NUR333 PrepU CH. 17
A nurse is precepting a nursing student, and together they are caring for a patient who is to receive interleukins. The student nurse asks what happens physiologically when a patient receives interleukins. What would be the nurse's best response? "It really helps the patient!" "The patient has increases in the number of natural killer cells." "The patient has decreased cytokine activity." "The patient gets really sick from flu-like symptoms and then they get better."
Correct response: "The patient has increases in the number of natural killer cells." Explanation: When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets.
Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition? Seizure disorder Increased intracranial pressure Autoimmune disorder AIDS
Correct response: Autoimmune disorder Explanation: Some immunosuppressant drugs are used in the treatment of autoimmune disorders like asthma, Crohn's disease, and rheumatoid arthritis.
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? Respiratory distress Mental depression Infection Severe diarrhea
Correct response: Infection Explanation: Azathioprine and other immunosuppressant drugs can increase the risk of infection.
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? Monoclonal antibody Interleukin receptor antagonist T- and B-cell suppressor Interferon
Correct response: Interferon Explanation: Interferons and interleukins are immune stimulants; monoclonal antibodies, interleukin receptor antagonists, and T- and B-cell suppressors are immune suppressants.
Which agent would be classified as an immune stimulant? Interferon alfa-2b Abatacept Mycophenolate Sirolimus
Correct response: Interferon alfa-2b Explanation: Interferon alfa-2b would be classified as an immune stimulant. Abatacept, mycophenolate, and sirolimus are T- and B-cell suppressors that are immune suppressant
A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's best response? It is caused by a variety of reasons. It is caused by inadequate production of WBCs. It is caused by a decrease in the number of RBCs. It is caused by an increase in the number of platelets.
Correct response: It is caused by a decrease in the number of RBCs. Explanation: Anemia is a condition caused by an insufficient amount of hemoglobin delivering oxygen to the tissues. Causes of anemia include a decrease in the number of RBCs, a decrease in the amount of hemoglobin in RBCs, or both. A variety of reasons does not specify the causes of anemia. Anemia is not associated with WBCs or platelets.
A client is prescribed filgrastim. Which is the nurse's <b>best</b> explanation of how this drug works? It inhibits the growth of bacteria in the body. It functions like insulin, lowering the blood sugar. It aids in the development of platelets by the bone marrow. It stimulates growth and production of WBCs to fight off infection.
Correct response: It stimulates growth and production of WBCs to fight off infection. Explanation: Filgrastim is a colony stimulating factor (CSF) that stimulates the growth and production of WBCs to assist the body in fighting off infection. Bacteriostatic medications inhibit the growth of bacteria in the body. Filgrastim does not aid in the development of platelets by the bone marrow.
A client is administered cyclosporine to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine? Congestive heart failure Nephrotoxicity Anaphylaxis Respiratory arrest
Correct response: Nephrotoxicity Explanation: The major adverse effect of cyclosporine is nephrotoxicity. Congestive heart failure is not noted as an adverse effect of cyclosporine. Anaphylaxis and respiratory arrest are not adverse effects of cyclosporine.
A client has been prescribed oral cyclosporine following a successful liver transplant. When providing education, the nurse should advise the client to avoid mixing the drug with what liquid? grapefruit juice milk vegetable juices low-pH beverages
Correct response: grapefruit juice Explanation: Clients should be cautioned against mixing cyclosporine with grapefruit juice because it inhibits metabolism. Dairy, vegetable, and acidic beverages are not necessarily contraindicated.
A client is experiencing flu-like symptoms related to immune stimulant therapy. Which instructions would be most appropriate for the client? "Do not use acetaminophen for your fever or aches." "Keep your environment nice and warm." "You need to try and stay as busy as possible." "Drink plenty of fluids throughout the day."
Correct response: "Drink plenty of fluids throughout the day." Explanation: Supportive care and comfort measures are appropriate, including drinking plenty of fluids, using acetaminophen for fever or aches and pains, maintaining a comfortable environment such as one that is neither too warm nor too cool, and getting plenty of rest.
Which statement indicates that the client understands immunosuppressant therapy following a solid organ transplant? "I know that I will need to stay on this medication for a few months." "I know that I will need to stay on this medication for the rest of my life." "I know that I will need to stay on my medication for at least 1 year." "I do not need to worry about taking any special precautions."
Correct response: "I know that I will need to stay on this medication for the rest of my life." Explanation: Infection is a major cause of morbidity and mortality, especially in patients who are neutropenic or who have had bone marrow or solid organ transplantation. For those with solid organ transplantation, who must continue lifelong immunosuppression to avoid graft rejection, serious infection is a constant hazard. If efforts to prevent infections are unsuccessful, infections may be fatal unless recognized promptly and treated aggressively.
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? "The weekly CBC is routine and prescribed for all clients." "The weekly CBC assesses for the development of bleeding." "The weekly CBC assesses for the development of infection." "The weekly CBC assesses for changes in your blood's oxygen-carrying capacity."
Correct response: "The weekly CBC assesses for the development of infection." Explanation: The weekly CBC is to assess for infection, neutropenia, and thrombocytopenia. Stating to the client that the CBC is routine is a belittling response that does not provide client education. The weekly CBC is not indicated to assess for bleeding or a decrease in erythrocytes.
The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosporine? A client with chronic renal failure who is recovering from a kidney transplant A client who has multiple sclerosis and who has not responded to conservative treatment A client who has undergone treatment for malignant melanoma but who is now palliative A client being treated for active pulmonary tuberculosis
Correct response: A client with chronic renal failure who is recovering from a kidney transplant Explanation: Cyclosporine is a major component of most clients' post-transplant anti-rejection regimens. It is not used in the treatment of multiple sclerosis, malignant melanoma or bacterial infections such as tuberculosis.
A client who must use long-term immunosuppressant agents is at risk for what complications? (Select all that apply.) Lymphoma Hypotension Metabolic bone disease Migraine headaches Liver disease
Correct response: Lymphoma Metabolic bone disease Liver disease Explanation: Clients who use long-term immunosuppressant agents are at risk for malignancies (especially lymphoma), hypertension, metabolic bone disease, and renal and hepatic dysfunction. Migraine headaches are not a complication of long-term immunosuppressant therapy.
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? Nausea and changes in taste Significant weight loss Changes in blood pressure Dry skin
Correct response: Nausea and changes in taste Explanation: The most common adverse effects of interferon alfa-2a are dizziness, confusion, lethargy, flu-like symptoms, anorexia, nausea, and changes in taste. Other adverse effects include hypotension or hypertension, edema, arrhythmias, depression of bone marrow function, increased liver enzymes, rash, dry skin, partial alopecia, and glucose intolerance. Blood pressure changes and dry skin are adverse reactions to the medication but not common. Weight loss is not an adverse reaction of the medication.
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? Place the client in a single, protective isolation room. Arrange for the client to receive a raw-food, organic diet. Wash the client's skin with chlorhexidine twice daily. Have the client wear a gown and gloves when outside the room.
Correct response: Place the client in a single, protective isolation room. Explanation: Clients receiving antirejection therapy are at a greatly heightened risk of infection; protective isolation is warranted. Raw foods are normally contraindicated, and the use of a gown and gloves does not protect the client sufficiently from infectious microorganisms. It is not necessary to perform twice-daily antiseptic washes.
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? Pregnancy status history regarding depression response to a cardiac nonstress test social support network
Correct response: Pregnancy status Explanation: The FDA has issued a black box warning for mycophenolate mofetil regarding the risk of fetal loss and malformations. Women of childbearing age must use contraception, and a negative pregnancy test for such women is required prior to starting therapy. History of depression and the presence of a support network are relevant nursing considerations but neither relates directly to safety. Cardiac testing is not normally required.
The nurse is caring for a child who will be receiving a renal transplant and who has been prescribed cyclosporine. When teaching the parents and child about this drug, the nurse should explain what primary rationale for administering this drug? Prevention of organ rejection Prevention of infection due to immunocompromised status Preservation of remaining renal function Slowing of metabolic processes postoperatively to prevent an immune response
Correct response: Prevention of organ rejection Explanation: Cyclosporine is used to prevent or suppress rejection in a variety of transplant situations, such as renal transplantation. The drug is an immunosuppressant so it would increase the child's risk for infection. The drug has no effect on renal function or metabolic processes.
What disorder of the immune system may affect both the skin and the joints? Rheumatoid arthritis Crohn's disease Psoriasis Graft versus host disease
Correct response: Psoriasis Explanation: Psoriasis is an autoimmune disorder that causes a skin condition and may also cause arthritic changes in the joints, a condition called psoriatic arthritis. Rheumatoid arthritis, Crohn's disease, and graft versus host disease are all autoimmune disorders that do not have both skin and arthritic joint changes.
The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues? WBCs RBCs platelets leukocytes
Correct response: RBCs Explanation: Red blood cells (RBCs) or erythrocytes supply cells with oxygen from the lungs to the tissues. WBCs protect the body from dangerous microorganisms. Platelets are used for clotting. Leukocytes are another name for WBCs.
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? Risk for infection Risk for injury Impaired skin integrity Acute pain
Correct response: Risk for infection Explanation: Although all the nursing diagnoses may be appropriate, the priority would be risk for infection because the client is receiving anakinra, which suppresses the immune system and places the client at higher risk for infection following an invasive procedure.
What is an adverse effect of excessive immunosuppression? Graft-versus-host disease Respiratory depression Graft rejection Serious infection
Correct response: Serious infection Explanation: Excessive immunosuppression significantly increases the risk of serious infection. Graft rejection and graft-versus-host disease result from inadequate immunosuppression.
A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action? Stop the drug immediately. Notify the prescriber that the client is experiencing an adverse effect. Reposition the client Auscultate the client's apical heart rate for 2 minutes.
Correct response: Stop the drug immediately. Explanation: If a client is receiving an immune stimulant and develops a cardiac arrhythmia, the drug must be stopped immediately. The prescriber should be notified promptly, but the nurse should first pause the infusion. Further assessment would be performed alter. Repositioning is an inadequate response.
A client has been discharged from the hospital after a kidney transplant. Which nursing intervention is the first line of defense against the immunosuppressant client developing an infection? Ensure visitors do not come to the home. Teach the client to wear a mask consistently. Administer prophylactic antibiotics. Teach the client the importance of personal hygiene.
Correct response: Teach the client the importance of personal hygiene. Explanation: With clients who are taking immunosuppressant drugs, a major role of the home care nurse is to assess the environment for potential sources of infection, assist clients and other members of the household to understand the client's susceptibility to infection, and teach ways to decrease risks of infection. Meticulous environmental cleansing as well as personal and hand hygiene are required. Visitors do not necessarily need to be wholly barred from the home, and a mask is not always required. Prophylactic antibiotics are not normally used.
A client is receiving immunosuppressant therapy. Which adverse effects should the client be educated about regarding these effects? The importance of a high-protein diet The need to maximize fluid intake The need for regular physical activity The importance of keeping the home clean
Correct response: The importance of keeping the home clean Explanation: Meticulous environmental cleansing and personal and hand hygiene will protect from the development of serious infection. The importance of this infection control measure is greater than that of dietary or exercise guidelines.
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? The patient may have misunderstood the potential benefits of interferon alfa-2a. The patient may be having psychological adverse effects of interferon alfa-2a. The patient is likely to experience a compensatory period of mania in the coming days. The patient is likely becoming aware of psychosocial issues that surround interferon alfa-2a treatment.
Correct response: The patient may be having psychological adverse effects of interferon alfa-2a. Explanation: Depression, anxiety, and suicidal ideation have been reported in a substantial number of patients taking interferon alfa-2a. The possibility of this adverse effect is more likely than other psychosocial factors, given his previous baselines.
What client assessment finding will have the greatest effect on the half-life of methotrexate therapy? history of chronic renal impairment history of peripheral vascular disease the presence of an active infection inadequate fluid intake
Correct response: history of chronic renal impairment Explanation: Excretion of methotrexate is mainly in the urine, so the drug's half-life is prolonged in clients with renal impairment, with risks of accumulation to toxic levels and additional renal damage. Infection and fluid intake must be addressed in the client's plan of care, but neither factor directly increases the half-life of a drug. While a health factor, peripheral vascular disease will have little or no effect of the half-life of methotrexate.
A 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to: nausea. dizziness. respiratory depression. infection.
Correct response: infection. Explanation: Because of the immune system suppression that results from cyclosporin therapy, assessments related to infection are a high priority, superseding the importance of assessments of dizziness, nausea, or respiratory depression.
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: hyperthyroidism. nephrotoxicity. gastritis. cardiac effects.
Correct response: nephrotoxicity. Explanation: Nephrotoxicity is one of the most common and severe adverse effects of cyclosporine. The other common and serious adverse effects are hepatotoxicity, malignancies, and neurotoxicity. Gastritis may also occur but would not be considered as severe an adverse effect as nephrotoxicity. The drug is not associated with hyperthyroidism or cardiac effects.
A client who is recovering from bone marrow transplantation has been prescribed sargramostim 250 mcg/m2 IV daily. The client weighs 66 kg and is 168 cm tall, with a body surface area of 1.76 m2. What dose of sargramostim should the nurse administer?
The dose is calculated by multiplying the client's body surface area and the ordered dose/m2. 1.76 x 250 mcg = 440 mcg.
