Pharmacology PrepU Chapter 17: Immune Modulators

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."

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 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."

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."

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 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 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 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

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

Chemotherapy-induced neutropenia

Which would the nurse expect to administer orally? A. Alefacept B. Cyclosporine C. Abatacept D. Glatiramer acetate

Cyclosporine

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

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

False

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

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

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

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

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 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

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

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 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

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

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

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 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 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? 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

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 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

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

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

platelets

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 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."

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."

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 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

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 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

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

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.

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 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

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

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

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 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

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

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