Chapter 17 PrepU
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?
"Drink plenty of fluids throughout the day."
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 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 patient is administered mycophenolate (CellCept) 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 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.
Immunosuppressant drugs are given after organ transplantation. For which disorder will immunosuppressant agents also be prescribed?
Autoimmune disorders
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
The nurse educator is teaching a class of online learners about the actions and uses of colony stimulating factor. The nurse lists what as part of the class?
Chemotherapy-induced neutropenia during solid-tumor cancer treatment
Which would the nurse expect to administer orally?
Cyclosporine
What 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
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 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
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 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 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
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 to the drug or any component of the drug
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 patient is administered cyclosporine (Sandimmune, Neoral) 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 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
When describing the action of trastuzumab, what should the nurse include?
Reaction with human epidermal growth factor receptor 2
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
A patient is receiving immunosuppressant therapy. Which adverse effects should the patient be educated about regarding these effects?
Serious infection
What is an adverse effect of excessive immunosuppression?
Serious infection
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 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.
A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action?
Stop the drug immediately.
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
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.
Interferons and interleukins demonstrate no drug-drug interactions.
True
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
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 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to:
infection.
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
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 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.
The nurse closely monitors a client who is receiving anakinra and etanercept for:
severe infection.