CH49: Immune Blockers
A client with severe psoriasis has been precribed apremilast 15 mg PO daily. The medication is available as 30-mg tablets. How many tablets should the nurse administer?
0.5 tabs Explanation: The dose required (15 mg) should be divided by the dose available (30 mg). 15/30 = 0.5 tabs
The nurse educator is teaching students regarding different types of immunostimulant drugs. When discussing lab values associated with the administration of these drugs, which cell counts should the nurse tell the students to expect? Fibrinogen levels and white blood cell count. Bleeding times and low white blood cell count. Low platelet and low white blood cell count. Abnormal partial thromboplastin and white blood cell count.
Low platelet and low white blood cell count. Explanation: Drugs that are used to treat potential bleeding or infection as a result of low platelet or white blood cell count caused by chemotherapy are the focus. Bleeding times, PTT, and fibrinogen are blood test values that help diagnose deficits in clotting, or in the clotting cascade.
A client with severe asthma has been told by the primary care provider that monoclonal antibodies (mABs) will likely be prescribed. The nurse should prepare for what route of administration? Oral Subcutaneous IV by central line Peripheral IV
Subcutaneous Explanation: A large majority of the mABs prescribed for asthma are administered by the subcutaneous route.
An older adult client with vision loss due to macular degeneration has been prescribed afilbercept, a VEGFR antagonist. Which information would be included in the teaching about this medication? 1) "I will help teach you to give yourself subcutaneous injections at home." 2) Your care provider will inject this medication into your eyeball on a scheduled basis." 3)
"Your care provider will inject this medication into your eyeball on a scheduled basis." Explanation: VEGFR antagonists are administered by intravitreal injection, not SC or oral. No particular dietary modifications are indicated.
After two years of waiting, the client is to receive a new kidney. The client asks, "Why do I need to be on immunosuppressant therapy?" What is the best response from the nurse? "Immunosuppressant therapy helps to protect all of your existing organs." "These medications are used to help you fight infection and boost immunity." "This is standard treatment for the immediate postop period." "To reduce the chance of organ rejection by your body."
"To reduce the chance of organ rejection by your body." Explanation: Immunosuppressant therapy after a kidney transplant is a lifetime regimen. The body recognizes transplanted organs and tissues as foreign, and without immunosuppressant therapy the new organ will be attacked as foreign and rejected. This therapy only helps to protect the new organ, not existing organs. Immunosuppressant therapy suppresses the production and activitiy of immune cells, which does not fight infection or boost immunity, but leaves the client susceptible to infection.
After two years of waiting, the client is to receive a new kidney. The client asks, "Why do I need to be on immunosuppressant therapy?" What is the best response from the nurse? "These medications are used to help you fight infection and boost immunity." "To reduce the chance of organ rejection by your body." "Immunosuppressant therapy helps to protect all of your existing organs." "This is standard treatment for the immediate postop period."
"To reduce the chance of organ rejection by your body." Explanation: Immunosuppressant therapy after a kidney transplant is a lifetime regimen. The body recognizes transplanted organs and tissues as foreign, and without immunosuppressant therapy the new organ will be attacked as foreign and rejected. This therapy only helps to protect the new organ, not existing organs. Immunosuppressant therapy suppresses the production and activitiy of immune cells, which does not fight infection or boost immunity, but leaves the client susceptible to infection.
A client has failed to respond to first-line treatments for asthma and has experienced significant declines in respiratory function and quality of life. The nurse should be prepared to discuss which form(s) of immunotherapy for this disease? Select all that apply. Benralizumab Sirolimus Mepolizumab Dupilumab Dimethyl fumarate
Benralizumab Dupilumab Mepolizumab Explanation: Benralizumab, dupilumab, and mepolizumab are among the monoclonal antibodies administered to treat asthma. Dimethyl fumarate is used to treat multiple sclerosis, and sirolimus is an antirejection medication.
After reviewing information about the use of epoetin alfa, the nurse demonstrates understanding of the information by identifying that this drug is contraindicated in clients with which medical conditions? uncontrolled dyslipidemia uncontrolled hypothyroidism uncontrolled diabetes uncontrolled hypertension
uncontrolled hypertension Explanation: The use of epoetin alfa is contraindicated in clients with uncontrolled hypertension. The use of epoetin alfa is not contraindicated in clients with uncontrolled diabetes, uncontrolled hypothyroidism, or uncontrolled dyslipidemia.
Which foods should a nurse encourage for a client diagnosed with megaloblastic anemia? Select all that apply. fish leafy green vegetables citrus fruits nuts whole grains
whole grains leafy green vegetables fish
A client has a low white blood cell count and is concerned about acquiring an infection. The client will not sign the informed consent due to a knowledge deficit about the CSF. How should the nurse respond? "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. These cells are called white blood cells that grow in stages but are not effective until the cell is in the immature stage. A colony-stimulating drug acts on the cell to stimulate growth to the immature white blood cell stage so the cells can help protect you from infection." "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages, but are not effective until the cell is in the adult, mature stage. But a colony-stimulating drug has no affect on white cell stimulation in the body. " "Chemotherapy kills cancer cells but has no effect on white cells that fight infection. A colony-stimulating drug acts on white cells to stimulate growth to the mature adult stage to help protect you from infection." "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage, so that the cells can go to work to help protect you from infection."
"Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage, so that the cells can go to work to help protect you from infection." Explanation: The correct option is the best way for the nurse to respond to the client's concerns about receiving CSF. Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. These cells are called white blood cells that grow in stages, but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage so the cells can help protect the client from infection.
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? "Is there any chance at all that she may be pregnant?" "Has she ever been the recipient of a tissue transplant?" "Do you happen to know her HIV status?" "Has she ever been treated for cancer?"
"Has she ever been the recipient of a tissue transplant?" Explanation: The combination of cyclosporine and mycophenolate suggests that the client may be a transplant recipient. This may or may not have been related to cancer. The client's HIV status and pregnancy status are relevant, but are not directly related to this aspect of the client's drug regimen.
The nurse, as part of the healthcare team, has requested a dietary consult for a client receiving immunosuppresant therapy. The nurse bases the need for the consult on which statement made by the client? "I rarely eat breakfast but I do eat lunch and a large supper with steak, potatoes, and sweet tea." "I usually have toast with jelly, oatmeal, and grapefruit juice for breakfast." "Mostly I eat brunch around 10am with sausage, biscuits and gravy, and coffee." "My main meal is breakfast, so I load up on 2 eggs, pancakes, bacon and a large glass of milk."
"I usually have toast with jelly, oatmeal, and grapefruit juice for breakfast." Explanation: Many immunosuppressant agents interact with grapefruit juice and other citrus. The nurse should consult with a clinicial nutritionist for client instruction and dietary restrictions. Eating a nutritional breakfast is always a good thing, and even though bacon, sausage, and gravy have lots of calories, they do not interfere with immunosuppresant therapy. Skipping breakfast is not a good idea, but this is common behavior for many on the go; eating a later breakfast is also common. Eating a diet high in red meat and carbs with potatoes can have other health risks but does not effect immunosuppresant therapy.
A client began treatment with monoclonal antibodies 10 days ago and has subsequently developed a skin rash. What self-care practice described by the client should the nurse address with further teaching? "I've switched to using a hypoallergenic soap." "It's hard to do, but I avoid rubbing my skin, even when it's itchy." "I've been staying indoors more than usual to prevent sun damage." "I've been taking diphenhydramine with each meal to reduce the inflammation."
"I've been taking diphenhydramine with each meal to reduce the inflammation." Explanation: For many clients, multiple doses of dyphenhydramine are unnecessary and carry a high risk for adverse effects. Avoiding sun and rubbing the skin as well as using mild soaps are recommended health behaviors.
The home health nurse is caring for an older adult with rheumatoid arthritis (RA). The healthcare provider has ordered sarulimab for treatment. The client asks about the dosage and frequency associated with this drug. What is the nurse's response? "You can take 2 mg of this medication daily by mouth." "The medication is based on 4 mg per kilogram IV every 4 weeks." "It is given as one gram intravenously every two weeks." "Dosage will be 200 mg subcutaneously every two weeks."
"It is given as one gram intravenously every two weeks." Correct response: "Dosage will be 200 mg subcutaneously every two weeks." Explanation: Sarulimab is ordered as 200 mg subc every 2 weeks, whereas the dosage and frequency of all of the other meds used to treat RA are different. For example, rituximab is given as 1g IV every 2 weeks, baricitinib is given 2 mg orally daily, and toclizumab is given as 4 mg/kg IV every 4 weeks.
A client with severe rheumatoid arthritis is scheduled to begin treatment with monoclonal antibodies (mABs). What information should the nurse provide to the client? "Your arthritis symptoms will likely be worse for 24-48 hours before getting better." "You'll be asked to take nothing by mouth in the three hours before your first dose." "It's likely that you'll feel flu-like symptoms after receiving the medication." "You'll likely experience a reduction in urine output the day after the medication."
"It's likely that you'll feel flu-like symptoms after receiving the medication." Explanation: mABs often cause flu-like symptoms, and the client should be made aware of this possibility. Transient decrease in urine output is atypical, as is an exacerbation of symptoms. There is no reason for a client to be NPO prior to receiving mABs.
The client is receiving immunosuppressant therapy with a calcineurin inhibitor and states, "My gums seems to be swelling, they feel terrible." What is the best response from the nurse? "I can notify your healthcare provider for new orders to help with these symptoms." "The swelling of your gums may be an adverse reaction of your medication." "With this type of therapy, you are more susceptible to the bleeding gums." "We will need to discontinue your treatment until you no longer have these symptoms."
"The swelling of your gums may be an adverse reaction of your medication." Explanation: The best response is that the symptoms the client is experiencing are due to the immunosuppressant therapy of the calcineurin inhibitor medication, as gum hyperplasia is an adverse effect of its use. Immunosuppressant therapy does not have the adverse effect of bleeding gums per se, which is more likely seen with anticoagulant therapy or gingivitis. There would be a need to notify the provider about the adverse effects so the medication dose may be changed or modified, but it is unlikely the provider would order additional medication for swollen gums. The adverse effect of gum hyperplasia with the treatment of calcineurin inhibitor therapy may be discontinued but not likely restarted when the symptoms are gone.
A client with multiple sclerosis has been prescribed an immunosuppressant and asks the nurse, "Won't I get infections if my immune system is suppressed by this medication?" What is the nurse's most appropriate response? "Remember that immunosuppressants have the potential to relieve many of your most distressing symptoms." "These medications affect a different part of your immune system than the one that usually fights infection." "These medications can make you more vulnerable to infection, so we'll monitor your health closely." "Antibiotics will be readily available if you develop an infection."
"These medications can make you more vulnerable to infection, so we'll monitor your health closely." Explanation: Immunosuppressants indeed carry a risk for infection due to their effect on the immune system. They do not affect a "different part" of the immune system. Antibiotics are available, but this does not address the client's stated concern. Similarly, focusing solely on the benefits does not address the client's concern about developing an infection.
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? "They normalize RBCs manufacture." "They are involved in a variety of disease-related regulations." "They aid in the growth of WBCs." "They regulate the production of erythrocytes."
"They regulate the production of erythrocytes." Explanation: Erythropoiesis-stimulating agents are glycoproteins that stimulate and regulate the production of erythrocytes. The client is wrong if they state "they aid in the growth of WBCs" or "normalize RBC manufacture." The client is not addressing how the erythropoiesis-stimulating agents work by stating "they are involved in a variety of disease-related regulation."
A client with cirrhosis has recently been added to the liver transplant list, and the nurse is providing anticipatory guidance about the transplant procedure and follow-up. When teaching the client about the need for antirejection drugs after the surgery, which instructions would the nurse give to the client? "Most clients need these medications for 6 to 12 months, until the body accepts the foreign tissue." "You'll take these medications for as long as you remain in the hospital post-op." "You'll need to take these medications long term." "Your transplant surgeon will explore tapering off these drugs at your first follow-up assessment."
"You'll need to take these medications long term." Explanation: Because the body recognizes organ transplants as foreign, antirejection drugs must be taken long term. Clients are normally unable to taper off them, and stopping them at the time of discharge would trigger organ rejection.
The nurse is preparing to administer the first dose of a client's newly prescribed monoclonal antibody. What characteristic of the medication should the nurse recognize as increasing the client's risk for a hypersensitive infusion reaction? The medication will be administered into a central venous catheter. The client's blood type is O. The client has a comorbid diagnosis of asthma. The medication is derived from mouse tissue.
The medication is derived from mouse tissue. Explanation: Mouse-derived monoclonal antibodies carry a significantly higher risk for an infusion reaction. The use of a CVC, the presence of asthma, and type-O blood do not constitute known risks for infusion reactions.
The client is newly diagnosed with systemic lupus erythematosus (SLE). The client asks the nurse, "What does it mean to have an autoimmune disease?" What is the most appropriate response by the nurse? "This disease can be treated by boosting your immune system." "You have been exposed to some type of external allergen that has caused your disease." "Your disease is entirely hereditary so you may need genetic counseling." "Your body has antibodies that mistake your own tissue as foreign and attacks it."
"Your body has antibodies that mistake your own tissue as foreign and attacks it." Explanation: Autoimmune diseases such as SLE and MS cause the immune system to attack the body's own tissue. Immunosuppressant drugs are used to treat these diseases to weaken the immune system, not boost the immune system, thus suppressing the self-attack reaction. SLE is not caused by an external allergen and is not entirely hereditary. Some people with no family history of the disease develop SLE.
The client is newly diagnosed with systemic lupus erythematosus (SLE). The client asks the nurse, "What does it mean to have an autoimmune disease?" What is the most appropriate response by the nurse? "Your body has antibodies that mistake your own tissue as foreign and attacks it." "This disease can be treated by boosting your immune system." "Your disease is entirely hereditary so you may need genetic counseling." "You have been exposed to some type of external allergen that has caused your disease."
"Your body has antibodies that mistake your own tissue as foreign and attacks it." Explanation: Autoimmune diseases such as SLE and MS cause the immune system to attack the body's own tissue. Immunosuppressant drugs are used to treat these diseases to weaken the immune system, not boost the immune system, thus suppressing the self-attack reaction. SLE is not caused by an external allergen and is not entirely hereditary. Some people with no family history of the disease develop SLE.
A teenage client presents to the clinic for treatment after laboratory and initial testing revealed a diagnosis of idiopathic juvenile arthritis. Client weight is 99 pounds. The health care provider orders tocilizumab 4mg/kg IV over one hour. The medication was diluted in 100 mL of 0.9% NS by the pharmacy. At what rate will the nurse administer the medication on the IV pump?
100 The client weighs 99 pounds. This weight must be converted to kg by dividing by 2.2. 99 / 2.2 = 45 kg. The kg weight must then be multiipled by the dosage ordered. 45 kg x 4 mg = 180 mg. This amount of medication was added to the prescribed volume of IV fluid by the pharmacy. The pump will be set to deliver the 100 mL of fluid over 1 hour by setting the pump at 100 mL/hr.
A client with severe asthma has been prescribed reslizumab 3 mg/kg IV, to be administered every three weeks on an outpatient basis. The client's current weight is 110 lbs. The nurse should prepare what dose? Provide your answer to the nearest mg.
150mg
A teenage client with juvenile arthritis has been prescribed tocilizumab 4 mg/kg IV every four weeks. The client weighs 51.5 kg. The nurse should anticipate that the pharmacy will supply what dose? Provide your answer to the nearest mg.
206 Explanation: The client's prescribed dose of 4 mg/kg must be multiplied by the client's weight: 4 mg/kg x 51.5 kg = 206 mg.
A client with severe asthma is not experiencing symptom relief with their current medication regimen, so the primary care provider has prescribed reslizumab 3 mg/kg IV, to be administered every 4 weeks. The nurse has assessed the client and obtained a weight of 154 lbs. The nurse should confirm what dose when the medication comes from the pharmacy? Record your answer in mg.
210 Explanation: The client's weight must first be converted to kg, by dividing the weight in pounds by 2.2. This reveals of weight of 70 kg. The dose prescribed should be multiplied by the weight in kg: 70 kg X 3 mg/kg = 210 mg.
A client weighing 165 pounds has a history of rheumatoid arthritis and has been taking methotrexate, and is now newly diagnosed with ulcerative colitis. The health care provider has ordered infliximab 3 mg/kg IV to be given weekly. How many milligrams will the nurse administer?
225 Explanation: The client weighs 165 pounds. This must be converted to kilograms by dividing by 2.2. 165 / 2.2 = 75 kg. Then multiply the kilograms by the dosage ordered. 75 kg x 3 mg = 225 mg.
Administration of an immunosuppressant would be the highest priority for which client? A client experiencing an adverse reaction to a blood transfusion A client who has recently undergone a kidney transplant A client with late stage renal cancer with metastases A client whose multiple sclerosis has not responded to conservative treatment
A client who has recently undergone a kidney transplant Explanation: Immunosuppressants (antirejection drugs) are critical to the success of solid organ transplants. They do not normally treat diagnoses such as cancer or transfusion reactions. Some clients with MS are treated with immunosuppressants but the priority would be higher for a client undergoing a transplant, since rejection is certain without antirejection medications.
A client with multiple sclerosis is experiencing good symptom relief following weekly treatments with a monoclonal antibody (mAB). However, each dose has precipitated a mild hypersensitive infusion reaction. What intervention(s) should the nurse perform to reduce the effects of this reaction? Select all that apply. Change from parenteral to oral administration. Keep the client warm and comfortable during and after administration. Administer diphenhydramine before administration as prescribed. Administer acetaminophen before administration as prescribed. Administer the medication as slowly as permissible.
Administer acetaminophen before administration as prescribed. Administer diphenhydramine before administration as prescribed. Keep the client warm and comfortable during and after administration. Administer the medication as slowly as permissible. Explanation: Hypersensitivity reactions can be lessened by preadministration of acetaminophen and diphenhydramine as well as keeping the client warm and comfortable after administration. Most mABs are only available for parenteral administration. Altering the infusion time often reduces the chance of a reaction.
The nurse is infusing a monoclonal anitbody to a client diagnosed with multiple sclerosis. The nurse determines the client is experiencing a hypersensitivity reaction and notifies the healthcare provider. The infusion is stopped. Which intervention(s) will the nurse then anticipate? Select all that apply. Administer diphenhydramine. Administer acetylcysteine. Infuse a bolus of normal saline. Administer corticosteroids. Administer nebulized bronchodilators.
Administer diphenhydramine. Administer corticosteroids. Explanation: A hypersensitivity reaction may necessitate diphenhydramine or corticosteroids to speed resolution. Acetylcysteine and boluses of IV fluids do not counter the effects of monoclonal antibodies. Respiratory distress, if present, would not normally be treated with inhaled bronchodilators.
An adult client with severe asthma will begin treatment with an immunosuppressant. What teaching plan should the nurse provide to the client? Take over-the-counter iron supplements throughout treatment. Avoid grapefruit juice unless told otherwise. Maximize soluble and insoluble fiber intake. Limit intake of leafy, green vegetables.
Avoid grapefruit juice unless told otherwise. Explanation: Many of the immunosuppressant agents interact with grapefruit juice and other citrus; these should be avoided unless the primary care provider or nutritionist specifies otherwise. Nausea and diarrhea are the more common forms of GI effects, so fiber intake is lower priority. There is no particular reason to avoid leafy, green vegetables or to take iron supplements, unless directed by the primary care provider.
A client is at an acute risk for organ rejection following a liver transplant and has been prescribed high doses of calcineurin inhibitors. Which laboratory value may indicate a potential adverse effect? C-reactive protein Calcium Blood urea nitrogen (BUN) D-dimer
Blood urea nitrogen (BUN) Explanation: Calcineuirin inhibitors are nephrotoxic so the nurse should monitor the client's BUN closely. This risk exceeds those of thrombotic events, hypo/hypercalcemia, and inflammation, so D-dimer, calcium levels, and C-reactive protein would be lower priorities.
A client with multiple sclerosis is scheduled to begin treatment with a monoclonal antibody. What guidance should the nurse provide the client? The dose will be titrated to eliminate adverse effects. Alopecia is likely in the early weeks of treatment. Expect to experience some flu-like symptoms. An antidote must readily available at all times during initiation of treatment.
Expect to experience some flu-like symptoms. Explanation: Flu-llike symptoms are expected when monoclonal antibodies are first administered due to the response to treatment. In general, doses are not titrated with the goal of eliminating adverse effects, since this would compromise their efficacy. Specific antidotes are not normally available. Monoclonal antibodies can cause altered skin integrity, but alopecia is atypical.
A client comes to the clinic asking what hematopoiesis means. How should the nurse explain this to the client? 1) Hematopoiesis means undifferentiated stem cells are not stimulated to become specific blood cells. 2) Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells. 3) Hematopoiesis means undifferentiated stem cells are not stimulated to become specific blood cells. 4) Hematopoiesis means differentiated stem cells are stimulated to become specific blood cells.
Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells. Explanation: Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells. Not stimulating the cell, stimulating undifferentiated cells, and stimulating the production of nonspecific blood cells would not produce a therapeutic effect.
A nurse educator is teaching nursing students about the administration colony-stimulating factors. Teaching is effective when the students identify the need to assess for which adverse reaction related to this drug? Yeast infections Fungal infections Hypertension Fluid retention
Hypertension Explanation: Expected adverse reactions of colony-stimulating factors are bone pain, nausea and vomiting, alopecia, and hypertension. Fluid retention and peripheral edema, yeast infections, and fungal infections are not expected. Reference:
The nurse is assessing a client with severe rheumatoid arthritis who began treatment with monoclonal antibodies 72 hours ago. The nurse should prioritize assessments related to what potential nursing diagnosis? Disturbed body image Decreased cardiac output Impaired comfort Constipation
Impaired comfort Explanation: Clients being treated with immunosuppressants frequently experience impaired comfort related to the flu-like symptoms that result from stimulation of the immune system. Altered skin integrity is also possible, but this rarely exists to the extent that body image is affected. In most cases, cardiac output is unaffected. Diarrhea is a more likely GI effect than constipation.
The nurse is providing care for an inpatient whose medication regimen includes cyclosporine. The nurse should prioritize what aspect of care? Encouraging the client to consider an advance directive Encouraging fluid intake of at least 2 L per day Monitoring the client for indications of suicidality Implementing infection control principles
Implementing infection control principles Explanation: Antirejection drugs like cyclosporine carry a risk for infection because the client's immune response is blunted. For this reason, there is a heightened need for infection control. This does not necessarily mean the client needs an advance directive, however, and there is no increased need to scree
A student nurse is preparing to administer an oral iron supplement to a client diagnosed with iron deficiency anemia. The supervising nurse should question the student regarding which interaction caused when iron and antibiotics are used together for treatment? Iron causes a decreased vascular absorption of the antibiotic. Iron has no known interaction with antibiotic administration. Iron causes a decreased gastrointestinal absorption of the antibiotic. Iron causes an increased gastrointestinal absorption of the antibiotic.
Iron causes a decreased gastrointestinal absorption of the antibiotic. Explanation: A known interaction is that iron causes a decreased, not an increased, gastrointestinal absorption of the antibiotic. Iron has no effect on vascular absorption.
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 has a narrow therapeutic range. It can precipitate a thyroid storm. It decreases erythropoiesis. It has been linked to spontaneous hemolysis.
It has a narrow therapeutic range. Explanation: Cyclosporine has a very narrow therapeutic index; therefore, prescribers use serum drug levels to regulate cyclosporine dosing, and close monitoring is necessary. Cyclosporine does not have a significant bearing on RBC production and has not been closely linked to thyroid function of hemolysis.
A client is being treated with a monoclonal antibody whose name ends with the suffix -momab. The nurse recognizes what characteristic of this medication? It is derived from mouse tissue. It is water-soluble. It is a schedule 2 medication. It is a schedule 3 medication.
It is derived from mouse tissue. Explanation: Drugs ending in -momab are derived from mice and have the highest risk for hypersensitive reactions. This suffix does not denote the drug schedule or if the drug is water-soluble.
The nurse is teaching a client about megaloblastic anemia. What information would the nurse include in the teaching plan? Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency. Megaloblastic anemia is characterized by small immature erythrocytes, due to folic acid deficiency. Megaloblastic anemia is characterized by large immature erythrocytes, due to amino acid deficiency. Megaloblastic anemia is characterized by large mature erythrocytes, due to lactic acid deficiency.
Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency. Explanation: Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency. Small immature erythrocytes, amino acids, and lactic acid do not cause megaloblastic anemia.
A hospitalized client has just begun a regimen of cyclosporine and tacrolimus. What is the nurse's most appropriate action? Educate the client about subcutaneous self-administration. Assess for improved respiratory function. Monitor the client for signs of organ rejection. Assess the client for improved stamina and gait.
Monitor the client for signs of organ rejection. Explanation: Cyclosporine and tacrolimus are antirejection medications administered to prevent rejection of solid organ transplants. As such, respiratory status and gait are not central focuses for assessment. These medications are not administered by SC self-administration.
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? Question the care provider about the concurrent use of a beta-blocker with interferon alfa-2b. Monitor the client's response to the medication and assess for adverse effects. Monitor for orthostatic hypotension and assess postural blood pressure once per shift. Assess the client daily for signs and symptoms of hypothyroidism
Monitor the client's response to the medication and assess for adverse effects. Explanation: There are no reported drug-drug interactions with the interferons, so there is no need to question the use of a beta-blocker. As well, there is no reason to believe that the client has an increased risk for orthostatic hypotension or that levothyroxine would cease being effective. The nurse should monitor the client's response to the medication and assess for known adverse effects.
The client has been on monoclonal antibiotic therapy. During treatment, the client reports headache and the nurse notes chills are also present. What should be the nurse's next step? Maintain strict bed rest. Encourage cold water and beverages. Provide a warm blanket. Administer an antipyretic.
Provide a warm blanket. Explanation: Promoting optimal comfort is paramount in this type of therapy. Providing a warm blanket helps to promote comfort. An antipyretic will not be given unless there is evidence of a fever and none is noted in this question. If GI upset occurs, warm liquids may be provided. Clients do not need to be maintained on strict bed rest for this therapy.
The nurse is providing care for a client whose current medication regimen includes tacrolimus and cyclosporine. The client's health history most likely includes which of the following? Renal transplant Multiple sclerosis Psoriasis Rheumatoid arthritis
Renal transplant Explanation: Cyclosporine and tacrolimus are antirejection medications administered to prevent acute organ rejection following renal or liver transplant. These medications do not relieve the symptoms of psoriasis, arthritis, or multiple sclerosis.
A client with severe rheumatoid arthritis who lives independently has been prescribed a monoclonal antibody, adalimumab, 40 mg SC every other week. What should be the nurse's focus for client education? Appropriate use of IV prednisolone to prevent flu-like symptoms Dietary modifications to prevent constipation Dietary modifications to prevent flu-like symptoms Safe and effective technique for self-administration
Safe and effective technique for self-administration Explanation: While there is a possibliity for flu-like symptoms post-administration, these are not normally prevented by IV corticosteroids or by dietary modifications. Constipation is an atypical adverse effect. For clients living in the community, there is a strong possibility of self-administration.
The nurse is administering a dose of alemtuzumab 12 mg IV to a client with multiple sclerosis. The client has begun to exhibit signs of a hypersensitivity reaction. What is the nurse's priority action? Administer a corticosteroid as ordered. Administer diphenhydramine as ordered. Stop the infusion. Move the client to a high-Fowler position.
Stop the infusion. Explanation: In cases of hypersensitivity reaction, the immediate priority is to stop the administration of the medication. Once this is done, steroids and//or diphenhydramine may be administered. There is no immediate benefit to high-Fowler positioning.
The client with ulcerative colitis is being given a monoclonal antibody IV infusion slowly, and the nurse detects a hypersensitivity reaction. Place in order from highest to lowest, the nurse's actions that must be taken for the care of this client. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down Admin IV steroid and/or diphenhydramine stop infusion instruct client that reactions decrease with ongoing therapy notify the healthcare provider
Stop the infusion. Administer IV steroids and/or diphenhydramine. Instruct the client that reactions decrease with ongoing therapy. Notify the healthcare provider.
A child will soon be starting kindergarten and is scheduled to receive the MMRV (measles, mumps, rubella, varicella) vaccine. Which information from the client's history would hinder the safe use of the vaccine? The child is taking monoclonal antibodies for severe asthma. The child's weight and height are both below the tenth percentile for age. The child's parent is immunocompromised. The child experienced anaphylaxis after being treated with penicillin one year ago.
The child is taking monoclonal antibodies for severe asthma. Explanation: Live vaccines, such as MMRV, cannot be administered to clients on monoclonal antibodies, due to their compromised immune response. The parent's immune status will not normally impact the child's vaccine schedule, nor do penicillin allergies, or delayed growth and development.
A client with iron deficiency is prescribed parenteral iron dextran. Based on the nurse's understanding of this drug, the nurse would expect to administer a test dose to reduce the risk for what adverse effect? black stool muscle soreness anaphylaxis constipation
anaphylaxis Explanation: Parenteral iron dextran can result in fatal anaphylactic-type reactions. For this reason, a test dose is given to allow observation of the client and to confirm that it is safe to administer the prescribed dose. Muscle soreness is a potential adverse effect of parenteral iron, but that effect is not serious to warrant a test dose. Black stool and constipation are potential effects of oral administration of iron, and neither is as serious as anaphylaxis.
