Chapter 49: Immunologic Agents and Chapter 51: Immunomodulating Drugs

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? A. "The weekly CBC is routine and prescribed for all clients." B. "The weekly CBC assesses for changes in your blood's oxygen-carrying capacity." C. "The weekly CBC assesses for the development of infection." D. "The weekly CBC assesses for the development of bleeding."

"The weekly CBC assesses for the development of infection."

The nurse is assigned to perform telephone triage for the clinic and receives a call from a young mother whose 6-month-old baby received her third diphtheria-pertussis-tetanus immunization that morning. The mother reports the baby's temperature is 99.8° axillary, the site of injection is "a little red," and the baby is irritable. After checking the standing orders provided by the pediatrician, what teaching would the nurse provide this mother? Select all that apply.

"These are common adverse effects reported after immunizations." "Apply a warm moist compress to the baby's leg." "Symptoms should subside within 2 to 3 days." Explanation: The symptoms reported by this mother are all common adverse effects following immunization that will subside within 2 to 3 days. In the meantime, the mother can make the baby more comfortable by administering a weight appropriate dosage of acetaminophen, applying warm compresses to the injection site, and providing a quiet environment. If the symptoms do not subside within 2 to 3 days, the baby should be seen for follow-up care. Aspirin should not be given due to risk of Reye's syndrome. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585. Chapter 49: Immunologic Agents - Page 585 Add a Note

The nurse is teaching a client about macrocytic anemia. Which of the following information would the nurse include in the teaching plan?

"This is an anemia that results from the abnormal formation of erythrocytes."

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

What occurs when the host human responds to the injected antibodies circulating through the body?

The host produces its own antibodies to the injected antibodies. Explanation: In some cases, the host human responds to the circulating injected antibodies, which are foreign proteins to the host's body, by producing its own antibodies to the injected antibodies. This results in serum sickness, a massive immune reaction which is manifested by fever, arthritis, flank pain, myalgia, and arthralgia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, pp. 580-582. Chapter 49: Immunologic Agents - Page 580-582 Add a Note

A client's health care provider has concluded the client is likely to benefit from treatment with a monoclonal antibody. The success or failure of treatment will primarily depend on what variable?

The match between target cell receptor sites and the monoclonal antibody

When instructing the parents of a child who has received immunization in the vastus lateralis, which reaction is most common in the days after the administration?

tenderness and redness at the site Explanation: Pain, tenderness, and redness at the injection site are associated with the administration of immunizations. Nausea, vomiting, diarrhea, rash, edema, weakness, or difficulty walking are not general reactions to immunizations. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 587. Chapter 49: Immunologic Agents - Page 587 Add a Note

A group of students are role playing various scenarios related to biological weapons. In one of the situations, an adult client develops botulism. What is the appropriate choice for treatment?

Antitoxin Explanation: A botulism antitoxin is available for clients who receive specific exposure. There is no bacterial vaccine for botulism. Antivenin would be used to treat a snake bite. Botulism immune globulin is reserved for infants. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note

A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action? A. Notify the prescriber that the client is experiencing an adverse effect. B. Reposition the client C. Stop the drug immediately. D. Auscultate the client's apical heart rate for 2 minutes.

Stop the drug immediately

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 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."

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 nurse is teaching a novice nurse hire how to administer colony-stimulating factors. It is important to include which of the following information?

"Colony-stimulating factors are fragile and must be mixed before administration."

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."

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? A. "I should stop taking these drugs if I get sick." B. "I will always be at risk for serious infection." C. "I need to take these drugs until my prescription runs out." D. "I'm at risk for infection until my body accepts my new liver."

"I will always be at risk for serious infection."

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."

A client 72 years of age 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."

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 learns that a client in a clinic is taking folic acid to treat an associated anemia. The client decided to go on a fasting diet for the last two weeks to lose weight before her daughter's wedding. How would the nurse explain the importance of staying on the diet that the provider prescribed last month?

"The prescribed diet and drug are necessary to correct anemia associated with folic acid deficiency."

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 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 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."

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."

A client prescribed prednisone 40 mg daily should be provided what information about immunizations by the nurse?

"You should wait at least 3 months after chemotherapy to obtain a live vaccine immunization." Explanation: Clients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before being given a live virus vaccine. Immunizations are not contraindicated with short-term use (less than 2 weeks) or low to moderate doses (less than 20 mg daily) of prednisone. None of the other options present accurate information concerning immunizations for a client currently prescribed prednisone.

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 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

Which are the LEAST serious adverse effects associated with the use of monoclonal antibodies? Select all that apply. A. diarrhea B. fever C. acute pulmonary edema D. malaise E. cytokine release syndrome

-Fever -Malaise -Diarrhea

A neonate who weighs 7 lbs, 8 oz kg is prescribed the hepatitis B immune globulin at a dose of 0.06 mL/kg IM. To one decimal place, what dose should the nurse administer?

0.2 Explanation: The neonate's weight in kg is 3.41 kg (7.5 lbs divided by 2.2). The prescribed dose is 0.06 X 3.41, which yields 0.2 mL to one decimal place. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

What client would be most likely to benefit from the administration of an antitoxin?

A client in distress who is showing signs and symptoms of botulism Explanation: Botulism is an example of a health problem that can be treated with an antitoxin. HPV and yellow fever do not have a toxic etiology and cannot be treated by an antitoxin. Antitoxins are not used in the treatment of anaphylaxis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

The client asks the nurse about possible interactions of iron with other prescribed medications. The nurse knows that there are known drug-to-drug interactions, including which of the following?

Antibiotics

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

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 cardiovascular system reactions in the client teaching plan?

Arrhythmia resulting in stroke and pulmonary edema

A patient with chronic renal failure is prescribed darbepoetin alfa. Which of the following adverse reactions should the nurse closely monitor for in the patient? Select all that apply.

Arthralgia Rashes Hypertension

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

Immunosuppressant drugs are given after organ transplantation. For which disorder will immunosuppressant agents also be prescribed?

Autoimmune disorders

When describing the action of vaccines, the nurse identifies their action as primarily affecting:

B lymphocytes. Explanation: Vaccines exert their action on B cells, which in turn stimulate the formation of antibodies. Interleukins, histamine release, and effector T cells are not affected by vaccines. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

A female client 50 years of age has a history of an allergy to cyanocobalamin. Based on the history, the nurse knows which of the following vitamins is contraindicated?

B12

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 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

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

In addition to autoimmune disorders, immunosuppressant medications are used to treat which disorder?

Crohn's disease

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

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

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 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.

Dyspnea Difficulty swallowing

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.

Dyspnea Difficulty swallowing

A client 22 years of age is receiving parenteral administration of an iron supplement. The nurse knows that this method of administration can cause a fatal anaphylactic reaction. During administration, the nurse will monitor and report which of the following adverse reactions immediately?

Dyspnea, urticaria, rashes, itching, and fever

The nurse is caring for a client who is receiving parenteral administration of an iron supplement. During administration, the nurse will monitor and report which of the following adverse reactions immediately?

Dyspnea, urticaria, rashes, itching, and fever

A client with renal cancer is prescribed aldesleukin. What action should then nurse perform?

Ensure the client has adequate intravenous access

A patient suffering from anemia resulting from chronic kidney disease might be treated with which of the following drugs? (Choose one)

Epoetin alfa (Epogen)

Which monoclonal antibody would the nurse expect to administer orally?

Erlotinib

True or False: Most of the drugs that affect the immune system are highly recommended for use in children.

False

An immunocompromised client is exposed to hepatitis A. The health care provider orders an injection of immunoglobulin as prophylaxis against the hepatitis A. What adverse effects would the nurse advise the client might occur? (Select all that apply.)

Fever Angioedema Urticaria Explanation: Adverse effects: Tenderness, muscle stiffness at site of injection; urticaria, angioedema, nausea, vomiting, chills, fever, and chest tightness. An immunocompromised client would not be told to watch for rhinitis or severe abdominal pain. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

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 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

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

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

The nurse is teaching a course to students about immunologic agents. In order for the students to understand active immunity, the nurse explains that there are agents that provide active immunity. Which is an active immunity agent?

Haemophilus influenzae type B conjugate Explanation: A vaccine is an active immunity agent. Haemophilus influenzae type B conjugate is a live vaccination. The remainaing answer options offer agents that are either Immune globulins or antivenins which are passive immunity agents. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 587. Chapter 49: Immunologic Agents - Page 587 Add a Note

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 monitors the client receiving eculizumab for what serious potential adverse effect?

Hemolysis

A nurse is to administer a viral vaccine. A vaccine for what would be appropriate?

Hepatitis A Explanation: Hepatitis A would be a viral vaccine. Meningococcal is a bacterial vaccine. Haemophilus influenza B is a bacterial vaccine. Typhoid is a bacterial vaccine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

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

History of chronic renal impairment

What client assessment finding will have the greatest effect on the half-life of methotrexate therapy? A. history of peripheral vascular disease B. inadequate fluid intake C. the presence of an active infection D. history of chronic renal impairment

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

Which would a nurse expect to administer to a client who has not been immunized and has sustained a bite from an animal with rabies?

Immune globulin Explanation: An immune globulin, specifically rabies immune globulin, would be used to prevent rabies in nonimmunized clients who are exposed to rabies. An antitoxin is used to treat poisonous substances released by invading pathogens, for example, botulism. Antivenin would be used to treat snake bites. Immune sera is a general term that includes immune globulins, antitoxins, and antivenins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note

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 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

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? A. Interferon B. Monoclonal antibody C. Interleukin receptor antagonist D. T- and B-cell suppressor

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

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? A. Mycophenolate B. Abatacept C. Interferon alfa-2b D. Azathioprine

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

To help understand how vitamin B12 is absorbed, the client comes to the clinic for a class. The nurse explains that there is a substance produced by the cells in the stomach necessary for the absorption of vitamin B12. What is that substance called?

Intrinsic factor

The nurse is caring for a female client, aged 62, who has been admitted for treatment of metastatic melanoma. What agent would the nurse anticipate the client is likely to order?

Ipilimumab

A freshman nursing student is preparing to administer an antibiotic to a client in a clinic, 22 years of age, diagnosed with iron deficiency anemia. The client takes oral iron supplements daily. The lead nurse supervising the student stops to teach which of the following important interactions when iron and antibiotics are used together for treatment?

Iron causes a decreased gastrointestinal absorption of the antibiotic.

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 gastrointestinal absorption of the antibiotic.

The nurse is in the process of creating test questions about immunostimulant drugs for nursing students in an online RN to BSN nursing program. Which of the following drugs would be included?

Iron dextran, filgrastim, and leucovorin

A client is prescribed filgrastim. Which is the nurse's best explanation of how this drug works? A. It aids in the development of platelets by the bone marrow. B. It inhibits the growth of bacteria in the body. C. It stimulates growth and production of WBCs to fight off infection. D. It functions like insulin, lowering the blood sugar.

It stimulates growth and production of WBCs to fight off infection.

The nurse educator is teaching a class of RN to BSN online learners about different types of immunostimulant drugs. A student asks about the goal of hematopoietic drugs. The nurse knows it is important to explain about stimulation of the body in order to make more of the specific cell. Which of the following cell counts would the nurse want to emphasize when the topic is chemotherapy?

Low platelet and low white blood cell count.

The nurse is teaching a client about megaloblastic anemia. Which of the following information would the nurse include in the teaching plan?

Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency.

The client enters the clinic complaining that oral B12 is making her sick. The nurse knows that vitamin B12 has known adverse reactions, including which of the following? Select all that apply.

Mild diarrhea Itching Acne Congestive heart failure

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 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? A. Dry skin B. Nausea and changes in taste C. Significant weight loss D. Changes in blood pressure

Nausea and changes in taste

The nurse is teaching the parents of a child who has received immunizations and possible adverse effects. What would the nurse identify as common adverse effects? (Select all that apply.)

Nodule at the injection site Fretfulness Chills Anorexia Explanation: Common adverse effects include moderate fever, rash, malaise, chills, fretfulness, drowsiness, anorexia, vomiting, irritability, and pain, redness, swelling, and nodule formation at the injection site. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

A client is to receive erlotinib. The nurse would expect to administer this drug by which route?

ORAL

A patient with iron deficiency is prescribed iron dextran. In which of the following patients should iron dextran be used cautiously?

Patients with asthma

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.

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

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

The nurse is providing care for a client whose current medications include tacrolimus (Prograf). The nurse should anticipate that this client is likely to be taking what medication concurrently?

Prednisone

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

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? A. Prevention of infection due to immunocompromised status B. Slowing of metabolic processes postoperatively to prevent an immune response C. Prevention of organ rejection D. Preservation of remaining renal function

Prevention of organ rejection

A nurse is participating in an influenza vaccination clinic on a college campus. What action will best prepare the nurse for this role?

Review the procedure for intramuscular injection Explanation: Influenza vaccinations are given by the IM route. The nurse must monitor for adverse effects, but it is unnecessary to teach each client the details of serum sickness. Clients do not need to know their blood types. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 589. Chapter 49: Immunologic Agents - Page 589 Add a Note

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 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? A. Acute pain B. Impaired skin integrity C. Risk for infection D. Risk for injury

Risk for infection

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: A. She may not have the stamina to work at the clinic. B. It is too soon to volunteer in a clinic setting. C. It will increase the risk of rejection. D. She may develop an infectious process at the clinic.

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 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 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? A. Increased stimulation of the normal effects of the immune system in the body B. Suppression of the normal effects of the immune system in the body C. Targeting of various receptor sites of cells D. Targeting of specific receptor sites of cells

Suppression of the normal effects of the immune system in the body

Most of the drugs that affect the immune system are not recommended for use in children or have not been tested in children. T/F

TRUE

The nurse is providing care for a client who has chronic hepatitis C. The client has recently been prescribed peginterferon alfa-2b. What is the nurse's most appropriate action?

Teach the client how to self-administer subcutaneous injections

The nurse is caring for a client who has a diagnosis of chronic hepatitis B and has been prescribed an immune stimulant. The client provides client education. How would the nurse evaluate the effectiveness of the teaching plan?

The client can state specific measures to avoid adverse effects.

The nurse is caring for a client who has a diagnosis of chronic hepatitis B and has been prescribed an immune stimulant. The client provides client education. How would the nurse evaluate the effectiveness of the teaching plan? You Selected:

The client can state specific measures to avoid adverse effects.

The nurse is caring for a client who has a diagnosis of chronic hepatitis B and has been prescribed an immune stimulant. The client provides patient education. How would the nurse evaluate the effectiveness of the teaching plan?

The patient can state specific measures to avoid adverse effects.

A nurse is assigned to care for a patient with iron deficiency anemia who is prescribed iron compounds. Which of the following should the nurse confirm to ensure that iron compounds are not contraindicated in this patient?

The patient does not have hemochromatosis

A 65-year-old client has come to the clinic after receiving the shingles vaccine two weeks ago. The client asks the nurse how long the immunity will last. The nurse would include which information in the explanation?

The varicella virus (shingles) vaccine protects the recipient for several years or for life. Explanation: The varicella virus (shingles) vaccine protects the recipient for several years or, in some cases, for life. There is no recommended booster vaccine available. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 581. Chapter 49: Immunologic Agents - Page 581 Add a Note

What is the difference between toxoids and vaccines?

Toxoids always require occasional boosters. Explanation: Many (but not all) vaccines produce long-lasting immunity. Attenuated live vaccines produce immunity, usually lifelong, that is similar to that produced by natural infection. Toxoids are bacterial toxins or products that have been modified to destroy toxicity while retaining the ability to induce antibody formation. Immunization with toxoids is not permanent; scheduled repeat doses (boosters) are required to maintain immunity. No immunization is wholly free of adverse effects. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

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 use of epoetin alfa (Epogen) is contraindicated in patients with which of the following medical conditions? (Choose one)

Uncontrolled hypertension

A nurse is reviewing laboratory values of a client who has a urinary tract infection. Which cells protect the body from microorganisms?

WBCs

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 asks what neutropenia is. Which is the nurse's <b>best</b> response?

a condition when the neutrophil level is very low

A client asks what neutropenia is. Which is the nurse's best response? A. a condition when the neutrophil level is very low B. an issue with red blood cells and their ability to carry oxygen C. a problem associated with old age D. a disease where the body has to fight infections

a condition when the neutrophil level is very low

What would contraindicate the administration of scheduled immunizations at a client visit for a 6-month-old infant?

a low-grade fever Explanation: Contraindications to most vaccines and toxoids include acute febrile illness. Fussy crying, loose stools, and poor feeding would warrant further assessment but may not contraindicate the administration of a vaccine.

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.

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 is to receive a physical prior to starting immune sera therapy. What would the nurse assess for?

adventitious breath sounds Explanation: Perform a physical assessment to determine baseline status before beginning therapy and for any potential adverse effects; inspect for presence of any skin lesions to monitor for hypersensitivity reactions; monitor temperature to monitor for possible infection, pulse, respirations, and blood pressure; auscultate lungs for adventitious sounds; assess level of orientation and affect to monitor for hypersensitivity reactions to the vaccine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note

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 with iron deficiency is prescribed iron dextran. Based on the nurse's understanding of this drug, the nurse would expect to administer it cautiously to a client with which condition?

asthma

The nurse is assessing a client during a home health visit. The client asks how interferon works. The nurse should inform the client that interferon works by:

controlling cellular proteins.

A client is diagnosed with anemia. The nurse understands that anemia can result in which effect?

decreased platelet production

A client suffering from anemia resulting from chronic kidney disease might be treated with which drugs?

epoetin alfa

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 nurse is describing the process by which the body is stimulated to make more of a specific type of blood cells. The nurse is describing which process?

hematopoiesis

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

Filgrastim (Neupogen) should be used cautiously in clients with which medical conditions?

hypothyroidism

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

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 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 group of nursing students demonstrate understanding of blood cells when they identify which cell as responsible for controlling the bleeding from microscopic to major tears in our tissues?

megakaryocytes

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 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.

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

Oprelvekin is a drug that stimulates the process of making which blood cells?

platelets

An older adult woman has experienced a sharp decline in her mobility and quality of life due to severe rheumatoid arthritis. As a result, her care provider has recently prescribed abatacept. This fusion protein inhibitor will achieve a therapeutic effect by what means?

preventing the activation of T cells

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

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? A. the client's response to a cardiac nonstress test B. the fact that the client is not pregnant C. the client's history regarding depression D. the quality of the client's social support network

the fact that the client is not pregnant

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."

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 plans to explain how the drug will help alleviate the fatigue and give her more energy, thus calming her fears. The nurse would include which statement to explain the action of drug?

"Chemotherapy kills cancer cells and blood cells, causing fatigue. Adding immunostimulants to stimulate the production of these cells would help you feel better."

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. 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."

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."

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." Correct response:

The parents of an infant are skeptical of immunizing their child, stating, "I've heard a lot about the risks of autism, and I'm not comfortable with increasing that risk." What is the nurse's best response?

"Could we talk about some of the risks that you heard about?" Explanation: The nurse should take an approach that is respectful and which fosters further dialogue without dismissing or downplaying the parents' concerns.

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 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?

"Has she ever been the recipient of a tissue transplant?"

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."

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."

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 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? A. "The drug is used if treatment with romiplostim does not work." B. "The drug is used to increase platelet count during chemotherapy." C. "The drug is used only after unsuccessful removal of the spleen." D. "The drug is used to prevent fluid retention."

"The drug is used to increase platelet count during chemotherapy."

The nurse is preparing to administer a dose of the human papillomavirus vaccine to a middle school student. What assessment question should the nurse prioritize when interacting with the student?

"What's your understanding of why you're getting this vaccination?" Explanation: The nurse cannot make the assumption that the client knows about the rationale for the vaccination. The client may know nothing about HPV or its relationship to her future cancer risk. This assessment question can be used to introduce client teaching. A middle school student is unlikely to know whether her parents or caregivers have ensured that her immunizations match the recommended schedule. The HPV vaccine does not require a booster and minimal - if any - side effects are anticipated. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

A client prescribed prednisone 40 mg daily should be provided what information about immunizations by the nurse?

"You should wait at least 3 months after chemotherapy to obtain a live vaccine immunization." Explanation: Clients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before being given a live virus vaccine. Immunizations are not contraindicated with short-term use (less than 2 weeks) or low to moderate doses (less than 20 mg daily) of prednisone. None of the other options present accurate information concerning immunizations for a client currently prescribed prednisone. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note

For the first time, a 10 year-old female has received an IM injection of Gardasil. What follow-up education should the nurse provide?

"You'll have to get another shot in around 2 months." Explanation: Gardasil requires a series, a with a second dose two months after the first. A fever is not expected, nor is stomach pain. Without the appropriate boosters, the client will not be protected later in life. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

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? A. "Chemotherapy causes nausea and vomitting. This medication will prevent dehydration." B. "This medication will help to prevent low thyroid which can result from chemotherapy treatment." C. "You are more likely to have hypertension now. This medication will prevent that from happening." D. "Your body is going to have trouble fighting off infections on it's own. This medication will help with that."

"Your body is going to have trouble fighting off infections on it's own. This medication will help with that."

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? A. "Your body is going to have trouble fighting off infections on it's own. This medication will help with that." B. "You are more likely to have hypertension now. This medication will prevent that from happening." C. "Chemotherapy causes nausea and vomitting. This medication will prevent dehydration." D. "This medication will help to prevent low thyroid which can result from chemotherapy treatment."

"Your body is going to have trouble fighting off infections on its own. This medication will help with that."

A post-transplant client is prescribed tacrolimus (Prograf) 0.03 mg/kg/d IV as a continuous infusion. The client weighs 220 lbs. How many mg of tacrolimus should the nurse administer during an 8-hour shift?

1 mg -The client's weight, in kilograms, is 100 kg (220 lbs divided by 2.2). Multiplying the client's weight (100 kg) by the prescribed daily dose per kg (0.03 mg) yields 3 mg per day. Dividing 3 mg by 3 gives the dose of 1 mg for an eight-hour shift (i.e. 1/3 of a day).

The onset of protection after the administration of an immune globulin to a client is rapid but its duration is short, typically which time frame?

1 to 3 months Explanation: While onset after immune globulin administration is rapid, the duration is short, only 1 to 3 months. Vaccinations have some minor adverse reactions, such as fever, rashes, and aching joints, are possible with the administration of a vaccine. In most cases, these reactions subside within 48 hours. It is recommended that the live virus vaccines be administered 14 to 30 days before or 6 to 12 weeks after administration of immune globulins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

A client bitten by a copperhead snake will benefit the most if the antivenin is administered within how long after exposure?

4 hours Explanation: The most effective response from an antivenin is obtained when the drug is administered within 4 hours after exposure. Longer than 4 hours the venom has spread more systemic and may not be beneficial. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

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

What client would be most likely to benefit from treatment with filgrastim (Neupogen)? A. A client who has a diagnosis of chronic hepatitis B B. A young adult client who has just been diagnosed with human immunodeficiency virus (HIV) C. A client who has recently undergone bone marrow transplant to treat leukemia D. A client who has recently undergone a prostatectomy for the treatment of prostate cancer

A client who has recently undergone bone marrow transplant to treat leukemia

The nurse at an ambulatory clinic has seen several clients with suspected or confirmed infectious diseases in recent days. Which client is most likely to benefit from the administration of an immune serum.

A client who is known to have contracted hepatitis B from sexual activity Explanation: There is a hepatitis B immune globulin, but none exists for influenza, tuberculosis or varicella. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosprorine? A. A client who has undergone treatment for malignant melanoma but who is now palliative B. A client who has multiple sclerosis and who has not responded to conservative treatment C. A client being treated for active pulmonary tuberculosis D. A client with chronic renal failure who is recovering from a kidney transplant

A client with chronic renal failure who is recovering from a kidney transplant

A client in the emergency department hasn't passed urine for four days and has developed periorbital edema. The client was diagnosed with anemia during a previous visit and was prescribed iron pills. The nurse expects that which of the following types of anemia would be a priority part of the initial workup?

Anemia in chronic kidney disease

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 client comes to the clinic asking what hematopoiesis means. Which of the following information would the nurse include in the teaching plan?

Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells.

The nurse explains the purpose of vaccines is to promote what? Select all that apply.

Active immunity Lifetime immunity Activation of the immune system Explanation: The word vaccine comes from the Latin word for smallpox, vaccinia. Vaccines are immunizations containing weakened or altered protein antigens that stimulate the formation of antibodies against a specific disease. They are used to promote active immunity that will last for a lifetime, although some clients will require smaller booster doses to maintain immunity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

A hospitalized client is about to receive immunological therapy and asks the nurse to explain the difference between passive and active immunity. In order to provide complete information, the nurse knows to include which information during the teaching session?

Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine). Explanation: Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine). Passive immunity occurs when immune globulin or antivenins are given to provide the person with ready-made antibodies from another human or animal. Cipro is an antibiotic, not an immunologic agent. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

A client has been exposed to hepatitis A after eating at a restaurant. The client's care provider has prescribed a dose of hepatitis A immune globulin. the nurse learns that the client has a history of chronic renal failure and successfully received a donor kidney three years ago. What is the nurse's best action?

Administer the immune globulin as prescribed Explanation: Organ transplants do not contraindicate the use of immune globulins, which do not differ significantly from the antibodies that are produced by active immunity. There would be no obvious reason to admit the client for care or to increase the client's fluid intake. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note

A 55-year-old presents at the Emergency Department reporting chest tightness and difficulty breathing. The client tells the nurse they had immune sera earlier that day at the clinic. What does the nurse suspect is happening with this client?

An allergic reaction to the immune sera Explanation: Adverse effects can be attributed either to the effect of immune sera on the immune system (rash, nausea, vomiting, chills, fever) or to allergic reactions (chest tightness, falling blood pressure, difficulty breathing). Local reactions, such as swelling, tenderness, pain, and muscle stiffness at the injection site are very common. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

The nurse is caring for a client diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant. What immunosuppressant could this client be prescribed that would treat both diagnoses?

Anakinra (Kineret)

A male client is brought to the Emergency Department (ED) after being bitten by a rattlesnake. The nurse asks the client to describe the snake that bit him. Why would the nurse ask this question?

Antivenin is very specific for antigens to which they can respond. Explanation: The term antivenin is used to refer to immune sera that have antibodies to venom that might be injected through spider or snake bites. These drugs are used to provide early treatment following exposure to known antigens. They are very specific for antigens to which they can respond. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

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 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.

The nurse at the pediatric clinic gives the mother of an infant a written record of the infant's immune sera use. The nurse encourages the mother to keep the information. What is the rationale behind keeping a written record of immune sera use?

Avert future reactions Explanation: Provide a written record of immune sera use and encourage the patient or family to keep that information to ensure proper medical treatment and to avert future reactions. Written records are not kept to keep track of where the immune sera was given or to identify who gave the immune sera or to identify the lot number of the immune sera used. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 586. Chapter 49: Immunologic Agents - Page 586 Add a Note

A client comes to the clinic to learn about pernicious anemia. Which of the following would the nurse include in the lesson plan?

Avoid contact with infection.

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.

What are important precautions a nurse should teach a client receiving an immunosuppressant? (Select all that apply.)

Avoid crowds. Take precautions to avoid getting pregnant. Keep follow-up appointments for laboratory assessments.

A client has undergone organ transplant and fears that she will die of a virus infection because of the postoperative anti-rejection drug therapy. The nurse should provide what information to the client about anti-rejection treatment?

CMV-IGIV is routinely administered for prevention of cytomegalovirus after organ transplant. Explanation: Cytomegalovirus immune globulin (CMV-IGIV) is routinely administered for prevention of cytomegalovirus infection after organ transplant. BIG-IV treats infant botulism. Imogam treats rabies exposure. Atgam is lymphocyte immune globulin administered as an anti-rejection agent. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note

A school nurse at a large high school is attempting to determine correct vaccine guidelines. What is the best source for current recommendations?

Centers for Disease Control and Prevention Explanation: Recommendations regarding immunizations change periodically as additional information and new immunizing agents become available. Consequently, health care providers need to update their knowledge at least annually. The best source of information for current recommendations is the Centers for Disease Control and Prevention. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

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? A. Chemotherapy-induced neutropenia B. Chemotherapy-induced alopecia C. Chemotherapy-induced hypertension D. Chemotherapy-induced bone pain

Chemotherapy-induced neutropenia

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 Headache Fever

The nurse is addressing with a nursing student the types of treatments to expect when caring for a client with chronic kidney disease. Which of the following would the nurse include in the lesson plan?

Colony stimulating factors are one type of immunostimulant that can boost the diminished cell count caused by chronic kidney failure.

Routine immunization can help reduce the spread of disease. Which of the following is a strategy that is used to promote routine immunization?

Combining vaccines so that only one injection is required Explanation: Two strategies to promote immunization are the development of combination vaccines and the administration of multiple vaccines during one visit to a health care provider. Combination vaccines decrease the number of injections, and giving multiple vaccines during a single visit allows patients to schedule immunizations more easily. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585. Chapter 49: Immunologic Agents - Page 585 Add a Note

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

Confirming the order with the prescriber

A 79 year-old client has been prescribed a single dose of influenza A vaccine 0.5 mL SC. What is the nurse's best action?

Contact the provider to confirm the route Explanation: The influenza vaccine is given IM, not subcutaneously. The dose is appropriate, but the nurse would have to confirm the route before performing education or administering the vaccine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 589. Chapter 49: Immunologic Agents - Page 589 Add a Note

The school nurse is interviewing the family of a 5 year-old who is beginning kindergarten. The parents state that the child's immunizations are all "up to date." The nurse recognizes that the child has immunity to what illnesses? Select all that apply.

Diphtheria Varicella Tetanus Hepatitis B Poliovirus Explanation: Childhood immunization schedules dictate immunizations against polio, diphtheria, varicella, tetanus and hepatitis B. Human papillomavirus is administered at age 11 or 12. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

The nurse is preparing for a visit with a 4-month-old infant. What immunizations will the nurse prepare? Select all that apply.

Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) Inactivated poliovirus vaccine (IPV) Haemophilus influenzae type b vaccine (Hib) Explanation: At 4 months of age, the child will receive a DTaP, Hib, IPV, and PCV. Varicella vaccine is not given until the child is at least 1 year of age, and Meningococcal is usually given at age 11 to 12 years unless the client is at high risk for development of the disease before that age. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585,588. Chapter 49: Immunologic Agents - Page 585,588 Add a Note

The mother of a preschool aged child brings her child to the clinic and asks what immunizations the child needs before starting school. What immunizations will the nurse expect this child needs if the child is healthy and has received immunizations on schedule in the past? Select all that apply.

Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) Inactivated poliovirus vaccine (IPV) Measles, mumps, and rubella vaccine (MMR) Hepatitis A Explanation: The 4- to 6-year-old, preparing to enter school needs booster DTaP, IPV, MMR, influenza and varicella. Hepatitis A vaccine is administered at age 2 or 3. HPV vaccine is given to older children. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

Which of the following types of cells supply our cells with oxygen from the lungs? (Choose one)

Erythrocytes

The nurse is administering cyclosporine. The nurse should anticipate the client may report which adverse reaction?

Excessive hair growth

The nurse administered an immunostimulant drug called oprelvekin to a female 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

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

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? A. Assess for cancer B. Administer a corticosteroid C. Have epinephrine available D. Avoid high-fat foods

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? A. Administer high-flow oxygen prior to administration. B. Have epinephrine available during administration. C. Administer a corticosteroid prior to administration. D. Avoid high-fat foods during the course of treatment.

Have epinephrine available during administration

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.

The process by which the body is stimulated to make more of a specific type of blood cells is known as which of the following? (Choose one)

Hematopoiesis

A client is undergoing a yearly physical. While discussing immunizations, the client states not wanting any immunizations because they can cause diseases. The nurse's best response is:

Immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. Explanation: In general, immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. However, risks and benefits for particular recipients should be considered because no vaccine is completely effective or completely safe. Some people may develop a disease after being immunized against it. However, if this happens, symptoms are usually less severe and complications are fewer than if the person had not been immunized. Adverse effects are usually mild and of short duration. Although the FDA evaluates vaccine safety before and after a vaccine is marketed, some adverse effects become apparent only after a vaccine is used in a large population. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

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 client with a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements related to iron deficiency. Which instructions should the nurse offer the client when providing care?

Increase intake of lean red meats.

The nurse has been administering interleukins to a client. What change in the client's health status would indicate successful therapy? A. Increase in the number of lymphocytes B. Maintenance of adequate circulating platelets C. Decrease in number of natural killer cells D. Decrease in inflammation

Increase the number of lymphocytes

The nurse administers aldesleukin to a client diagnosed with renal cell carcinoma. When assessing the client five days later, what abnormal findings should the nurse most likely attribute to the medication? Select all that apply.

Increased lymphocyte count Increased platelet count Irregular pulse rate

A patient has been administered folic acid for the treatment of megaloblastic anemia. The patient has informed the nurse that she has also been taking hydantoins. Which of the following conditions should the nurse monitor for in this patient due to the interaction of these two drugs?

Increased seizure activity

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 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: A. cardiac effects. B. hyperthyroidism. C. gastritis. D. nephrotoxicity.

Nephrotoxicity

A patient is administered cyclosporine (Sandimmune, Neoral) to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine?

Nephrotoxicity

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

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

A nurse is attending a professional development class on hematopoietic drugs used in treating clients with anemia. The class is designed to help the nurse create teaching plans for clients who experience the various types of anemia. The course syllabus would include which of the following types of anemia? Select all that apply.

Iron deficiency anemia Anemia in chronic kidney disease Pernicious anemia Folic acid deficiency anemia

A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's <b>best</b> response?

It is caused by a decrease in the number of RBCs.

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.

A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's best response? A. It is caused by a decrease in the number of RBCs. B. It is caused by inadequate production of WBCs. C. It is caused by a variety of reasons. D. It is caused by an increase in the number of platelets.

It is caused by a decrease in the number of RBCs.

The nurse is creating a public education blog for a health media company. The topic is megaloblastic anemia. Which of the following is an important food choice that the nurse would include on the public education website?

It is important to eat foods high in protein.

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 client is prescribed filgrastim. Which is the nurse's <b>best</b> explanation of how this drug works?

It stimulates growth and production of WBCs to fight off infection.

A mother has brought her infant to the clinic for the first immunization. What would the nurse be sure to include when providing education for the infant's mother?

Keep a written record of the child's immunizations. Explanation: Provide thorough client teaching, including measures to avoid adverse effects, warning signs of problems, and the need to keep a written record of immunizations, to increase knowledge about drug therapy and to increase compliance with the drug regimen. The nurse would not teach the mother to avoid having her child take more than one vaccine at a time; or to stop the immunizations after the age of 2 or to omit the immunizations if the injections are too upsetting to her child. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585. Chapter 49: Immunologic Agents - Page 585 Add a Note

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

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? A. Food allergies B. Rash C. Known hypersensitivity D. Asthma

Known hypersensitivity

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

The nurse is caring for a client who has been prescribed cyclosporine following organ transplant. While teaching the client about the medication, the nurse describes its adverse effects. What would the nurse include in the discussion? A. Hypotension B. Nephrotoxicity C. Bone marrow depression D. Graft rejection

Nephrotoxicity

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?

Low platelet and low white blood cell count.

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

Which of the following types of cells control the bleeding from microscopic to major tears in our tissues? (Choose one)

Megakaryocytes

The nurse is teaching a client about megakaryocytes. Which of the following information would the nurse include in the teaching plan?

Megakaryocytes are precursor cells to platelets.

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.

A client is administered cyclosporine to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine? A. nephrotoxicity B. congestive heart failure C. respiratory arrest D. anaphylaxis

Nephrotoxicity

A client is to receive erlotinib. The nurse would expect to administer this drug by which route? A. Subcutaneous B. Intramuscular C. Oral D. Intravenous

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: 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 discussing vaccines in class, a student asks the instructor what an antitoxin is? What is an example of an antitoxin?

Passive immunity Explanation: An antitoxin is an example of passive immunity. Antitoxins contain antibodies to very specific toxins. The antibodies are injected into the system and react with invading pathogens. Active immunity occurs when the body recognizes a foreign protein and begins producing antibodies to react with that specific protein or antigen. Vaccines are immunizations containing weakened or altered protein antigens that stimulate formation of antibodies against a specific disease. They are used to promote active immunity. Toxoids are vaccines that are made from the toxins produced by the microorganisms. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

The nursing instructor is discussing immunity with the clinical group. What statement would the instructor make that would be an accurate statement concerning immunity?

Passive immunity is limited. Explanation: Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies as with active immunity. People are born with active immunity in which the body recognizes a foreign protein and begins producing antibodies to react with specific proteins or antigens. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

Which statement should the nurse include in a discussion about passive immunity?

Passive immunity provides temporary protection from disease. Explanation: Passive immunity results from parenteral administration of immune serum containing disease-specific antibodies to a nonimmune person. Passive immunity is only temporary, and the person still needs a vaccine against a specific disease to develop antibodies that provide long-term immunity. It is inaccurate to characterize passive immunity as being safer than active immunity. Administration of antigens results in active immunity.

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 has undergone bone marrow transplant for the treatment of multiple myeloma. The client has been prescribed filgrastim (Neupogen) 6 mcg/kg IV daily. What outcome should indicate successful medication therapy to the nurse?

The client remains free of infection

The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues?

RBC's

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

When describing the action of trastuzumab, what should the nurse include?

Reaction with human epidermal growth factor receptor 2

A client comes to the clinic for follow-up for a diagnosis of hypertension. During the intake history, the nurse finds that the client is scheduled for epoetin alfa therapy. The nurse knows that the client's hypertension will need to be monitored closely during administration of the drug. Which of the following actions will the nurse take?

Report any rise in the blood pressure of 20 mm Hg or more in the systolic or diastolic to the primary care provider.

In reviewing a client's record, the nurse observes that the health care provider suspects a Vitamin B12 deficiency. What test is used to diagnosis a vitamin B12 deficiency?

Schilling test

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? A. Graft-versus-host disease B. Graft rejection C. Respiratory depression D. Serious infection

Serious infection

The nurse closely monitors a client who is receiving anakinra and etanercept for: A. severe infection. B. anemia. C. bleeding. D. hypersensitivity.

Severe 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.

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.

A client, currently undergoing chemotherapy, asks what type of immunizations to get in the next few months. Which is the nurse's best response?

Such clients should not be given live vaccines and should wait for 3 months after stopping chemotherapy to get the vaccines. Explanation: Clients with active malignant disease may be given killed vaccines but should not be given live vaccines. When vaccines are used, they should be given at least 2 weeks before the start of chemotherapy or 3 months after chemotherapy is completed. Passive immunity with immunoglobulins may be used in place of active immunity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note

Which is responsible for a delayed-type immune response?

T lymphocytes Explanation: T lymphocytes are responsible for a delayed-type immune response, seen in cell-mediated immunity. Antibody-mediated immunity involves the B lymphocytes and is referred to as humoral immunity. When exposed to an antigen, the B cells produce antibodies as a defense against the offending antigen. Macrophages are a type of large white blood cell in cell-mediated immunity that engulfs and destroys an antigen. An antibody is a globulin (protein) produced by the B lymphocytes as a defense against an antigen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. (T/F)

TRUE

Which intervention regarding the oral administration of mycophenolate should the nurse encourage the client to implement to minimize the risk of undesired effects? A. taking the pill only if there are early signs or symptoms of infection B. crushing the pills and mixing them with applesauce or jam C. holding the pill under the tongue for 30 seconds before swallowing D. taking the pills on an empty stomach

Take the pills on an empty stomach

A 45-year-old female client is being seen at the oncology clinic for a two-year follow up for cancer. Within the past two days, the client was exposed to hepatitis A and requests immune globulin prophylaxis. The nurse checks the electronic health record and discovers the client has had extensive immunosuppressive drug therapy in the past. The nurse knows that the client's history guides the nurse to take which of the following actions?

Teach the client that the administration of immune globulin is contraindicated for clients with a history of immunosuppressive drug therapy and leukemia. Explanation: The administration of immune globulin is contraindicated for clients with a history of immunosuppressive drug therapy and leukemia. The administration of immune globulin is contraindicated for both males and females with a history of cancer or immunosuppressive drug therapy. Immune globulin prophylaxis is indicated for up to two weeks after exposure to Hepatitis A. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note

A nurse is assigned to care for a client with iron deficiency anemia who is prescribed iron therapy. Which should the nurse confirm to ensure that iron compounds are not contraindicated in this client?

The client does not have hemochromatosis.

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? A. The patient may have misunderstood the potential benefits of interferon alfa-2a. B. The patient is likely becoming aware of psychosocial issues that surround interferon alfa-2a treatment. C. The patient is likely to experience a compensatory period of mania in the coming days. D. The patient may be having psychological adverse effects of interferon alfa-2a.

The patient may be having psychological adverse effects of interferon alfa-2a

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.

A 72-year-old female client has come to the primary care provider's office asking for the varicella virus vaccine to prevent shingles. The nurse knows that the vaccine can only be administrated to people who have never had herpes zoster before for which reason?

The varicella virus vaccine contains the live, attenuated varicella virus that causes a mild form of the infection, producing immunity against the virus. Explanation: The varicella virus vaccine contains the live, attenuated varicella virus that causes a mild form of the infection, producing immunity against the virus. The varicella virus vaccine does not include killed varicella virus. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 581. Chapter 49: Immunologic Agents - Page 581 Add a Note

The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects.

True

The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. T/F

True

True or False Most of the drugs that affect the immune system are not recommended for use in children or have not been tested in children.

True

True or False: The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects.

True

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? A. CD4 count B. White cell differential C. HIV viral load D. C-reactive protein level

White cell differential

A client asks what neutropenia is. Which is the nurse's best response? A. a problem associated with old age B. a disease where the body has to fight infections C. a condition when the neutrophil level is very low D. an issue with red blood cells and their ability to carry oxygen

a condition when the neutrophil level is very low

Which statement best describes the recommended vaccination schedule for a 63-year-old client?

a tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age Explanation: Recommended immunizations for older adults have usually consisted of a tetanus-diphtheria (Td) booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age. A second dose of pneumococcal vaccine may be given at 65 years if the first dose was given 5 years previously. None of the other options present accurate information concerning currently recommended vaccination scheduling for older clients.

A client receives an immunization. The nurse interprets this as providing the client with which type of immunity?

artificially acquired active immunity Explanation: Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease. Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity.

A client is scheduled to receive an immunization. Administration of live vaccine is contraindicated in the client with:

steroid therapy. Explanation: A risk of producing disease exists with live vaccines, especially in people with impaired immune function. Clients who are on steroid therapy should not receive live vaccines due to impaired immune function. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Clients over the age of 65 should receive immunizations as needed to protect from infectious disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note

When describing the various types of blood cells, which cell type would the instructor describe as supplying our cells with oxygen from the lungs?

erythrocytes

Which are common adverse reactions that is included in teaching a client about epoetin? Select all that apply.

fatigue nausea headache

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

filgrastim

The nurse should monitor clients receiving human immune globulin intravenous (IGIV) products closely for problems with which organs?

kidneys Explanation: IGIV products have been associated with renal impairment, acute renal failure, osmotic nephrosis, and death, so the nurse should monitor a client's renal function carefully during the administration of IGIV products. The liver, heart, and lungs are not affected. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note

When educating clients on the immune system, the nurse identifies which white blood cells to be involved in cell-mediated immunity (CMI) along with T lymphocytes?

macrophages Explanation: Macrophages are involved in maintaining CMI along with T lymphocytes. Macrophages are large cells that surround, engulf, and destroy microorganisms and cellular debris. T lymphocytes and macrophages work together to destroy the antigens in CMI. T lymphocytes attack the antigens directly without producing antibodies. Neutrophils, eosinophils, and basophils are not associated with T lymphocytes in cell-mediated immunity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

A client about to receive an injection of influenza vaccination should be informed of the possibility of experiencing which short-term adverse effect? Select all that apply.

malaise muscle aches low-grade fever erythema at the injection site Explanation: Influenza vaccine via injection may cause pain, induration, and erythema at injection sites and flu-like symptoms such as chills, fever, malaise, and muscle aches. Anorexia is not generally associated with the short-term adverse effects of an influenza vaccination.

When teaching new parents about the benefits of adhering to the recommended vaccination schedule for their infant, the nurse should cite protection against which diseases? Select all that apply.

measles varicella poliomyelitis hepatitis B Explanation: Measles, varicella, polio, and HBV are all within the schedule of infant vaccinations. The zoster vaccination to prevent herpes zoster (shingles) is recommended for adults 60 years and older. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note

The school nurse at a junior high school shares with the student's parents that which vaccination will require administration of booster?

meningococcal vaccine Explanation: Adolescents should receive meningococcal vaccine at age 11 or 12 with a booster dose at age 16. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 587. Chapter 49: Immunologic Agents - Page 587 Add a Note

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

The administration of immune globulins or antivenins to a client is a form of what type of immunity?

passive immunity Explanation: Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity. Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

A nursing student is scheduled to receive the hepatitis B series. What type of immunity will this immunization provide?

passive immunity Explanation: The hepatitis B series produces passive immunity. Passive immunity occurs when antibodies are formed by the immune system of another person or animal and transferred to the host. Active immunity is produced by the person's own immune system in response to a disease caused by a specific antigen or administration of an antigen from a source outside the body, usually by injection. Innate or natural immunity, which is not produced by the immune system, includes the general protective mechanisms. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note

Oprelvekin is a drug that stimulates the process of making which blood cells? A. neutrophils B. monocytes C. lymphocytes D. platelets

platelets

A nurse is educating a group of nursing students about the contraindications of human immune globulin. Which would the nurse include? Select all that apply.

preexisting renal disease age more than 65 years diabetes mellitus Explanation: Human immune globulin intravenous (IGIV) product can cause renal impairment, osmotic nephrosis, and death as its complications. Hence, it is contraindicated in individuals with acute renal failure, pre-existing renal disease, or diabetes mellitus; individuals older than 65 years; or clients receiving nephrotoxic drugs. Human immune globulin is not contraindicated in pregnancy or anemic disorders but should be administered with caution. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note

A group of students are reviewing class material about immunizations and vaccines. The students demonstrate understanding of the topic when they state that immunizations and vaccines:

provide the person with active immunity. Explanation: Vaccines provide active immunity. Severe reactions are rare. The person experiences an immune response without having to suffer the full course of the disease. Vaccines promote the formation of antibodies against a specific disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, pp. 580-581. Chapter 49: Immunologic Agents - Page 580-581 Add a Note

Which conditions in a client's history should the nurse report to the health care provider who prescribed epoetin alfa? Select all that apply.

seizures hypertension congestive heart failure

The nurse closely monitors a client who is receiving anakinra and etanercept for:

severe infection.

A student asks the instructor how vaccines provide active immunity. The instructor's best answer explains that active immunity is provided by stimulating production of antibodies to a:

specific protein. Explanation: Vaccines provide active immunity by stimulating production of antibodies to a specific protein, which may produce the signs and symptoms of a mild immune reaction, but protects the person from the more devastating effects of disease. All responses are essentially correct. However, "a specific protein" is the best answer to the question. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

When describing cell-mediated immunity, a nurse would explain that this type of immunity depends on which response or action?

the action of T lymphocytes Explanation: Cell-mediated immunity depends on the actions of T lymphocytes. Antibody-mediated immunity involves the B lymphocytes and is referred to as humoral immunity. When exposed to an antigen, the B cells produce antibodies as a defense against the offending antigen. Antigen--antibody response is antibodies formed in response to exposure to a specific antigen. Globulins are proteins present in blood serum or plasma that contain antibodies. Immune globulins are solutions obtained from human or animal blood containing antibodies that have been formed by the body to specific antigens. Globulin production occurs when antigens are present. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note

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 client being vaccinated for measles asks the nurse about the contents of the vaccine. During the explanation, the nurse mentions a poisonous substance produced by some bacteria that is capable of stimulating antitoxin production. Which is the nurse referring to in the explanation?

toxin Explanation: A toxin is a substance that is capable of stimulating the body to produce antitoxins, which act in the same manner as antibodies. Toxins are powerful substances, and they can be attenuated and used as toxoids to produce antitoxins. Toxoids are attenuated toxins, which are capable of stimulating antibody production and creating immunity. Vaccines are attenuated or killed antigens, which are capable of stimulating antibody production and creating immunity. Immune globulins are antibodies containing solutions formed to specific antigens and are obtained from human or animal blood. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

The nurse must administer which to a client prior to exposure to the disease-causing organism in order for the client to be protected against the disease?

toxoids Explanation: The nurse must administer toxoids and vaccines to a client prior to exposure to the disease-causing organism in order for the client to be protected against the disease. Immune globulins are solutions obtained from human or animal blood containing antibodies that have been formed by the body to specific antigens. Antivenins are used for passive, transient protection from the toxic effects of bites by spiders (black widow and similar spiders) and snakes (rattlesnakes, copperhead and cottonmouth, and coral). An antibody is a globulin (protein) produced by the B lymphocytes as a defense against an antigen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note

What common adverse reactions of tacrolimus should the nurse teach the client? (Select all that apply.)

tremors hair growth gum hyperplasia

Which of these conditions or lifestyle choices would put clients at risk for developing a B12 deficiency? Select all that apply.

vegan lifestyle gastric cancer ulcerative colitis

A 70-year-old client is seen in the family practice clinic. Which vaccine should be administered to prevent herpes zoster?

zoster vaccine Explanation: Zoster vaccine is administered to adults 60 years and older to prevent herpes zoster (shingles). The Haemophilus influenzae type B is not administered to prevent herpes zoster. HPV and pneumococcal vaccine do not address the risk factors for shingles. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 589. Chapter 49: Immunologic Agents - Page 589 Add a Note