module 7

Avoid alcohol

A nurse is discussing interferon alfa-2b with a patient. What will the nurse encourage the patient to do while taking this drug?

increased risk of infections.

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:

Adhering strictly to the prescribed administration schedule

A 40-year-old, diagnosed with myasthenia gravis (MG), is scheduled to begin treatment with oral neostigmine. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on what personal behavior?

"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."

A 42-year-old client is experiencing chemotherapy-induced thrombocytopenia. The nurse is providing information to the client regarding the medication oprelvekin. Which information would the nurse include in the explanation?

infection.

A 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to:

atropine.

A 78-year-old client is admitted to the Emergency Department (ED) and is diagnosed with bradycardia. The client tells the nurse that the client is taking donepezil (Aricept), a cholinergic agent, for Alzheimer's disease. The nurse knows that the drug of choice for bradycardia is:

Infections

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?

a condition when the neutrophil level is very low

A client asks what neutropenia 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?

It stimulates the parasympathetic nervous system.

A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?

Cholinergic drugs

A client has atony of the smooth muscle of the gastrointestinal tract. Which type of medication will be administered to increase smooth muscle strength?

grapefruit juice

A client has been prescribed oral cyclosporine following a successful liver transplant. When providing education, the nurse should advise the client to avoid mixing the drug with what liquid?

Cholinergic overdose

A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. The nurse prepares to intervene for what condition?

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

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?

Oral

A client is placed on tacrolimus and has an increased blood urea nitrogen level. Based on this finding, which route of administration is preferred?

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

A client is prescribed filgrastim. Which is the nurse's best explanation of how this drug works?

The importance of keeping the home clean

A client is receiving immunosuppressant therapy. Which adverse effects should the client be educated about regarding these effects?

oral

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

Miosis

A client receives carbachol eye drops. Which effect would the nurse expect to assess?

A patient with asthma

A nurse is monitoring a patient with Alzheimer's disease for initiation of therapy. In which patient is the administration of donepezil contraindicated?

take the medication with food.

A client taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the client to do which?

"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."

A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response?

Parkinson's disease

A client with Alzheimer's disease is being treated with the medication Exelon. The nurse knows that this drug is also used to treat which disorder?:

Contact the health care provider as the client may be experiencing a cholinergic crisis.

A client with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. When the nurse finds the client anxious, diaphoretic, and visibly flushed, what action should the nurse take to best assure the client's safety?

Namenda.

A client with advanced-stage Alzheimer's disease is seen by a health care provider who prescribes a newer drug that is not a cholinesterase inhibitor. This drug is a N-methyl-D-asparate (NMDA) receptor antagonist. This drug is better known as:

Direct-acting cholinergic drug

A female client had surgery 24 hours ago to repair a hernia. The nurse finds that the client has not had a bowel movement since the day before the surgery. She is experiencing abdominal distention, and during auscultation the nurse notes an absence of bowel sounds. Further examination and testing reveal a paralytic ileus. The provider orders bethanechol. The nurse is aware that bethanechol is included in which drug classification?

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?

Increased risk of GI bleeding

A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient?

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

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?

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?

To increase white blood cells

A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect?

Continue the medication because it is lifelong therapy.

A male client received a kidney transplant 2 years ago. He asks the provider if he may begin to wean himself off of the immunosuppressive drug therapy. He is healthy and works as an engineer full time, and he finds the cost of the medication prohibitive. What would the nurse expect the health care provider to do?

sudden muscle weakness

A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up?

Restore anticholinesterase function

A military nurse is part of a team reviewing the appropriate response to chemical weapons attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment?

cholinergic medications' ability to stimulate the parasympathetic nervous system.

A new patient has come to the clinic. The patient tells the nurse that the patient takes Aricept. It would be important for the nurse to assess the patient's medical and medication history because many bodily functions are affected by the:

30 to 90 minutes

A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration?

Cholinergic crisis

A nurse is caring for a 49-year-old client who has been taking bethanechol for treatment of neurogenic bladder. After one week, the client develops sweating, heavy salivation, and bronchospasm. What would the nurse suspect is happening with this client?

orange juice.

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:

"They regulate the production of erythrocytes."

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?

Infection

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?

Myasthenia gravis ( droopy eyelids and mouth A weakness and rapid fatigue of muscles under voluntary control. The condition is caused by a breakdown in communication between nerves and muscles. Symptoms include weakness in the arm and leg muscles, double vision, and difficulties with speech and chewing.)

A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem?

"The patient has increases in the number of natural killer cells."

A nurse is precepting a nursing student, and together they are caring for a patient who is to receive interleukins. The student nurse asks what happens physiologically when a patient receives interleukins. What would be the nurse's best response?

Acetylcholine

A nurse is preparing to administer a cholinergic medication. To prepare to administer the medication, the nurses is assessing the client for anticholinergic effects. Cholinergic medications act like which neurotransmitter?

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:

Platelets

A nurse is reviewing the laboratory values of a client admitted for gastrointestinal bleed. Which cells control bleeding?

Bethanechol

A nurse is reviewing the medication history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would most likely identify which drug?

Rotate sites to a dry area daily. Document the placement of the medication. Place the medication on an area where the client will not pick at or remove.

A nurse is teaching a caregiver of a client diagnosed with AD about the medications. What are necessary to include in the teaching about rivastigmine? Select all that apply.

It should be taken on an empty stomach.

A nurse is teaching a client about an iron supplement. Which should be included in the teaching a client about this medication?

Cholinergic crisis

A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following?

Risk for Injury related to dizziness and fatigue

A nursing student is preparing a care plan and is choosing a nursing diagnosis for her client with Alzheimer's disease. The client is taking Exelon. Which would be an appropriate nursing diagnosis for this client?

Parasympathomimetic drug Cholinergic drug

A nursing student is preparing to administer the drug bethanechol to a client with urinary retention. After researching the drug's actions and uses, the student demonstrates understanding of the drug by identifying it as which type of medication? Select all that apply.

"I should expect the medication to decrease pressure in my eye."

A patient has just received carbachol (Miostat). Which statement indicates the patient understands the nurse's teaching about this medication?

Have epinephrine available

A patient 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?

blood in stool.

A patient receiving neostigmine uses naproxen for relief of low back pain. The nurse would caution the patient to report:

orally

A patient with dementia of Alzheimer's disease is prescribed rivastigmine by the primary health care provider. Which is the correct method of administering rivastigmine to the patient?

Prednisone

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

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?

Neostigmine

After teaching a group of students about indirect acting cholinergic agonists used to treat myasthenia gravis, the instructor determines that the teaching was effective when the students identify which agent?

apply the patch to the client's back to reduce the chance that he will remove it.

An 83-year-old client has a diagnosis of moderate Alzheimer's disease. The client's physician recently prescribed oral rivastigmine, but the client was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should do which?

Schilling test

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?

urinary retention or postoperative abdominal distention due to paralytic ileus.

Cholinergic drugs are contraindicated in all situations except in clients with:

Alzheimer's disease.

Decreased acetylcholine levels are characteristic of what disorder?

ex2 module7

Immune Modulators chapter17

True

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

Pregnancy status

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?

platelets

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

She may develop an infectious process at the clinic.

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:

Weak and easily fatigued muscles

The client has been diagnosed with myasthenia gravis. The nurse knows that which is a symptom of myasthenia gravis?

Urinal, bed pan, and call light

The client is ordered bethanechol subcutaneously. After giving the client the injection of bethanechol, the nurse should make sure that what is available?

"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?

Atropine

The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?

bethanechol

The health care provider is preparing to write a prescription for a client diagnosed with urinary retention. Which medication does the nurse expect to be prescribed?

Improved memory

The nurse administered donepezil (Aricept) to a patient. What is the therapeutic response the nurse expects to assess?

This is cholinergic crisis, and the provider needs to be notified immediately.

The nurse administered neostigmine to a client with myasthenia gravis. The nurse is doubling the dose that the client was taking at home. Three hours later, the nurse is assessing the client and notes the following symptoms: nausea with vomiting, diarrhea, and sweating. What does the nurse interpret these symptoms to be?

Increased voiding

The nurse administers a drug that will increase micturition. What should the nurse assess for a therapeutic effect?

severe infection.

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

Chemotherapy-induced neutropenia

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?

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?

White cell differential

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?

"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?

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?

Edrophonium

The nurse is caring for a client in the emergency department who has a history of myasthenia gravis. The client has symptoms that could be interpreted as either myasthenic crisis or cholinergic crisis. The nurse is aware that the health care provider will order what medication to help determine the type of crisis the client is experiencing?

Nephrotoxicity

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?

taking the pills on an empty stomach

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

Alzheimer's disease

The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition?

excessive stimulation of the parasympathetic nervous system

The nurse is caring for a client who is receiving neostigmine for the treatment of myasthenia gravis. The nurse is aware that a potential complication of the treatment is cholinergic crisis, which is characterized by which event?

Bronchoconstriction

The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause which effect?

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

The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosporine?

Review the purpose of the drug therapy with the patient and family.

The nurse is developing a teaching plan for an outpatient receiving cholinergic drugs. What should be the role of the nurse when developing a 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?

Having small, frequent meals

The nurse is preparing a teaching plan for a client who is taking rivastigmine. What precaution should the nurse teach the client and family to minimize the risk of adverse GI effects?

Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration.

The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching?

Atropine

The nurse is providing information about how to care for clients during a bioterrorism attack. The nurse knows that which drug will be administered in the case of a sarin attack?

Parasympathetic nervous system

The nursing instructor is discussing cholinergic drugs with his clinical group. What system would the instructor tell the students is stimulated by cholinergic drugs?

Degeneration of cholinergic pathways

The nursing instructor is teaching students about Alzheimer's disease. The instructor informs the students that clients with this illness experience problems with memory and thinking. The reason that this happens is which?

Alzheimer's

The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which?

Improve cholinergic neurotransmission to the brain

The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms?

Lung auscultation

What assessment should the nurse perform when monitoring for the most serious adverse effects that can occur with the use of monoclonal antibodies?

history of chronic renal impairment

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

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)?

Serious infection

What is an adverse effect of excessive immunosuppression?

Urinary urgency

When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find?

Interferon alfa-2b

Which agent would be classified as an immune stimulant?

Donepezil

Which agent would be most appropriate to administer to a client with Alzheimer's disease?

Organ transplantation

Which is the most likely indication for the use of immunosuppressant agents?

platelets

Which laboratory values should a nurse monitor for a client prescribed oprelvekin?

Donepezil

Which medication would the nurse expect to administer orally once a day to a client with AD?

"I know that I will need to stay on this medication for the rest of my life."

Which statement indicates that the client understands immunosuppressant therapy following a solid organ transplant?

They interfere with the ability of viruses in infected cells to replicate.

While studying for a pharmacology test, a student asks peers about interferons. What statement about interferons is true?

Cyclosporine

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