NUR 2144 Pharmacology Chapter 17 Immune Modulators

A client is receiving etanercept for treatment of rheumatoid arthritis. The health care provider has decided to add anakinra to the regimen. When the nurse is teaching the client about this new drug regimen, what is the highest-priority teaching point to stress?

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

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

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

A 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?

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

The nurse is teaching a client receiving interferon therapy about measures to combat possible adverse effects. Which statement by the client indicates the need for more teaching?

"I need to be out in the sun so that I can get vitamin D."

A home care nurse is caring for a client who has received a liver transplant. The nurse is reinforcing earlier teaching about the client's immunosuppressant therapy and the need for appropriate self-care. Which client statement suggests that the client understands?

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

A client is undergoing chemotherapy for vulvar cancer. The client had a friend who died after treatment, which has caused severe anxiety and fear; the client is constantly tired and sees this as an indication she won't survive. The nurse knows that the client is scheduled for immunostimulant drug therapy to support the hematopoietic system. The nurse would include which statement to explain the action of drug?

"Taking immunostimulants to stimulate the production of blood cells will help you feel better."

The nurse is preparing 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."

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?

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

A client is administered mycophenolate to prevent rejection of the transplanted heart. It is recommended that the client have a CBC drawn weekly. The client asks the nurse the reason for the weekly CBC. What is the nurse's best response?

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

A nurse is 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."

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."

What client would be most likely to benefit from treatment with filgrastim (Neupogen)?

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

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

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

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

Alefacept

The pharmacology instructor is talking about interferon. The instructor explains that agents such as interferons have more than one biologic function. What are the functions of interferons? (Mark all that apply.)

Antiviral Immunomodulatory Antiproliferative

The nurse is discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan?

Arrhythmia

A 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 medical history. Inspect for the presence of any skin lesions. Obtain a baseline electrocardiogram. Assess for allergies.

The nurse educator is teaching a class of students about the actions and uses of colony stimulating factor. The nurse should inform students CSF is indicated for what secondary problem related to cancer treatment?

Chemotherapy-induced neutropenia

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

Continue the medication because it is lifelong therapy.

The health care provider has decided to prescribe T- and B-cell suppressors for a client diagnosed with psoriasis. What drug will be ordered for this client?

Cyclosporine

Which would the nurse expect to administer orally?

Cyclosporine

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

Cyclosporine .

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

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

Ensure the client has adequate intravenous access

The nurse has an order to administer oprelvekin to a patient for the first time. Prior to administering the drug, what would the nurse question the patient about?

Escherichia coli products

Interleukins act to prevent virus particles from replicating inside the cells.

False

A 45-year-old male patient is receiving interferon alfa-2a therapy for hepatitis C. The nurse should teach the patient that he may experience which adverse effect?

Flu-like symptoms

Which adverse reactions should the nurse discuss with a client prior to the administration of oprelvekin ? (Select all that apply.)

Fluid retention Syncope Fever

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?

Have epinephrine available

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 what condition?

Hepatotoxicity

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?

Hypertension

A nurse is caring for a patient who is receiving azathioprine following kidney transplant. For what serious adverse effect should the nurse monitor the patient?

Infection

A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality?

Infections

A group of students are reviewing information about immune modulators in preparation for a test. The students demonstrate understanding of the material when they identify what as an immune stimulant?

Interferon

After teaching a group of students about immune modulators, the instructor determines that additional teaching is needed when the students identify what as an immune suppressant?

Interferon alfa-2b

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

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

A female client's physician prescribes leflunomide for her rheumatoid arthritis. Six months later, the client presents for routine laboratory testing. The physician would discontinue the medication if what laboratory test was abnormal?

LFT

A client is being treated for malignant melanoma 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 34-year-old man is prescribed interferon alfa-2a for the treatment of chronic hepatitis C. When teaching John about the medication, which side effect will the nurse explain is among the most common?

Nausea and changes in taste

A client is administered cyclosporine to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine?

Nephrotoxicity

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?

Nephrotoxicity

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

Oral

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

Organ transplantation

An adult client experienced a kidney transplant 2 days ago, and the 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 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

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

Prednisone

The nurse is caring for a child who will be receiving a renal transplant and who has been prescribed cyclosporine. When teaching the parents and child about this drug, the nurse should explain what primary rationale for administering this drug?

Prevention of organ rejection

A client is receiving anakinra for treatment of rheumatoid arthritis. The client is scheduled to have arthroscopic evaluation of the right knee. What is the priority nursing diagnosis for this client after the procedure?

Risk for infection

What is an adverse effect of excessive immunosuppression?

Serious infection

A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action?

Stop the drug immediately.

A female client is prescribed cyclosporine after her bone marrow transplant. What is the mechanism of action of cyclosporine that makes this an ideal drug for this patient?

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

A client has been discharged from the hospital after a kidney transplant. Which nursing intervention is the first line of defense against the immunosuppressant client developing an infection?

Teach the client the importance of personal hygiene.

A client has been placed on tacrolimus, and the route will be changed from IV to oral prior to discharge home from the hospital. How will this change in administration route affect the client's plan of care?

The client's dose of tacrolimus will have to be increased.

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 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 patient has been newly diagnosed with malignant melanoma. The patient is taking phenytoin for a seizure disorder, and Intron-A has been prescribed. What is the nurse aware will probably occur?

The phenytoin dose will be decreased.

The pharmacology instructor is explaining interleukins to the class. What would be the best definition of interleukins?

They are chemicals used to communicate between leukocytes and are produced by T cells.

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

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

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

To increase white blood cells

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

True

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 best response?

a condition when the neutrophil level is very low

The nurse will appraise the success or failure of treatment of filgrastim therapy by regularly monitoring the results of what diagnostic test?

absolute neutrophil count

The nurse 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.

What is the role of interferons in the normal function of the immune system?

countering the replication and spread of viruses

Which are the LEAST serious adverse effects associated with the use of monoclonal antibodies? Select all that apply.

diarrhea fever malaise

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?

grapefruit juice

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

history of chronic renal impairment

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

platelets

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

severe infection.

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

taking the pills on an empty stomach