic response. Corticosteroids increase serum glucose, but this is not a therapeutic response. These medications decrease immunity.
109. A client who has undergone renal transplantation is receiving ongoing therapy with cyclosporine. The nurse would be sure to immediately report which abnormal finding? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Decreased white blood cell (WBC) count 4. Elevated blood urea nitrogen (BUN) level
Correct answer: 4 4. Elevated blood urea nitrogen (BUN) level Rationale: Cyclosporine is an immunosuppressant. The use of cyclosporine can cause nephrotoxicity. This complication is detected by assessing for elevated levels of BUN and serum creatinine. Decreased hemoglobin level and WBC count are incorrect because cyclosporine does not depress the bone marrow.
103. The nurse notes that a client is receiving lamivudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV)
Correct answer: 4 4. Human immunodeficiency virus (HIV) Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and provide prophylaxis in health care workers who are at risk of acquiring HIV infection after occupational exposure to the virus. This medication is not used to treat the conditions identified in the remaining options.
41. The nurse is collecting subjective and objective data from a client and notes that the client is taking abacavir. The nurse determines that this medication has been prescribed to treat which condition? 1. Otitis media 2. Heart failure 3. Urinary tract infection 4. Human immunodeficiency virus (HIV) infection
Correct answer: 4 4. Human immunodeficiency virus (HIV) infection Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Abacavir is an antiviral medication and is used to treat HIV infection, in combination with other agents. It is not used to treat the conditions noted in the other options.
71. The nurse is collecting subjective and objective data from a client and notes that the client is taking zidovudine. The nurse determines that this medication has been prescribed to treat which condition? 1. Ulcerative colitis 2. Hyperthyroidism 3. Addison's disease 4. Human immunodeficiency virus (HIV) infection
Correct answer: 4 4. Human immunodeficiency virus (HIV) infection Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It is not used to treat ulcerative colitis, hyperthyroidism, or Addison's disease.
119. The client with acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci infection has been receiving pentamidine. The nurse caring for the client should monitor the client most closely for signs of which adverse effect of the medication? 1. Nausea 2. Fatigue 3. Vomiting 4. Infection
Correct answer: 4 4. Infection Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Pentamidine is an antiinfective medication. Adverse effects of pentamidine include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. The client also should have ongoing monitoring of a number of parameters because of the nature and side effects of the medication, including complete blood cell count; liver function; blood glucose; blood urea nitrogen; and serum creatinine, calcium, and magnesium levels. The items in the remaining options are not associated with an adverse effect of this medication.
66. Abacavir has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond? 1. Promotes viral DNA growth 2. Prevents the production of DNA 3. Splits DNA to prevent its production 4. Inhibits activity of HIV-1 reverse transcriptase
Correct answer: 4 4. Inhibits activity of HIV-1 reverse transcriptase Rationale: Abacavir is an antiretroviral agent that inhibits activity of HIV-1 reverse transcriptase and inhibits viral DNA growth. Abacavir does not promote viral DNA growth or do anything that would prevent the production of DNA.
62. Cyclosporine is prescribed to be administered by the intravenous (IV) route. Which is an inappropriate action in preparing and administering this medication? 1. Mixing the solution and covering it with a paper bag 2. Administering the medication over a period of 2 to 6 hours 3. Mixing 1 mL of concentrate in 50 mL of 0.9% sodium chloride and administering by infusion 4. Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection
Correct answer: 4 4. Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection Rationale: Cyclosporine is an immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. For IV administration of cyclosporine, 1 mL of concentrate is diluted in 20 to 100 mL of 0.9% sodium chloride or 5% dextrose. The solution should be protected from light. The initial dose is 5 to 6 mg/kg (one third of the oral dose) administered over a 2- to 6-hour infusion.
33. The nurse is monitoring a client who is receiving intravenous (IV) acyclovir. The nurse would monitor the client closely for which primary toxic effect of the medication? 1. Ototoxicity 2. Neurotoxicity 3. Cardiotoxicity 4. Nephrotoxicity
Correct answer: 4 4. Nephrotoxicity Rationale: Acyclovir is an antiviral medication. Although the most common side and adverse reactions with this medication are phlebitis and inflammation at the IV site, reversible nephrotoxicity, evidenced by elevated serum creatinine and BUN levels, can occur in some clients. The cause of nephrotoxicity is deposition of acyclovir in the renal tubules. The risk of renal injury is increased by dehydration and the use of other nephrotoxic medications. Ototoxicity, neurotoxicity, and cardiotoxicity are not specific to this medication.
47. A client is receiving ganciclovir. Which nursing action is appropriate during the time the client is receiving this medication? 1. Monitoring blood glucose levels for elevation 2. Administering the medication on an empty stomach only 3. Applying pressure to venipuncture sites for at least 1 minute 4. Providing the client with a soft toothbrush and an electric razor
Correct answer: 4 4. Providing the client with a soft toothbrush and an electric razor Rationale: Ganciclovir is an antiviral medication. Common adverse effects of ganciclovir are neutropenia and thrombocytopenia. For this reason, the nurse implements the same precautions that are used for a client receiving anticoagulant therapy. These include providing a soft toothbrush and an electric razor to minimize risk of trauma that could result in bleeding. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach. Pressure on venipuncture sites should be held for approximately 10 minutes.
72. Zidovudine has been prescribed for a client who asks the nurse about the action of the medication. The nurse responds that this medication performs which function? 1. Increases neutrophils 2. Kills bacteria and fungi 3. Promotes the function of natural killer cells 4. Slows the replication of human immunodeficiency virus (HIV)
Correct answer: 4 4. Slows the replication of human immunodeficiency virus (HIV) Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a nucleoside reverse transcriptase inhibitor that is used in combination with other antiretroviral agents to treat HIV infection. It interferes with viral RNA-dependent DNA polymerase, an enzyme necessary for viral HIV replication. It slows HIV replication, reducing the progression of HIV infection. Zidovudine does not increase neutrophils, kill bacteria and fungi, or promote the function of natural killer cells.
10. The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101°F (38.3°C). The nurse continues to assess the client, knowing that this sign most likely indicates which condition? 1. That the dose of the medication is too low 2. That the client is experiencing toxic effects of the medication 3. That the client has developed inadequacy of thermoregulation 4. That the client has developed another infection caused by leukopenic effects of the medication
Correct answer: 4 4. That the client has developed another infection caused by leukopenic effects of the medication Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Pentamidine is an antimicrobial used to treat PCP. Frequent side and adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. The remaining options are inaccurate interpretations.
1. The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101°F (38.3°C). The nurse continues to assess the client, knowing that this sign most likely indicates which condition? 1. That the dose of the medication is too low 2. That the client is experiencing toxic effects of the medication 3. That the client has developed inadequacy of thermoregulation 4. That the client has developed another infection caused by leukopenic effects of the medication
Correct answer: 4 4. That the client has developed another infection caused by leukopenic effects of the medication Rationale: Frequent adverse effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for
31. A client with acquired immunodeficiency syndrome who is taking zidovudine 200 mg orally 3 times daily has severe neutropenia noted on follow-up laboratory studies. The nurse interprets that which change is likely to occur at this point? 1. The medication dose probably will be reduced. 2. Prednisone probably will be added to the medication regimen. 3. Epoetin alfa probably will be added to the medication regimen. 4. The medication probably will be discontinued until laboratory results indicate bone marrow recovery.
Correct answer: 4 4. The medication probably will be discontinued until laboratory results indicate bone marrow recovery. Rationale: Zidovudine is a nucleoside-nucleotide reverse transcriptase inhibitor. Hematological monitoring should be done every 2 weeks in the client taking zidovudine. If severe anemia or severe neutropenia develops, treatment should be discontinued until evidence of bone marrow recovery is noted. If anemia or neutropenia is mild, a reduction in dosage may be sufficient. The administration of prednisone may further alter the immune function. Epoetin alfa is administered to clients experiencing anemia.
