pharm exam 3
The nurse has instructed a patient diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine. Which patient statement demonstrates a need for additional teaching?
"I do not need to use condoms as long as I take my medication as prescribed."
Which instruction does the nurse give to the patient regarding basiliximab?
"Use effective contraceptive measures before beginning treatment, during treatment, and for 4 months after the completion of therapy."
Enfuvirtide
- Anti HIV: Fusion Inhibitor - Action: Prevents HIV entry into healthy cells by inhibiting fusion of the virus to healthy cell membranes Side effects: , allergic reactions, Rash, diarrhea Injection site reactions Anaphylaxis, fever, hypotension
Maraviroc (MVC)
- Antiretroviral Drugs - Chemokine (CCR5) Coreceptor Antagonists - Action: Prevents viral replication by blocking CCR5 coreceptor needed for CCR5-tropic HIV entry into immune cells - Side effects/adverse effects: Upper respiratory infection, cough, pyrexia Rash, dizziness Abdominal pain Hepatotoxicity
Dolutegravir (DTG), Eelvitegravir (EVG), and Raltegravir (RTG)
- Antiretroviral Drugs - Integrase strand transfer inhibitors (INSTIs) - Action: Limits ability of virus to replicate and infect new cells by interfering with integrase (enzyme needed for HIV to multiply and divide) - Side effects: Nausea, diarrhea, Rash, insomnia, headache, pyrexia, Myopathy, hepatic damage, Rhabdomyolysis
Efavirenz
- Antiretroviral Drugs - Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - Action: Binds directly to reverse transverse transcriptase enzymes blocking DNA polymerization - pills cannot be crushed - Side effects/adverse effects: Dizziness, sedation, loss of concentration, Rash, nightmares, euphoria Hepatotoxicity, Stevens-Johnson syndrome
Tenofovir Disoproxil Fumarate (TDF) Zidovudine (ZDV)
- Antiretroviral Drugs - Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) - Action: Inhibit viral replication by interfering with HIV viral RNA-dependent DNA polymerase - Can take NRTIs without regard to food - Side effects/adverse effects: Nausea, diarrhea, rash, abdominal pain, Peripheral neuropathy, pancreatitis, lipoatrophy, myopathy
Trimethoprim/Sulfamethoxazole
- Bactrim - treat pneumocystis jiroveci pneumonia which is bacterial
The nurse would identify which of the following as examples of passive immunity? (Select all that apply.)
- Immune-globulin to provide antibodies against a specific disease - Antibodies from an outside source, such as the mother's placenta and breast milk
The patient has been taking ritonavir for a week and informs the nurse that the patient is experiencing occasional episodes of abdominal discomfort. What patient teaching will the nurse provide to the patient? (Select all that apply.)
- Instruct the patient to report episodes that increase in intensity or frequency. - Instruct the patient to stop taking the medication. - Reassure the patient that this is an expected side effect of the medication.
Postexposure prophylaxis regimens (PEP)
- PEP regimen should be initiated within 72 hours of the event and continued for 4 weeks. - Health care workers taking PEP have reported adverse reactions with the most common reactions being nausea, malaise, and fatigue
induction therapy
- Provides intense immunosuppression with drugs designed to diminish antigen presentation and T-cell response - Reduces risk of acute rejection during initial transplant period
The nurse advises human immunodeficiency virus (HIV)-positive patients about blood draws to obtain a CD4+ count. What is the correct information to give them about when and how this laboratory blood work should be done?
- The patient's viral load will become and remain undetectable. - The patient will not experience secondary infection. - The patient will promptly report new onset of symptoms and side effects. - The patient will adhere to the medication regimen and will report any difficulties related to adherence.
Antiretroviral Drug Therapy in Pregnancy
- Timing: Timing of initiation of treatment and the selection of regimens for pregnant patients may differ from those for nonpregnant adults or adolescents. - Goal: Achieve maximal and sustained viral suppression during pregnancy to prevent perinatal transmission. - Transmission: HIV-infected patients can transmit the virus during pregnancy, labor, delivery, and breastfeeding
opportunistic infections
- Tuberculosis infection: Usually affects lungs, may affect other organs - Kaposi sarcoma: Dark blue lesions in skin, mucous membranes, GI tract, lungs, or lymph nodes - Pneumocystis jiroveci pneumonia: Fungal infection in the lungs - Toxoplasmosis: Encephalitis due to protozoan found in uncooked meat and cat feces - Cryptosporidiosis: Infection usually in bowel mucosa due to protozoan parasite - Mycobacterium avium complex: Blood infection due to bacteria related to M. tuberculosis - Cytomegalovirus: Infection due to virus infecting entire body especially as retinitis leading to potential blindness
Atazanavir (ATV)
- antiretroviral drug - Action: Inhibits protease activi ty causing formation and release of immature, defective, and noninfectious virus particles - Side effects/adverse effects: Rash, nausea, vomiting, diarrhea Dyslipidemia, insulin resistance, Hemolytic anemia, Stevens-Johnson syndrome, EKG changes, MI
active immunity
- body produces antibodies - Natural immunity
cyclosporine, tacrolimus
- calcineurin inhibitors - Action: Suppress immune system by binding to cytoplasmic proteins that inhibit calcineurin phosphatase - Inhibits T-lymphocyte proliferation - Caution with cyclosporine: Avoid grapefruit and grapefruit juice --> May be given with orange or apple juice to improve taste
antithymocyte globulin (rabbit) rATG
- drug for Transplant Rejection When the immune system attacks - Action: Block T-cell membrane proteins - Cause altered T-cell function and lysis and prolonged T-cell depletion
Muromonab-CD3
- drug for transplant rejection -Action: Bind to CD3 complex on the surface of T lymphocytes - Quickly remove CD3 positive T lymphocytes from circulation
basiliximab, alemtuzumab
- drugs used for induction therapy before transplant - Action: Inhibits activation of lymphocytes --> Prevents body from mounting immune response against transplanted organ - calcineurin inhibitors - side effects: abdominal and back pain, fatigue, weakness, fever chills Dizziness, cough, sore throat, dyspnea, nausea, vomiting, Dysuria, edema, tremor, malignancy, blood dyscrasias, Sepsis, superinfection, cytokine release syndrome, Diabetes mellitus, capillary leak syndrome, anaphylaxis
Mycophenolate mofetil
- inosine monophosphate dehydrogenase inhibitors - Action: Block synthesis of purine nucleotides - Prevent proliferation of T-cells and lymphocytes - Prevent antibody formation from B cells - Inhibit recruitment of leukocytes to inflammatory sites
sirolimus, everolimus
- mammalian target of rapamycin inhibitors - iInhibit T-lymphocyte activation and proliferation - Inhibit antibody production
Nystatin
- prevents or treats thrush in mouth and esophagus - for fungal infection
Azathioprine
- purine antimetabolites - Action: Block purine metabolism and DNA synthesis - Suppress T- and B-lymphocyte proliferation - Use: Kidney transplant rejection
A 14-year-old girl requests a vaccination for human papillomavirus. After the nurse administers the first dose, which of the following is important to include in the patient's teaching?
. The date the patient needs to return to the clinic for the next human papillomavirus dose.
Which initial dose of basiliximab does the nurse anticipate to administer to a child who weighs 38 kg? (recommended dose is 5mg/kg IV)
20 mg
In organ transplant recipients taking nystatin for prevention of oral thrush, prophylactic use is to be discontinued when concomitant steroid administration is reduced below what dosage?
20 mg/day
A patient who has received a lung transplant has been prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) for prevention of Pneumocystis jiroveci pneumonia (PJP). The nurse instructs the patient to take one tablet with which frequency?
3 times a week
The nurse recognizes that compliance with antiretroviral therapy(ART) regimens is often problematic for patients. What level of compliance is needed to help ensure ongoing success with this therapy?
95%
It would be of greatest priority to notify the health care provider if a live vaccine was prescribed for a person in which situation?
A patient undergoing chemotherapy
Belatacept
Action: Bind costimulatory ligands CD80 and CD86 of antigen-presenting cells Inhibit T-cell activation and proliferation Inhibit T-lymphocyte proliferation and production of inflammatory mediator - costimulation blockers
prednisone
Action: Decrease inflammation, Suppress immune system Use: Acute transplant rejection - corticosteroid
neoadjuvant therapy
Administration of therapeutic agents before a main treatment
The nurse administers the herpes zoster vaccine to which patient?
An older adult
Concomitant administration of which drugs with tacrolimus can increase serum drug levels? Select all that apply.
Antacids Antifungal agents Protease inhibitors Calcium channel blockers
The nurse is preparing to administer vaccines to a young child. What will the nurse do first?
Ask the caregivers about food allergies and over-the-counter medications
Which phrase describes the mechanism of action of cyclosporine in preventing the body from mounting an immune response to the transplanted organ?
Binding to cytoplasmic proteins that inhibit calcineurin phosphatase
A patient is receiving antiretroviral therapy (ART). Which outcome should the nurse identify as indicating a therapeutic response to the medication therapy?
CD4 T-cell increase
Azathioprine is designated as which pregnancy category?
D
Azathioprine blocks which physiologic process? Select all that apply.
DNA synthesis purine metabolism
Which point should the nurse include in providing teaching regarding corticosteroid therapy? (Select all that apply.)
Do not stop medication abruptly. Do not receive live vaccines. Delayed wound healing may occur.
A recent laboratory results indicated an "undetectable" human immunodeficiency virus viral load. What is the nurse's best response?
Educate the patient about the continued need for his medications and ongoing laboratory monitoring.
The nurse is teaching the parents of a 1-year-old child about vaccinations. Which mild reaction are the parents likely to observe in the child a few hours after the administration of the varicella vaccine?
Fever, Pain at the injection site, and redness at the injection site.
The primary healthcare provider asks the nurse to administer the shingles vaccine to an adult and the chickenpox vaccine to a child. Which vaccines does the nurse administer to the patients?
Herpes zoster to the adult and varicella to the child
Which phrase describes a limitation of immunosuppressant drugs? Select all that apply.
High cost Toxic effects Must be taken daily Limited effectiveness
Basiliximab uses which action to prevent the body from mounting an immune response against the transplanted organ?
Inhibiting activation of lymphocytes
The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient contacts the nurse to report the onset of muscle pain and weakness. What is the nurse's priority action?
Instruct the patient to hold doses of the medication until further notice.
Which drug combination must be avoided due to the increased risk for GI bleeding?
Mycophenolate mofetil and NSAIDs
A patient diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy. The nurse will teach this patient about which medication?
Nevirapine
The health care provider is considering placing the patient on ritonavir. The patient tells the nurse that the patient has recently been diagnosed with type 2 diabetes mellitus. What is the nurse's priority action?
Notify the health care provider of the new information.
Under which condition is sirolimus to be used during pregnancy?
Only if the potential benefit outweighs the potential risk
A nurse is preparing discharge instructions for a patient who had been on neutropenic precautions while hospitalized. What should the nurse include in the plan of care?
Order foods prepared medium to medium well.
During routine prenatal testing, a patient is diagnosed with human immunodeficiency virus infection. To help prevent perinatal transmission of human immunodeficiency virus to the fetus, what is the nurse's best action?
Provide written and oral education about the use of antiretroviral therapy during pregnancy.
passive immunity
Receives antibodies from another source
The community health nurse is assessing a child who has a rash. The child is found to have measles. What is the nurse's best action?
Report the measles to public health officials.
Which information should the nurse provide to a patient receiving tetanus toxoid?
Soreness at the injection site is a common reaction.
Palliative chemotherapy
Symptom relief
Which intervention is a priority for a patient who is taking antiretrioviral therapy(ART)?
Teach adherence to the medication regimen.
A 38-year-old migrant farm worker is seen in the clinic with a cut to his arm from an old metal drum. The patient has sutures placed, and a tetanus, diphtheria, and acellular pertussis vaccine is given. What is the nurse's most important action after the vaccine has been administered?
The nurse provides the patient with a vaccine information statement about the tetanus, diphtheria, and acellular pertussis vaccine in the patient's primary language.
The father of a 4-month-old infant calls in to the clinic reporting that his child is having a reaction to immunizations. What is the most important piece of information the nurse should elicit?
The signs and symptoms the infant is experiencing
The nurse is preparing to administer routine, recommended immunizations to an immunocompromised 1-year-old child. What is the most important information to know before administering a vaccination?
The type of vaccine to be administered to the child
Cyclosporine became available in 1983 and was modified in 1994 for which purpose?
To improve to bioavailability
A nurse is administering the Tdap vaccine to the mother of an infant. Which statement describes the rationale for giving this vaccination?
To protect the infant from acquiring pertussis infection
A patient is taking the urinary antiseptic methenamine for a urinary tract infection (UTI). The nurse understands that this drug should not be given concurrently with which other drug to avoid crystalluria?
Trimethoprim-sulfamethoxazole
The nurse should identify which drug as the antibiotic of choice for Pneumocystis jirovecii pneumonia (PJP)?
Trimethoprim-sulfamethoxazole
The nurse administers the first dose of basiliximab to the patient receiving a kidney transplant at which time?
Within 2 hours before transplant surgery
A parent of children present for well-child visits says, "My children are being vaccinated. Are there any that I should have? What is the nurse's correct reply?
Yes, you need to stay up to date on several vaccines; check with your healthcare provider.
The nurse is preparing to administer the tetanus vaccine to the patient. The nurse recognizes that the patient will be receiving
a toxoid
With the help of an interpreter, the nurse has just immunized a 35-year-old woman with the tetanus, diphtheria, and acellular pertussis vaccine and the vaccine against measles, mumps, and rubella. It is essential that the nurse proceed with which action(s)? (Select all that apply.)
a. Provide a vaccine information statement in the patient's preferred language for each vaccine received. b. Document in the patient's record the date; site and route of administration; vaccine type, manufacturer, lot number, and expiration date; and the name, business address, and title of the person administering the vaccine.
A patient is to start on efavirenz. Which points are important for the nurse to include in health teaching for this patient? (Select all that apply.)
a. The dose is given at bedtime to minimize central nervous system adverse effects. b. Alcohol should be avoided because of adverse effects to the liver. d. High-fat meals can increase absorption of the medication.
The nurse administers the oral rotavirus vaccine to a 2 month old child on Februrary 2 and instructs the parents to bring the child for the next dose on which date?
april 2 (2 moths later)
WHich for of vaccine is Haemophilus influenzae type B vaccine?
bacterial conjugate
The nurse reviews the assessment data for a patient prescribed cyclosporine following as organ transplant. Which intervention would the nurse take based on the data in the patient's chart?
call the healthcare provider
Your patient is receiving basiliximab and develops cytokine release syndrome. You would expect to see:
chills
The nurse is explaining the complications associated with shingles to a patient who has recently recovered from a shingles infection. WHich condition might affect the patient in the future?
chronic debilitating pain
In an effort to prevent cytokine release syndrome associated with antirejection drugs, the nurse should anticipate the premedication with which agents? (Select all that apply.)
corticosteroids acetaminophen
Which immunosuppressant drug is classified as a calcineurin inhibitor (CNI)? Select all that apply.
cyclosporine and Tacrolimus
Which of the following patients would be eligible to receive the influenza vaccine?
d. The child who is 18 months old
The nurse is preparing to administer varicella vaccine to a young woman. Which of the following findings has the greatest implication for this young woman's care?
d. The patient appears to be pregnant.
The patient has been administered a toxoid. The patient is most likely being vaccinated against which disease?
diphtheria toxoid = Inactivated toxins that stimulate antitoxin formation but can't produce disease
community immunity
exposed to antigen
The nurse is preparing to administer the hepatitis A vaccine to the patient. The nurse recognizes that the patient will be receiving
inactivated viral antigen.
The measles vaccine consists of which substance?
live virus
A patient who takes azathioprine after an organ transplant is at an increased risk for which condition?
malignancy
Once a child has received a vaccination, what is the priority nursing action?
monitor for possible anaphylaxis
The nurse should identify which drug as the antibiotic of choice for fungal infections manifested as thrush in the mouth or esophagus?
nystatin
A patient is prescribed tacrolimus after a heart transplant. The nurse instructs the patient to avoid which food?
peanut butter
After a lung transplant, a patient has been prescribed trimethoprim- sulfamethoxazole (TMP-SMZ) for prophylaxis of Pneumocystis jiroveci pneumonia (PJP). The nurse provides the patient with information about which adverse effect of the medication?
photosensitivity
Which activity does the nurse instruct a patient who underwent a transplantation to avoid?
receiving any type of live vaccine
A patient being treated for cancer is receiving medication for palliation. The nurse understands that palliative therapy is used to
relieve symptoms
The nurse instructs the parent of a child who just received the varicella virus vaccine to avoid administering which medication to the child for 6 weeks after the vaccine?
salicylates
Which order should the nurse question if added to the patient receiving belatacept as a portion of the patient's drug regimen?
shingles vaccine
Which immunosuppressant drug is classified as a mammalian target of rapamycin (mTOR) inhibitor? Select all that apply.
sirolimus everolimus
A patient who has been administered a live virus as a vaccine has been vaccinated against which disease?
smallpox
The patient has been administered a live virus as a vaccine. The patient is most likely being vaccinated against which disease?
smallpox
adjuvant therapy
surgery/radiation plus chemo
A patient arrives at the clinic with a wound infected by a rusty nail. After checking the patient's history, the nurse finds that the patient last received the tetanus booster about 10 years earlier. The nurse contacts the health care provider to obtain a prescription to administer which medication?
tdap
ganciclovir, valganciclovir
used to prevent cytomegalovirus
A patient is newly prescribed azathioprine. The nurse instructs the patient to return with which frequency to have a complete blood count (CBC)?
weekly
