PrepU Chapter 13: Drug Therapy to Suppress Immunity

A client 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 client about this new drug regimen, what is the highest-priority teaching point to stress?

"Be sure to call your health care provider at the first sign of infection."

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."

You are preparing to perform a skin test on a client prior to the administration of Atgam, which is one form of antithymocyte globulin (ATG). If the client asks why you are performing the test, how would you respond?

"I need to determine if you're allergic to horse serum."

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 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse providing care for the man is explaining that while unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching point should the nurse not teach to the patient?

"Inflammation helps your body to produce the right antibodies to fight the infection."

The nurse is assessing a new client admitted to a nursing home. The client asks the nurse to explain interleukins. The nurse would include which information?

"Interleukins help the immune system with inflammation."

When explaining the risks of pretransplant immunosuppression, the nurse demonstrates understanding of the process when making which statement?

"Serious complications can occur if you are not monitored carefully while you are immunosuppressed."

A client who has recently been diagnosed with HIV is waiting for the results of lab work to determine their T-cell count. How should the nurse best explain a T cell to the client?

"T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."

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 caring for a patient newly diagnosed with multiple sclerosis. The patient asks why MS is called an autoimmune disease. What would be the nurse's best response?

"The body attacks its own cells because it responds to specific self-antigens to produce antibodies."

The nurse is caring for a client waiting for a heart transplant. The client's spouse asks the nurse, "Why don't they just choose any heart until the right heart can be found?" What is the nurse's best response?

"The more closely the new heart matches the client's tissue, the less aggressive the immune reaction will be."

The nurse is caring for a client who is immunocompromised and is explaining the function of cytotoxic T cells. What should the nurse explain to this client?

"These T cells can either destroy a foreign cell or mark it for aggressive destruction by another cell."

You are teaching a 32-year-old male client about the methotrexate therapy he is about to begin. What guidance should you offer this client?

"Use reliable contraception."

The nurse assists and educates clients about the structure and function of the immune system. Both B cells and T cells derive from stem cells in the bone marrow. Based on this information, what is the best information for the nurse to provide the client on the function of B lymphocytes? 1. Help protect against viral infections 2. Can detect and destroy some cancer cells 3. Develop into cells that produce antibodies 4.Provide humoral immunity

3, 4

Of the following patients, which are at greater risk for decreased wound healing?

80-year-old diabetic patient with a foot ulcer

A nurse is caring for a client who has undergone organ transplant surgery. The client asks the nurse what antibodies are. What is the best response by the nurse?

A protein substance that the body produces in response to an antigen

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has:

A severe bacterial infection

A female nursing student is diagnosed with rheumatoid arthritis. What is the probable cause of her rheumatoid arthritis?

Abnormal immune response

A nurse is caring for a client who has just had organ transplant surgery. Which nursing intervention should the nurse perform in case a rejection response is seen in the client?

Administer prescribed specific anti-rejection medication

A nurse is caring for a client who has been admitted for immunosuppressant treatment of severe psoriasis. Which drug is the nurse likely to administer?

Alefacept

The cascade of complement proteins form a ring around the antigen-antibody complex and have what actions on non-self-cells? Select all that apply.

Altering the antigen's membrane Inducing chemotaxis to draw phagocytic cells Increasing phagocyte activity Releasing histamine

A client is scheduled for renal transplantation. At what point in the client's care should the first dose of sirolimus be given?

As soon as possible after the transplant

The nurse is caring for an older adult receiving immune modulators. What are appropriate actions by the nurse? Select all that apply.

Assess carefully for infection. Obtain baseline liver function studies and monitor follow-up studies. Determine dosage based on renal and liver function.

Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition?

Autoimmmune disorder

What occurs when the body produces antibodies against its own cells?

Autoimmune disease

The nurse is explaining to a client how an antigen previously encountered elicits a much faster immune response because the body's immune cells "remember" previous encounters with the antigen. The nurse is describing the function of what cells?

B cells

The nurse is performing an assessment of a client in order to determine the functional status of the client's humoral immunity. What component of the client's immune function should the nurse prioritize?

B cells

Which monoclonal antibody is antibody specific to epidermal growth factor receptor sites?

Cetuximab

A 72-year-old male client has arrived at the outpatient unit to receive an infusion of alemtuzumab. The client 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?

Confirm the order with the health care provider.

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 a lifelong therapy.

Which would the nurse expect to administer orally?

Cyclosporine

While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is:

Cyclosporine.

Which of the T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?

Cytotoxic T cells

The nurse is caring for a client who has acquired immunodeficiency syndrome (AIDS) and whose CD4 (helper) T cell count is steadily decreasing. The nurse's assessment findings will reflect what pathophysiological process?

Decreased stimulation of B cells

A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that this is an allergic response based on a genetic predisposition. The specific allergen initiated by immunological mechanisms is usually mediated by immunoglobulin:

E.

A male client is prescribed cyclosporine after renal transplantation to prevent rejection. Initially, his BUN and creatinine levels were elevated; they diminished with medication adjustment and 3 weeks later are elevated again. What would the nurse expect the health care provider to do?

Evaluate the client for transplant rejection

A nurse is addressing a group of nursing students about gamma globulins. What is the best response to the nursing students about the function of IgA?

Helpful in defense against invasion of microbes via nose, eyes, lungs, and intestines

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.

A deficiency in what area would result in an inhibition of the inflammatory response?

Histamine

A client is experiencing an allergy to a penicillin antibiotic. What immunoglobulin (Ig) will most directly relate to this immune response?

IgE

In an allergic reaction, the immunoglobulin that binds to mast cells that release histamine is the:

IgE.

A nurse received the seasonal influenza vaccine 10 weeks ago has now been exposed to that strain of the influenza virus. What immunoglobulin will hasten the nurse's immune response to this pathogen?

IgG

A school-aged client was vaccinated against varicella several years ago according to the recommended immunization schedule. The client has now been exposed to the virus by a classmate with chickenpox. What immune response will prevent the client's infection?

IgG will be released by B memory cells

The nurse is reviewing the most recent laboratory findings of a hospital client. The client's neutrophil count is 950/µL (0.95 ×109/L), which is significantly below reference ranges. What is the nurse's best action?

Implement isolation precautions as per protocol.

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

The pathophysiology instructor is discussing phagocytosis. What types of responses would the instructor explain interact in complex ways and share a number of processes, including phagocytosis?

Inflammatory and immune

What best describes the role of the major histocompatibility complex as a barrier defense?

It allows the body to distinguish cells as foreign or belonging to the person.

What is one results of an antigen-antibody interaction?

Making of complement

A client has developed a wound infection and leukocytes are leaving the bloodstream to perform phagocytosis on pathogens. What white cells are most likely performing this function?

Neutrophils

A client presents to the emergency department with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The health care provider has ordered a complete blood count and white cell differential. Which blood components would the provider most likely anticipate to be elevated?

Neutrophils.

A client has just received a kidney transplant. In order to prevent rejection, the nurse should perform what action?

Perform interventions that minimize response to the major histocompatibility complex.

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.

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

Mycophenolate mofetil is being considered in the treatment of a 39-year-old female transplant recipient. Before the initiation of therapy, the nurse must assess the client for what information to ensure safety?

Pregnancy status

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's current immune response includes the release of basophils . What aspect of the client's immune response will be performed by these leukocytes?

Releasing histamine

A client who has been diagnosed with a compromised immune system is eager to know about the condition. Which explanation should the nurse provide regarding the potential consequences of a compromised immune system?

Results in immunodeficiency diseases

What is an adverse effect of excessive immunosuppression?

Serious infection

Six months after undergoing transplantation, a female client asks her health care provider 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 provider suggests alternate volunteer options because:

She may develop an infectious process at the clinic.

A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for treatment. What should the nurse teach the client about her drug therapy?

She should use barrier contraceptives while taking the drug.

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 client became ill with an influenza virus several days ago. Today, the client describes being free of symptoms. What component of the immune system will be predominant today?

Suppressor T cells

What would be considered a lymphocyte?

T cells

Which cells are responsible for cell-mediated immunity?

T cells

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.

A client is experiencing an immune response and the only immunoglobulin that is currently in circulation is IgM. How should the nurse best interpret this fact?

The client has very recently been exposed to the antigen

The nurse is providing care for a client who has been diagnosed with rheumatoid arthritis. The nurse has taught the client that the disease has an autoimmune etiology and should explain what phenomenon?

The client's immune system is responding to self-antigens on body cells.

The health care provider changes a female client's immunosuppressant to a newer drug. The client asks why this is necessary. What is true about the newer immunosuppressants?

They have fewer severe adverse effects.

A client is receiving immunizations before traveling to a storm-stricken region of the tropics where cholera, typhoid, and malaria are in epidemic. While specific immunizations to combat specific diseases would be administered, why would an injection of IgA also be administered?

To increase local antibody response

Within an infected wound bed, many cell types are involved in protecting the host and eliminating the "foreign invaders" to promote wound healing. How does the identification of body tissues from foreign substances occur?

Via the immune system

To help understand immunostimulant drug therapy, the client has come to the clinic for a class on leukocytes and infection. The nurse explains that the term leukocyte refers to:

White blood cells

What client is most likely benefiting from the effects of tumor necrosis factor (TNF) cytokines?

a client who has ductal carcinoma in situ (DCIS)

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 harried mother of four preschoolers voices confusion during their pediatric appointment that three of her immunized children avoided contracting chicken pox but the fourth "had a hard case." After describing the benefits the vaccine provided her children, the nurse explains that her three children avoided infection due to their:

active immunity.

A nurse is caring for a patient who has just had a successful liver transplant. When facilitating the patient's treatment with cyclosporine, the nurse should anticipate that administration will

begin with IV administration and then change to the oral route.

How do immune suppressants work when ordered for a client who has had an organ transplant?

blocking normal effects of the immune system

A client who has undergone an organ transplant is at a greatly heightened risk of health problems because of what impaired ability?

differentiate between its own cells and antigens on foreign cells

The nurse is caring for a client with an acute infection that resulted in a prompt immune reaction. What signs or symptoms experienced by the client would the nurse recognize as being mediated by interleukins? Select all that apply.

fever joint pain muscle pain

A client is prescribed which drug that acts on the hematopoietic cells to stimulate proliferation, differentiation, and maturation of white blood cells?

filgrastim

A client with human immunodeficiency virus has an impaired ability to stimulate lymphocytes to be aggressive and responsive during the immune response. This is primarily due to a deficiency in what cells?

helper T cells

What client assessment finding will have the greatest effect on the half-life of methotrexate therapy?

history of chronic renal impairment

A client has developed urosepsis following a urinary tract infection. The nurse is explaining how B cells are programmed to identify specific proteins or antigens in the fight against the client's infection. What process is the nurse describing?

humoral immunity

In the earlier stages of an inflammatory process leukocytosis occurs due to a(n):

increase in circulating neutrophils

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.

A client admitted to the ICU with gunshot wounds in the chest and thigh is noted to have extensive edema present. Anticipating a generalized reaction to tissue damage, the nurse concludes that the client's edema is the result of what development?

inflammatory process.

What assessment data would confirm that a client is demonstrating the presence of effective major defense mechanisms? Select all that apply.

intact skin and mucous membranes redness and heat at the site of a cut an elevated temperature an elevated white blood cell count

A client with chronic renal failure has been on the transplant list for several months and is awaiting an appropriate donor kidney. The care team should attempt to minimize the chances of the client's immune system rejecting the kidney by:

matching the client's HLA markers to that of the donor as closely as possible.

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.

The nurse is reviewing the results of the complete blood count of a client who is diagnosed with bacterial meningitis. What value should the nurse expect to see elevated?

neutrophil count

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.

A client's most recent laboratory work reveals neutropenia. This client will have a diminished capacity for:

phagocytosis.

A client's exposure to an infectious microorganism has stimulated the client's immune response, including activation of effector (cytotoxic) T cells. These cells will help to eliminate pathogens by:

releasing cytokines that will destroy the foreign cells.

The nurse is providing education for a client who has been scheduled for a kidney transplant. The nurse should inform the client that administration of antirejection drugs will be initiated when?

several hours before the surgery

Student nurses are discussing rheumatoid arthritis (RA) in their pathology class. The students learn that RA is treated with leflunomide because it relieves symptoms and

slows the progression of joint destruction.

A 56-year-old client, discharged from the hospital following a successful kidney transplant, is prescribed antirejection drug therapy. When performing health education with the client and the client's family, which topic should the nurse emphasize?

strategies for reducing the client's risk of infection

The nurse is caring for a client who has been prescribed mycophenolate mofetil following kidney transplant. What instruction should the nurse provide during client teaching to minimize the risk of undesired effects?

taking the pills on an empty stomach

A client who has received a heart transplant has been given a prescription for medications that block T-cell activity. What is the rationale behind this order?

to prevent an inflammatory reaction against the transplanted heart

You are caring for a client who is receiving corticosteroids to treat an acute exacerbation of multiple sclerosis. You know that the corticosteroids

will reduce inflammation but will not prevent tissue damage.