Chapter 17 Immune Modulators PrepU
A home care nurse is caring for a client who has received a liver transplant. The nurse is reinforcing earlier teaching about the client's immunosuppressant therapy and the need for appropriate self-care. Which client statement suggests that the client understands?
"I will always be at risk for serious infection."
A nurse is teaching about filgrastim to a client. During the teach-back session, which statement by the client indicates a need for additional teaching?
"I will take this medication until it is all gone."
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 regulate the production of erythrocytes."
Which are the LEAST serious adverse effects associated with the use of monoclonal antibodies? Select all that apply.
-Fever -Malaise -Diarrhea
Pts who are receiving an immune stimulant may experience any of the clinical signs of immune response activity, including: A) Flu-like symptoms B) Diarrhea C) Constipation D) HA
A
What monoclonal antibody is used to prevent respiratory syncytial virus (RSV) in high risk children? A) Palivizumab B) Natalizumab C) Belimumab D) Eculizumab
A
A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for treatment. What will be important to discuss with the patient when the nurse provides patient teaching about her treatment? A) The need to continue oral contraceptives B) The need to use barrier contraceptives while taking the drug C) The need to avoid sexual intercourse while taking the drug D) The importance of taking an aspirin daily to decrease the adverse effects of the drug
B
A veteran nurse is teaching a new nurse how to administer colony-stimulating factors. It is important to include which adverse reactions in the lesson plan?
Bone pain, nausea and vomiting, alopecia, and hypertension
A client underwent a solid organ transplant several years ago and has remained largely symptom free. The nurse should educate the client on long-term immunosuppressant therapy of what increased risk? A. type 2 diabetes B. renal failure C. heart disease D. cancer
Cancer
The nurse is caring for a female patient, aged 62, who has been admitted for treatment of metastatic melanoma. What agent would the nurse anticipate the physician is likely to order? A) Aldesleukin B) Interferon alfa 2b C) Cyclosporine D) Ipilimumab
D
If a client who is prescribed tacrolimus has impaired liver function, what would the nurse expect the health care provider to do?
Decrease the dose
What would lead the nurse to suspect that a client receiving a monoclonal antibody is experiencing pulmonary edema?
Dyspnea
Which of the following would lead the nurse to suspect that a client receiving a monoclonal antibody is experiencing pulmonary edema?
Dyspnea
A client with renal cancer is prescribed aldesleukin. What action should then nurse perform?
Ensure the client has adequate intravenous access
Which monoclonal antibody would the nurse expect to administer orally?
Erlotinib
Abatacept is classified as an interleukin receptor antagonist.
False
Interleukins act to prevent virus particles from replicating inside the cells.
False
Most of the drugs that affect the immune system are highly recommended for use in children.
False
The nurse monitors the patient receiving Eculizumab for what serious potential adverse effects?
Hemolysis
A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's best response?
It is caused by a decrease in the number of RBCs.
What assessment should the nurse perform when monitoring for the most serious adverse effects that can occur with the use of monoclonal antibodies?
Lung auscultation
To help understand immunostimulant drug therapy, the client has come to the clinic for a class on thrombopoiesis. The nurse explains that the term means the formation of which types of blood cells? A. Red cells B. White cells C. C-reactive protein D. Platelets
Platelets
What is an adverse effect of excessive immunosuppression?
Serious infection
A female client is prescribed cyclosporine after her bone marrow transplant. What is the mechanism of action of cyclosporine that makes this an ideal drug for this patient?
Suppression of the normal effects of the immune system in the body
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. (T/F)
TRUE
Interferons and interleukins demonstrate no drug-drug interactions.
True
The health care provider is planning to prescribe mycophenolate mofetil for a 28-year-old woman. The nurse understands that before receiving this prescription, the client is required to have:
a negative pregnancy test.
A nurse is teaching a client about immunosuppressants. Which common adverse reactions of immunosuppressants should be included in the teaching? (Select all that apply.)
chills fever headache
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 cyclosporine:
has a narrow therapeutic range.
A client develops neutropenia secondary to chemotherapy. The nurse would identify that this client is at risk for which complication?
infection
A 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to:
infection.
Which laboratory values should a nurse monitor for a client prescribed oprelvekin?
plts
Which intervention regarding the oral administration of mycophenolate should the nurse encourage the client to implement to minimize the risk of undesired effects?
taking the pills on an empty stomach
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?
the fact that the client is not pregnant
A client is receiving immunosuppressant therapy. Which adverse effects should the client be educated about regarding these effects?
the importance of keeping the home clean
A 72-year-old client has been diagnosed with iron deficiency anemia. The client comes to the clinic for the nurse to teach the recommended way to take the iron supplement. Which of the following information would the nurse include in the client's teaching plan?
"Take this drug with water on an empty stomach."
The nurse is administering colony-stimulating factors to an older adult client after chemotherapy. The nurse should explain to the client that this medication is being administered for which reason?
"Your body is going to have trouble fighting off infections on it's own. This medication will help with that."
A client with colorectal cancer has been prescribed bevacizumab. The client is relieved that he will only have to receive a dose of the medication every two weeks, but is skeptical that it will be effective if given so infrequently. What characteristics of the medication should the nurse explain? Select all that apply. A. The long duration of action B. The long half life C. The delayed peak D. The severe adverse effects E. The rapid onset
-the delayed peak -the long half life -the long duration of action
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?
440
A 72-year-old male patient has arrived at the outpatient unit to receive an infusion of alemtuzumab (Compath). The patient tells the nurse this is the second time his chronic lymphocytic leukemia has relapsed and the second time he will receive this drug because he failed alemtuzumab therapy after being treated with an alkylating agent. What is the priority nursing action? A) Calling the physician and questioning the order B) Washing your hands C) Beginning an intravenous infusion D) Canceling the infusion
A
A pt with renal cancer is prescribed Aldesleukin. What action should the nurse perform? A) Ensure the pt has adequate intravenous access B) Ensure that the pt is able to adhere to the prescribed treatment C) Assess whether the pt can sit upright after taking oral medications D) Assess the integrity of the pt's oral mucosa
A
The nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant. What immunosuppressant could this patient be prescribed that would treat both diagnoses? A) Anakinra (Kineret) B) Adalimumab (Humira) C) Sirolimus (Rapamune) D) Cyclosporine (Sandimmune)
A
When describing the action of Trastuzumab, what should the nurse include? A) Reaction with human epidermal growth factor receptor 2 B) Prevention of the formation of the immune complex C) Interaction with human T cells to disable them D) Interference with free floating tumor necrosis factor
A
The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosprorine?
A client with chronic renal failure who is recovering from a kidney transplant
When caring for older adults receiving immune modulators, what are the nurse's priorities of care? (Select all that apply.) A) Assess carefully for infection. B) Obtain baseline liver function studies and monitor follow-up studies. C) Determine dosage based on renal and liver function. D) Minimize teaching to avoid causing confusion. E) Encourage the family to visit often, especially young children.
A,B,C
A client is scheduled for renal transplantation. At what point in the client's care should the first dose of sirolimus (Rapamune) be given? A. As soon as transplant rejection has been ruled out B. Seven to ten days before the transplant C. Within 48 hours of the transplant D. As soon as possible after the transplant
As soon as possible after the transplant
The nurse administers Belimumab. What priority intervention should the nurse perform to avoid a risk associated with this drug? A) Monitor liver function studies closely B) Premedicate for hypersensitivity C) Encourage fluid intake D) Perform cardiac monitoring during administration
B
The nurse admits a patient who was newly diagnosed with Kaposi's sarcoma to the unit. The physician has ordered an IV infusion of an interferon. What drug would be appropriate? A) Interferon beta1a B) Interferon gamma 1b C) Interferon alfa 2b D) Peginterferon alfa 2b
C
You might us a monoclonal antibody in treating: A) Warts B) Herpes zoster C) Tumors that overexposes HER2 D) Kaposi sarcoma
C
A patient is receiving omalizumab (Xolair) to treat allergic asthma, which is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab?
Have epinephrine available
A client is receiving omalizumab to treat allergic asthma, which is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab?
Have epinephrine available during administration.
A client comes to the clinic asking what hematopoiesis means. How should the nurse explain this to the client?
Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells
Which of the following statements indicates that your client understands immunosuppressant therapy following a solid organ transplant?
I know that I will need to stay on this medication for the rest of my life.
A nurse is caring for a client following an organ transplant procedure. The client reports that oral cyclosporine tastes awful and that the client is unable to swallow it. The nurse tells the client that it is possible to make the medication more palatable by mixing it with: A. grapefruit juice. B. oatmeal. C. orange juice. D. ice cream.
Orange juice
Which is the most likely indication for the use of immunosuppressant agents? A. intractable seizure disorders B. organ transplantation C. increased intracranial pressure D. HIV/AIDS with multiple drug resistance
Organ transplantation
When describing the action of trastuzumab, what should the nurse include?
Reaction with human epidermal growth factor receptor 2
A client is receiving mycophenolate after undergoing a liver transplant. Which of the following would be a priority nursing diagnosis?
Risk for infection
A patient is receiving immunosuppressant therapy. Which adverse effects should the patient be educated about regarding these effects?
Serious infection
A patient is receiving immunosuppressant therapy. Which of the following adverse effects should the patient be educated regarding these effects?
Serious infection
The nurse closely monitors a client who is receiving anakinra and etanercept for:
Severe infection
A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action?
Stop the drug immediately.
The pharmacology instructor is explaining interleukins to the class. What would be the best definition of interleukins?
They are chemicals used to communicate between leukocytes and stimulate immunity.
A nurse is reviewing laboratory values of a client who has a urinary tract infection. Which cells protect the body from microorganisms?
WBCs
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:
nephrotoxicity.
A client is to receive erlotinib. The nurse would expect to administer this drug by which route?
oral
A nurse is caring for a client following an organ transplant procedure. The client reports that oral cyclosporine tastes awful and that the client is unable to swallow it. The nurse tells the client that it is possible to make the medication more palatable by mixing it with:
orange juice.
You are caring for a client following his organ transplant procedure. He complains that oral cyclosporine tastes awful and that he is unable to swallow it. You tell the client that he can make his medication more palatable by mixing it with
orange juice.
Which is the most likely indication for the use of immunosuppressant agents?
organ transplantation
A nurse is reviewing the laboratory values of a client admitted for gastrointestinal bleed. Which cells control bleeding?
platelets
What pt would be most likely to benefit from the administration of an immune suppressant? A) An older adult pt whose rheumatoid arthritis has not responded to conventional treatment B) A pt who has had a bone marrow transplant performed C) A pt who has developed Kaposi's sarcoma secondary to AIDs D) A pt who is being treated in the hospital for acute myeloid leukemia
A
The nurse is preparing a patient to receive immunosuppressant drugs on an outpatient basis. What is the priority for the nurse to arrange for this patient in the home environment? A) A caregiver who is skilled in cardiopulmonary resuscitation (CPR) B) A caregiver who will provide adequate nutrition C) Supportive care and comfort measures D) Arrange for a home care nurse to administer injections
C
A patient has been recovering in the transplant unit for several days following a successful heart-lung transplant. The patient has begun taking cyclosporine and the nurse has made necessary changes to the patient's nursing care plan. What nursing diagnosis is most relevant to this patient's current medication regimen?
Altered Tissue Perfusion related to hypertension
The nurse would expect to administer interferon alfa-n3 as the drug of choice for: A) Treatment of leukemias B) Treatment of multiple sclerosis C) Intralesional treatment of warts D) Treatment of Kaposi sarcoma
C
The nurse administered oprelvekin to a client diagnosed with a chemotherapy-induced bleeding disorder. The nurse plans to teach the client the expected adverse reactions to watch for and report. The nurse will include which reactions in the client teaching session?
Fluid retention
Which adverse reactions should the nurse discuss with a client prior to the administration of oprelvekin (Neumega)? (Select all that apply.)
Fluid retention Syncope Fever
What common adverse reactions of tacrolimus should the nurse teach the client? (Select all that apply.)
-tremors -hair growth -gum hyperplasia
A client is prescribed filgrastim. Which is the nurse's best explanation of how this drug works?
It stimulates growth and production of WBCs to fight off infection.
The nurse educator is teaching an online pharmacology class. The topic of the online seminar is the contraindications for the use of colony stimulation factor. The nurse includes which contraindication?
Known hypersensitivity
A female client's physician prescribes leflunomide for her rheumatoid arthritis. Six months later, the client presents for routine laboratory testing. The physician would discontinue the medication if what laboratory test was abnormal?
LFT
A client is receiving cyclosporine as an oral solution. What would the nurse mix this drug with to make it easy to administer to children? (Select all that apply.)
-Orange juice -Milk -Chocolate milk
A 42-year-old client is experiencing chemotherapy-induced thrombocytopenia. The nurse is providing information to the client regarding the medication oprelvekin. Which information would the nurse include in the explanation?
"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
A 42-year-old client is experiencing chemotherapy-induced thrombocytopenia. The nurse is providing information to the client regarding the medication oprelvekin. Which information would the nurse include in the explanation? A. "Chemotherapy has caused you to have a low platelet count that puts you at risk for bleeding, and without the drug you will bleed to death tonight." B. "Chemotherapy has caused you to have a low platelet count that puts you at risk for bleeding. Oprelvekin is just like aspirin and, in combination with chemotherapy, will reverse the risk for bleeding." C. "Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk." D. "We don't know why, but you have a low platelet count that puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
The client is a man 79 years of age admitted to the Cancer Treatment Center after chemotherapy for administration of colony-stimulating factors (CSFs). The client voices concern that the immunostimulant drugs will cause renal failure. The nurse knows that CSFs are used for both chronic renal failure and cancer treatment. How would the nurse explain the action of the drugs to calm the client's fears?
"Don't worry, the drugs you will receive today support what is called the hematopoietic system, which is composed of fluids and blood to support your body during chemotherapy and renal failure."
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 the rest of my life."
The nurse is preparing to administer oprelvekin to a client diagnosed with a chemotherapy-induced bleeding disorder. The nurse is explaining to the client the reason for administering this drug? Which explanation is best?
"The drug is used to increase platelet count during chemotherapy."
The nurse, working with a nursing student, is caring for a patient who is to receive interleukins. The student nurse asks you what happens physiologically when a patient receives interleukins. What is the nurse's best response?
"The patient has increases in the number of natural killer cells."
After a client age 65 years diagnosed with vitamin B12 deficiency learns about the use of the vitamin, she asks the nurse what caused her B12 deficiency anemia. Which of the following statements would the nurse use when teaching the client about vitamin B12?
"You have a deficiency because you are on a strict vegan diet."
The pharmacology instructor is talking about interferon. The instructor explains that agents, such as interferons, have more than one biologic function. What are the functions of interferons? (Select all that apply.)
-Antiviral -Antiproliferative -Immunomodulatory
A posttransplant pt is prescribed Tacrolimus 0.04 mg/kg/d IV as a continuous infusion. The pt weighs 220 lb. How many milligrams of Tacrolimus should the nurse administer during an 8 hour shift?
1 mg
The nurse teaches the female patient receiving immune modulating drugs about the need to use barrier contraceptives. The patient says, "I hate using barrier contraceptives. Why can't I just take oral contraceptives?" What is the nurse's best response? A) "Effects of oral contraceptives may be altered by liver changes or changes in immune response." B) "Oral contraceptives increase the action of immune modulating drugs so dosage needs to be reduced." C) "Immune modulators make oral contraceptives ineffective because of hormonal impact of drugs." D) "Oral contraceptives are acceptable if barrier contraceptives are distasteful, but only high-estrogen pills can be used."
A
The patient underwent an allograft renal transplant 48 hours earlier and is showing signs of rejection. What drug would the nurse expect the physician to order? A) Muromonab B) Anakinra C) Mycophenolate D) Sirolimus
A
A patient with chronic hepatitis C has been prescribed peginterferon alfa 2b (PEG-INTRON). By what route would the nurse administer this drug? A) Subcutaneously (SQ) B) Intramuscularly (IM) C) Intralesionally (IL) D) Orally
A
A pt is scheduled for renal transplanting. At what point in the pt's care should the first dose of Sirolimus be given? A) As soon as possible after the transplant B) As soon as transplant rejection has been ruled out C) Seven to ten days before transplant D) Within 48 hrs of transplant
A
A pt would be most likely to benefit from treatment with Filgrastim? A) A pt who has recently undergone bone marrow transplant to treat leukemia B) A pt who has recently undergone a prostatectomy for the treatment of prostate cancer C) A young adult pt who has just been diagnosed with HIV D) A pt who has a diagnosis of chronic hepatitis B
A
SATA. A pt with colorectal cancer has been prescribed Bevacizumab. The pt is relieved that he will only have to receive a dose of the medication every 2 weeks, but is skeptical that it will be effective if given so infrequently. What characteristics of the medication should the nurse explain? A) The delayed peak B) The long half life C) The sever adverse effects D) The long duration of action E) The rapid onset
A B D
SATA. The nurse is assigned to care for a pt who is receiving immune suppressants. The nurse would continually assess the pt for which of the following anticipated adverse effects? A) Development of cancers B) Increased risk of infection C) Cardiac standstill D) Development of secondary infections E) Increased bleeding tendencies F) Hepatomegaly
A B D
What client would be most likely to benefit from treatment with filgrastim (Neupogen)?
A client who has recently undergone bone marrow transplant to treat leukemia
The nurse is discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan? A. Drowsiness B. Bone loss C. Arrhythmia D. Vomiting
Arrhythmia
The nurse is teaching post-administration cardiovascular system reactions to the immunostimulant drug oprelvekin. The nurse would include which of the following cardiovascular system reactions in the client teaching plan?
Arrhythmia resulting in stroke and pulmonary edema
Which of the following drugs act on the hematopoietic cells to stimulate proliferation, differentiation, and maturation of white blood cells? (Choose one)
Filgrastim (Neupogen)
A client comes to the clinic to learn about pernicious anemia. What would the nurse include in the lesson plan?
Avoid contact with infectious disease.
The health care provider plans to inject an interferon directly into the patient's wart. What interferon will the nurse prepare? A) Interferon alfa 2a (Roferon-A) B) Interferon alfacon 1 (Infergen) C) Interferon alfa n3 (Alferon N) D) Interferon beta 1a (Avonex)
C
The nurse has been administering interleukins to a pt. What change in the pt's health status would indicate successful therapy? A) Decrease in inflammation B) Decrease in number of natural killer cells C) Increase in the number of lymphocytes D) Maintenance of adequate circulating platelets
C
A female pt has been admitted to the ER in distress and the nurse's review of the pt's medication administration record reveals that the pt takes Cyclosporine and Mycophenolate. What is the nurse's most appropriate assessment question for the pt's family members? A) Is there any chance at all that she may be pregnant? B) Has she ever been treated for cancer C) Has she ever been the recipient of a tissue transplant D) Do you happen to know her HIV status?
C
A patient has been diagnosed with hairy cell leukemia. The patient is to begin taking interferon alfa 2b. What will the nurse include in her instructions to the patient concerning this drug? A) Avoid drinking alcohol while taking the drug. B) Continue to maintain maximal physical activity. C) Increase fluid intake while taking the drug. D) Treat constipation with over-the-counter laxatives.
C
A patient who is receiving an immune suppressant has been admitted to the unit. What would be a priority action by the nurse? A) Monitor nutritional status. B) Provide patient teaching regarding the drug. C) Protect the patient from exposure to infection. D) Provide support and comfort measures in relation to adverse effects of the drug.
C
The nurse educator is teaching a class of students about the actions and uses of colony stimulating factor. The nurse should inform students CSF is indicated for what secondary problem related to cancer treatment?
Chemotherapy-induced neutropenia
A client is receiving oprelvekin. Which of the following would suggest that the client is experiencing a hypersensitivity reaction?
Chest tightness
A male client received a kidney transplant 2 years ago. He asks the provider if he may begin to wean himself off of the immunosuppressive drug therapy. He is healthy and works as an engineer full time, and he finds the cost of the medication prohibitive. What would the nurse expect the health care provider to do?
Continue the medication because it is lifelong therapy.
Which of the following would the nurse expect to administer orally?
Cyclosporine
Which would the nurse expect to administer orally?
Cyclosporine
Which would the nurse expect to administer orally? A. Alefacept B. Cyclosporine C. Abatacept D. Glatiramer acetate
Cyclosporine
While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is what?
Cyclosporine
A pt is receiving Etanercept for treatment of rheumatoid arthritis. The health care provider has decided to add Anakinra to the regimen. When the nurse is teaching the pt about this new drug regimen, what is the highest-priority teaching point to stress? A) Separate the times for taking the drugs by at least 2 hours to prevent interactions B) Report any signs that might suggest bleeding, such as easy bruising C) You might experience HA or nausea with this combo of drugs D) Be sure to call your health care provider at the first sign of infection
D
A pt is to receive interferon alfa-n3 intralesionally for the treatment of warts. The nurse would instruct the pt that the drug will be given at which frequency? A) Once a month B) One-time dose C) Daily for 7 days then weekly until the wart is gone D) Twice a week
D
A pt who weighs 176 lb has been prescribed Anakinra 0.15 mgkg/d PO in two divided doses to prevent rejection of the transplanted liver. How many 2 mg tablets should the nurse administer for each dose? A) 0.5 B) 6 C) 1.5 D) 3
D
In which situation would the nurse least likely expect to administer an immune suppressant? A) Treatment of transplant rejection B) Treatment of autoimmune disease C) Reduction of number of relapses in multiple sclerosis D) Treatment of aggressive cancers
D
Pt teaching for a pt receiving an interferon would include: A) Proper use of oral contraceptives B) Use of Aspirin to control adverse effects C) Importance of cardiovascular workouts D) Proper methods injecting the drug
D
What would lead the nurse to suspect that a client receiving a monoclonal antibody is experiencing pulmonary edema? A. Fever B. Myalgia C. Dyspnea D. Chills
Dyspnea
A male client is status post-kidney transplantation; he also has impaired liver function. What would the nurse expect the health care provider to do regarding the loading dose of sirolimus?
Follow existing dosing guidelines
A patient has received a bone marrow transplant. What will occur if the patient receives inadequate immunosuppression after the transplant?
Graft-versus-host disease
What client assessment finding will have the greatest effect on the half-life of methotrexate therapy?
History of chronic renal impairment
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? A. Yeast infections B. Hypertension C. Fluid retention D. Fungal infections
Hypertension
The nurse has been administering interleukins to a client. What change in the client's health status would indicate successful therapy?
Increase in the number of lymphocytes
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?
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?
Interferon
After teaching a group of students about immune modulators, the instructor determines that additional teaching is needed when the students identify what as an immune suppressant?
Interferon alfa-2b
Which agent would be classified as an immune stimulant?
Interferon alfa-2b
Which agent would be classified as an immune stimulant? A. Abatacept B. Sirolimus C. Mycophenolate D. Interferon alfa-2b
Interferon alfa-2b
When describing the production of interferons, the instructor discusses recombinant DNA technology. What would the instructor include as being produced this way? A. Interferon alfa-n3 B. Interferon gamma-1b C. Interferon beta-1a D. Interferon alfacon-1
Interferon alfacon-1
When describing the production of interferons, the instructor discusses recombinant DNA technology. Which of the following would the instructor include as being produced this way?
Interferon alfacon-1
The nurse is providing education to clients who are required to take B12 due to deficiency anemia. The nurse should discuss the role of which body substance responsible for absorption of this vitamin?
Intrinsic factor
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
A client is being treated for malignant melonoma 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?
Monitor the client's response to the medication and assess for adverse effects.
An adult male client experienced a kidney transplant 2 days ago, and his 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.
A client who is receiving an immune suppressant has been admitted to the hospital unit. What action should the nurse prioritize?
Place the client on protective isolation.
What disorder of the immune system may affect both the skin and the joints?
Psoriasis
The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues?
RBCs
The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues? A. platelets B. leukocytes C. WBCs D. RBCs
RBCs
Six months after undergoing transplantation, a female client asks her physician if it would be all right for her to volunteer at the local children's health clinic. She has limited adverse effects from her immunosuppressant drugs and is beginning to feel healthy again. The physician suggests alternate volunteer options. What is the physician's foremost concern?
She may develop an infectious process at the clinic.
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. T/F
True
True or False: The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects.
True
A client on the transplant unit is taking cyclosporine after receiving a liver transplant 4 days earlier. A coworker of the client has come for a visit and is apologetic because of a cough and runny nose. What is the nurse's best action?
Teach the visitor about the client's risk for infection and ask the visitor to return after becoming healthy
True or False: Interferons and interleukins demonstrate no drug-drug interactions
True
True or False: The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects.
True
A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect?
To increase white blood cells
Most of the drugs that affect the immune system are not recommended for use in children or have not been tested in children.
True
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects.
True
A 22-year-old woman has received an organ transplant and is on cyclosporine therapy. The nurse will encourage her to avoid crowds and limit social activities while on the medication due to:
increased risk of infections.
A client asks what neutropenia is. Which is the nurse's best response?
a condition when the neutrophil level is very low
The medication reconciliation of a newly admitted resident of a nursing home indicates that the patient takes cyclosporine. The nurse should initially suspect that this resident may have:
a previous organ transplant.
A client suffering from anemia resulting from chronic kidney disease might be treated with which drugs?
epoetin alfa
Which foods should a nurse encourage for a client diagnosed with megaloblastic anemia? Select all that apply.
fish whole grains leafy green vegetables
The client is a woman age 42 years who returns to the Cancer Treatment Center diagnosed with chemotherapy-induced thrombocytopenia. The nurse knows that the interleukin drug oprelvekin is used to increase platelet production and explains to the client the need for the drug. The client will not sign the informed consent because she doesn't understand why she needs platelets. Which of the following information would the nurse include in the explanation?
"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
The client is a woman, age 42 years, who returns to the Cancer Treatment Center diagnosed with chemotherapy-induced thrombocytopenia. The nurse knows that the interleukin drug oprelvekin is used to increase platelet production and explains to the client the need for the drug. The client will not sign the informed consent because she doesn't understand why she needs platelets. Which information would the nurse include in the explanation?
"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
The client is a woman, 42 years of age, admitted after breast cancer chemotherapy. The client has a low white blood cell count and is concerned about acquiring an infection. The client will not sign the informed consent because she doesn't understand the drug action. What explanation would the nurse give for how a CSF increases white blood cell production?
"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."
A client is experiencing flu-like symptoms related to immune stimulant therapy. Which instructions would be most appropriate for the client? A. "Do not use acetaminophen for your fever or aches." B. "Keep your environment nice and warm." C. "You need to try and stay as busy as possible." D. "Drink plenty of fluids throughout the day."
"Drink plenty of fluids throughout the day."
A client is experiencing flu-like symptoms related to immune stimulant therapy. Which of the following instructions would be most appropriate for the client?
"Drink plenty of fluids throughout the day."
Which statement indicates that the client understands immunosuppressant therapy following a solid organ transplant? A. "I know that I will need to stay on this medication for a few months." B. "I know that I will need to stay on my medication for at least 1 year." C. "I know that I will need to stay on this medication for the rest of my life." D. "I do not need to worry about taking any special precautions."
"I know that I will need to stay on this medication for the rest of my life."
A client is undergoing chemotherapy for vulvar cancer. The client had a friend who died after treatment, which has caused severe anxiety and fear; the client is constantly tired and sees this as an indication she won't survive. The nurse knows that the client is scheduled for immunostimulant drug therapy to support the hematopoietic system. The nurse would include which statement to explain the action of drug?
"Taking immunostimulants to stimulate the production of blood cells will help you feel better."
The nurse is preparing an immunostimulant drug called oprelvekin to administer to a client 32 years of age who is diagnosed with a chemotherapy-induced bleeding disorder. The nurse plans to teach the client about why the provider ordered the drug. What reason will the nurse give the client?
"The drug is used to increase platelet count associated with immunosuppression during chemotherapy."
A 56-year-old man is receiving immune stimulants during hospitalization. The nurse is aware of the potential contraindications and cautions for these drugs. Which interventions would be appropriate for the nurse to implement? (Select all that apply.)
-Assess for allergies -Assess medical history -Inspect for the presence of any skin lesions -Obtain a baseline electrocardiogram.
A client is receiving oprelvekin. What assessment finding would lead the nurse to suspect that the client is experiencing a severe hypersensitivity reaction? Select all that apply. A. Difficulty swallowing B. Dyspnea C. Lethargy D. Arthralgia E. Fever
-Dyspnea -Difficulty swallowing
What are common nursing diagnoses for a client diagnosed with cancer? (Select all that apply.) A. Fatigue B. Risk for infection C. Imbalanced nutrition D. Constipation E. Altered mental status
-Fatigue -Risk for infection -Imbalanced nutrition
A pt is to receive Oprelvekin after chemotherapy. What is the priority nursing assessment to evaluate the drug's effectiveness? A) Platelet count B) Renal function studies C) Hepatic enzyme levels D) White blood cell count
A
How do immune suppressants work when ordered for a patient who has had an organ transplant? A) Blocking normal effects of the immune system B) Stimulating immune system to fight off infection C) Working with corticosteroids to enhance healing D) Working with corticosteroids to promote suppressor cells
A
The nurse is caring for a child requiring cyclosporine to prevent rejection. Cyclosporine is given to adults using a dosage of 15 mg/kg. The nurse calculates the child's dosage is 20 mg/kg. What is the nurse's priority action? A) Administer the drug. B) Hold the dose and question the ordering provider. C) Complete an incident report if this dosage has already been given before. D) Notify the nursing supervisor of the medication error.
A
The nurse is caring for a young adult woman taking immune modulating medications who has been advised to use barrier contraceptives but she wants to start her family. What information can the nurse provide about these drugs to help this patient with her decision-making? A) "Discuss the desire to start a family with the provider so risk can be minimized." B) "Immune modulating drugs will need to be discontinued if pregnancy occurs." C) "Immune modulating drugs have been proven to be highly teratogenic." D) "Pregnancy is not an option when taking immune modulating drugs but adoption is an option."
A
SATA. Teaching points that the nurse would incorporate into the care of a pt receiving Cyclosporine would include which of the following? A) Use barrier contraceptives to avoid pregnancy B) If mouth sores occur, try to restrict eating as much as possible C) Dilute the solution with milk, chocolate milk, or orange juice and drink immediately D) Avoid drinking grapefruit juice when on this drug E) Stop taking the drug if GI upset or fever occurs F) Refrigerate the oral solution
A C D
The medication reconciliation of a newly admitted resident of a nursing home indicates that the patient takes cyclosporine. The nurse should initially suspect that this resident may have
A previous organ transplant Cyclosporine is used as an adjunct treatment to prevent rejection in solid organ transplantation and to prevent graft-versus-host disease in allogeneic bone marrow or stem cell transplants. It is not used in the treatment of multiple myeloma, diabetes, or AIDS
The nurse is caring for a patient in the immediate postoperative period following cardiac transplantation who is receiving mycophenolate (CellCept) twice a day IV. What will the nurse teach the patient regarding drug therapy? (Select all that apply.) A) "The drug will be given orally as soon as possible. B) "Take the medication three times a day." C) "Avoid people with contagious diseases." D) "Ask a pharmacist about drug-drug interactions before taking any over-the-counter (OTC) drug." E) "Never miss a dose of medication."
A,C,D,E
A patient has just been told that her cancer has metastasized to her right kidney. An interferon (Aldesleukin) has been prescribed to treat this metastasis. The patient asks why this interferon is ordered. What is the nurse's best response? A) "Aldesleukin has been shown to protect autologous tumor cells." B) "Aldesleukin has been shown to inhibit tumor growth." C) "Aldesleukin has been shown to enhance allogeneic stem-cell transplantation." D) "Aldesleukin has been shown to have a direct proliferative effect on renal tumors."
B
The nurse has an order to administer oprelvekin (Neumega) to a patient for the first time. Before administering the drug, what allergy would the nurse want to specifically question the patient about? A) Egg products B) Escherichia coli-produced products C) Lactose intolerance D) Penicillin
B
The nurse is caring for a patient with an allograft transplant. The physician orders a monoclonal antibody to prevent rejection of the transplant. What monoclonal antibody would the nurse expect to be ordered? A) Alemtuzumab B) Daclizumab C) Erlotinib D) Omalizumab
B
The nurse is writing a plan of care for a patient receiving immune suppressants for leukemia. What would be an appropriate nursing diagnosis for this patient? A) Anxiety related to diagnosis and drug therapy B) Acute pain related to central nervous system (CNS), gastrointestinal (GI), and flu-like effects C) Risk for infection related to immune stimulation D) Imbalanced nutrition: More than body requirements
B
What interleukin receptor antagonist would the nurse anticipate is most likely to be ordered for a patient, 25 years old, who has not responded to traditional antirheumatic drugs? A) Natalizumab (Tysabri) B) Anakinra (Kineret) C) Eculizumab (Soliris) D) Adalimumab (Humira)
B
What assessment should the nurse perform when monitoring for the most serious adverse effects that can occur with the use of monoclonal antibodies? A) Oral temp B) Pupillary response C) Lung auscultation D) Platelet levels
C
SATA. A pt is receiving Oprelvekin. What assessment finding would lead the nurse to suspect that the pt is experiencing a severe hypersensitivity rxn? A) Arthralgia B) Fever C) Dyspnea D) Lethargy E) Difficulty swallowing
C E
Organ transplants are often rejected by the body because the T cells recognize the transplanted cells as foreign and try to destroy them. Treatment with an immune suppressant would: A) Activate antibody production B) Stimulate interleukin release C) Stimulate thymus secretions D) Block the initial damage to the transplanted cells
D
The nurse is caring for a patient who has a diagnosis of chronic hepatitis B infection and has been prescribed an immune stimulant. After teaching the patient about the treatment plan, how might the nurse evaluate the effectiveness of teaching? A) The patient can state where to go to get the medication. B) The patient can state who will administer the medication. C) The patient can state what positive effects to watch for. D) The patient can state specific measures to avoid adverse effects.
D
The nursing class is studying monoclonal antibodies. What monoclonal antibody reacts to human T cells, disabling them and acting as an immune suppressor? A) Adalimumab B) Cetuximab C) Rituximab D) Muromonab-CD3
D
The patient has arrived in the short stay unit for an infusion of tositumomab with 131 tositumomab (Bexxar). Before beginning the infusion, the nurse assesses the patient's vital signs and finds the patient has a temperature of 101.5ºF, What is the nurse's priority action? A) Holding the infusion until patient is afebrile B) Notifying the physician C) Starting the infusion and inform the physician D) Treating the fever before beginning the therapy
D
The nurse is administering cyclosporine. The nurse should anticipate the client may report which adverse reaction?
Excessive hair growth
True or False: Abatacept is classified as an interleukin receptor antagonist.
False
A 45-year-old male patient is receiving interferon alfa-2a therapy for hepatitis C. The nurse should teach the patient that he may experience which adverse effect?
Flu-like symptoms
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? A. Mental depression B. Infection C. Severe diarrhea D. Respiratory distress
Infection
A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality?
Infections
A nurse is teaching a client about an iron supplement. Which should be included in the teaching a client about this medication?
It should be taken on an empty stomach.
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
A client is administered cyclosporine to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine?
Nephrotoxicity
A client is to receive oprelvekin after chemotherapy. What is the priority nursing assessment to evaluate the drug's effectiveness?
Platelet count
Oprelvekin (Neumega) is a drug that stimulates the process of making which blood cells?
Platelets
To help understand immunostimulant drug therapy, the client has come to the clinic for a class on thrombopoiesis. The nurse explains that the term means the formation of which types of blood cells?
Platelets
The nurse is providing care for a client whose current medications include tacrolimus. The nurse should anticipate that this client is likely to be taking what medication concurrently?
Prednisone
A patient who is receiving an immune modulator has been admitted to the unit. What would be a priority action by the nurse?
Protect the patient from exposure to infection.
A client is to begin treatment for rheumatoid arthritis with infliximab. What potential risk should the nurse identify as being associated with this drug?
Risk for infection
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 be having psychological adverse effects of interferon alfa-2a.
The nurse will appraise the success or failure of treatment of filgrastim therapy by regularly monitoring the results of what diagnostic test?
absolute neutrophil count
The nurse administers aldesleukin to a patient diagnosed with renal cell carcinoma. When assessing the patient a few days later, what abnormal findings would the nurse attribute to the medication? (Select all that apply.) A) Increased lymphocyte count B) Increased red blood cell count C) Increased platelet count D) Irregular pulse rate E) Increased blood pressure
A,C,D
The nurse is discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan?
Arrhythmia
A client is scheduled for renal transplantation. At what point in the client's care should the first dose of sirolimus (Rapamune) be given?
As soon as possible after the transplant
Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition?
Autoimmune disorder
A client is experiencing flu-like symptoms related to immune stimulant therapy. Which instructions would be most appropriate for the client?
"Drink plenty of fluids throughout the day."
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 assesses for the development of infection."
A nurse is discussing interferon alfa 2b with a patient. What will the nurse encourage the patient to do while taking this drug? A) To avoid crowds B) To increase salt intake C) To decrease milk intake D) To eat three meals a day
A
The physician has decided to prescribe T- and B-cell suppressors for a patient diagnosed with psoriasis. What drug will be ordered for this patient? A) Alefacept (Amevive) B) Azathioprine (Imuran) C) Cyclosporine (Neoral) D) Glatiramer acetate (Copaxone)
A
A 70-year-old patient with acute myelocytic leukemia is receiving sargramostim (Leukine). What is a priority nursing action for this patient? A) Providing a quiet environment B) Increasing fluids C) Providing comfort measures related to nausea D) Encouraging appropriate dietary intake
B
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
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
The home care nurse is caring for a female client who underwent renal transplantation 8 weeks ago and is self-administering immunosuppressant drugs. What situation in the client's life is the greatest cause for concern?
She runs a sick child day care.
While studying for a pharmacology test, a student asks his peers about interferons. What statement about interferons is accurate?
They interfere with the ability of viruses in infected cells to replicate.
The nurse has administered a client's prescribed daily dose of filgrastim. When assessing for a therapeutic effect, what laboratory finding should the nurse prioritize?
White cell differential
A client has a successful liver transplant. The nurse should advise the client prescribed oral cyclosporine to avoid mixing the drug with what form of liquid?
any type of grapefruit juice
A client is administered methotrexate for the treatment of severe rheumatoid arthritis. Administration of this drug should be performed with particular care because of the associated high risk of:
hepatotoxicity
Use caution and arrange to reduce the dose if a monoclonal antibody is combined with any other ________________ drug because severe immune suppression with increased infections and neoplasms can occur.
immunosuppressant
Use caution and arrange to reduce the dose if a __________________ is combined with any other immunosuppressant drug because severe immune suppression with increased infections and neoplasms can occur.
monoclonal antibody
Oprelvekin is a drug that stimulates the process of making which blood cells?
platelets
