Practice PrepU ?'s
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." "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 that puts you at risk for bleeding, and without the drug you will bleed to death tonight." "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."
"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? "I do not need to worry about taking any special precautions." "I know that I will need to stay on this medication for a few months." "I know that I will need to stay on my medication for at least 1 year." "I know that I will need to stay on this medication for the rest of my life."
"I know that I will need to stay on this medication for the rest of my life."
A patient being placed on drug therapy for rheumatoid arthritis (RA) asks the nurse why she will have to take methotrexate as well as naprosyn (Naproxyn). What is the best response by the nurse? "Methotrexate will work only with a nonsteroidal anti-inflammatory drug (NSAID)." "NSAIDs reduce the disease activity more than methotrexate." "NSAIDs are given to control the symptoms of rheumatoid arthritis until the methotrexate action starts." "NSAIDs begin the immunosuppression until methotrexate takes over."
"NSAIDs begin the immunosuppression until methotrexate takes over."
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? "Be sure to take your tetracycline medicine at the same time you take the iron dose." "Be sure to take your antacid medicine at the same time you take the iron dose." "Be sure to take your fluoroquinolone medicine at the same time you take the iron dose." "Take this drug with water on an empty stomach."
"Take this drug with water on an empty stomach."
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 gets really sick from flu-like symptoms and then they get better." "The patient has decreased cytokine activity." "It really helps the patient!" "The patient has increases in the number of natural killer cells."
"The patient has increases in the number of natural killer cells."
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 fasting diet is acceptable as long as you go back on the prescribed diet within six months." "The prescribed diet and drug are necessary to correct anemia associated with folic acid deficiency." "The prescribed diet is not necessary to correct anemia associated with folic acid deficiency." "The fasting diet is acceptable as long as you go back on the prescribed diet within six weeks."
"The prescribed diet and drug are necessary to correct anemia associated with folic acid deficiency."
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 decrease in hematocrit." "The weekly CBC is routine and ordered for all patients." "The weekly CBC assesses for the development of bleeding." "The weekly CBC assesses for the development of infection."
"The weekly CBC assesses for the development of infection."
What should the nurse teach the patient about gold salts therapy? "This is a therapy for pain relief that is similar to opioids." "This therapy is contraindicated in patients with rheumatoid arthritis." "This therapy can cause excessive bleeding." "This therapy can decrease inflammation."
"This therapy can decrease inflammation."
A patient sees a physician for pain in the joints of fingers with significant swelling. X-rays reveal extensive joint damage from theumatoid arthritis (RA); laboratory results are definitive. Which medication does the nurse anticipate the patient will receive to decrease the extensive joint damage? A nonsteroidal anti-inflammatory medication, such as Ibuprofen A glucocorticoid steroid, such as prednisone An uricosuric medication, such as Allopurinol A disease-modifying antirheumatic drug (DMARD), such as methotrexate
A disease-modifying antirheumatic drug (DMARD), such as methotrexate
A patient has just been told that their cancer has metastasized to their right kidney. An interferon (Aldesleukin) has been prescribed to treat this metastasis. The patient asks why the interferon is ordered. What is the nurse's best response? Aldesleukin has been shown to have a direct proliferative effect on renal tumors. Aldesleukin has been shown to inhibit tumor growth. Aldesleukin has been shown to enhance allogeneic stem-cell transplantation. Aldesleukin has been shown to protect autologous tumor cells.
Aldesleukin has been shown to inhibit tumor growth.
A patient on methotrexate therapy complains of mouth ulcers. Which treatment does the nurse anticipate the patient will be prescribed? Ibuprofen 400 mg every 6 hours by mouth Folic acid 1 mg daily by mouth Nystatin oral suspension, swish and swallow Allopurinol 300 mg dissolved in 50 mg of water, swish and spit
Allopurinol 300 mg dissolved in 50 mg of water, swish and spit
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? Vomiting resulting in dehydration Fainting resulting in falls with injury Arrhythmia resulting in stroke and pulmonary edema Bone loss
Arrhythmia resulting in stroke and pulmonary edema
Immunosuppressant drugs are given after organ transplantation. For which disorder will immunosuppressant agents also be prescribed? HIV/AIDS Autoimmune disorders Seizure disorders Increased intracranial pressure
Autoimmune disorders
A nurse is discussing interferon alfa-2b with a patient. What will the nurse encourage the patient to do while taking this drug? Avoid alcohol Increase salt intake Decrease milk intake Eat 3 meals a day
Avoid alcohol
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? Fluid retention and peripheral edema Yeast infections Fungal infections Bone pain, nausea and vomiting, alopecia, and hypertension
Bone pain, nausea and vomiting, alopecia, and hypertension
Upon return from from active duty in Zimbabwe, a military veteran asks the nurse about a painful rash on her side that is triggered by stress. The nurse knows to ask the history of where the veteran has traveled and about any exposure to rash-causing agents. An order for a PCR shows that the rash is caused by herpes zoster (shingles). The nurse explains that the painful rash is called shingles and is caused later in life by which of the following infections? Measles Mumps Chickenpox HSV-1
Chickenpox
While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is: Azathioprine (Imuran) Pimecrolimus (Elidel) Glatiramer (Copaxone) Cyclosporine (Sandimmune).
Cyclosporine (Sandimmune).
Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis. True False
False
Sirolimus is the most commonly used immune suppressant. True False
False
A client comes to the clinic complaining of a three-week history of intermittent pain, redness, and swelling in the knees. Lab results reveal an increased uric acid level. Which medication does the nurse anticipate being prescribed for this client? Baclofen (Lioresal) Methotrexate Alendronate (Fosamax) Febuxostat (Uloric)
Febuxostat (Uloric)
The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Hydroxychloroquine Humira Gold salts Azothiaprine
Gold salts
What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals? Gold salts Cox 2 inhibitors Propionic Acids Fenamates
Gold salts
A patient has received a bone marrow transplant. What will occur if the patient receives inadequate immunosuppression after the transplant? Graft-versus-host disease Hepatic failure Renal failure Serious infection
Graft-versus-host disease
A patient with rheumatoid arthritis is receiving cyclophosphamide (Cytoxan) for treatment of his disease. When administering an immunosuppressant, the nurse must be alert to which of the following side effects of this medication? Infection Nystagmus Muscle rigidity Hyperthermia
Infection
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 small immature erythrocytes, due to folic acid deficiency. Megaloblastic anemia is characterized by large immature erythrocytes, due to amino acid deficiency. Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency. Megaloblastic anemia is characterized by large mature erythrocytes, due to lactic acid deficiency.
Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency.
A patient is administered cyclosporine (Sandimmune, Neoral) to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine? Congestive heart failure Anaphylaxis Nephrotoxicity Respiratory arrest
Nephrotoxicity
A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? Oral Subcutaneous Intramuscular Intravenous
Oral
Which nursing diagnosis is most appropriate for a patient receiving interferon alfa-2a who is also experiencing depression? Alteration in thought process due to psychosis Potential for maladaptive coping related to fatigue, mental status changes from medication Alteration in self-protection due to delusions Alteration in self-care due to fatigue
Potential for maladaptive coping related to fatigue, mental status changes from medication
The patient is having an acute exacerbation of rheumatoid arthritis. What medication does the nurse anticipate giving as "pulse therapy"? Etanercept Prednisone Remicade Cyclosporine
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 infection due to immunocompromised status Slowing of metabolic processes postoperatively to prevent an immune response Preservation of remaining renal function Prevention of organ rejection
Prevention of organ rejection
The patient informs the nurse that he has been taking methotrexate for 1 week and it is not working to control the rheumatoid arthritis (RA) symptoms. What should the nurse explain to the patient about the onset of action? Relief of symptoms should occur within 3-6 weeks. Relief of symptoms should occur within 3 days. Relief of symptoms should occur within 1 week. Relief of symptoms should occur within 2 months.
Relief of symptoms should occur within 3-6 weeks.
Marge, a 38-year-old woman, is seen in the physician's office for the first time. She complains of fatigue, decreased range of motion in her hands, pain with activities that require her to use her hands, loss of strength in her hands and arms, and a low-grade fever. What is the most likely diagnosis that would explain Marge's symptoms? Inflammatory osteoarthritis Multiple sclerosis Rheumatoid arthritis Gouty arthritis
Rheumatoid arthritis
Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema? Rheumatoid arthritis (RA) Systemic lupus erythematosus Osteoporosis Polymyositis
Rheumatoid arthritis (RA)
A patient has been diagnosed with rheumatoid arthritis. he patient shows the nurse small nodules on both elbows and hands. What does the nurse understand that these nodules are? Lipomas Calcification nodules Tophi Rheumatoid nodules
Rheumatoid nodules
The nursing instructor is explaining the best way to assess whether active immunity has developed from the administration of the hepatitis B series. What would the instructor cite as the best assessment method? Liver is not palpable AST is within normal limits Client does not develop hepatitis B Serum antibody levels
Serum antibody levels
Which adverse effects does the nurse attribute to methotrexate (Rheumatrex) therapy for rheumatoid arthritis (RA)? Select all that apply. Stomatitis Thinning hair Fatigue Cirrhosis Angina
Stomatitis Thinning hair Fatigue Cirrhosis
A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action? Auscultate the client's apical heart rate for 2 minutes. Notify the prescriber that the client is experiencing an adverse effect. Reposition the client Stop the drug immediately.
Stop the drug immediately
Disease-modifying antirheumatic drugs (DMARDs) are administered to produce which therapeutic effect? Stop the progression of the disease. Increase the immune response. Reverse joint deformity. Increase cerebrospinal fluid secretion.
Stop the progression of the disease.
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? Targeting of specific receptor sites of cells Targeting of various receptor sites of cells Increased stimulation of the normal effects of the immune system in the body Suppression of the normal effects of the immune system in the body
Suppression of the normal effects of the immune system in the body
A client who has received a heart transplant has been prescribed an oral cyclosporine solution. Which of the following should the client be advised to do as part of his self-care? Measure the cyclosporine with a kitchen teaspoon. Take the medication at the same time each day. Take a double dose of cyclosporine to make up for any missed dose. Dilute the cyclosporine with orange or grapefruit juice.
Take the medication at the same time each day.
A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for treatment. What will be important to discuss with the patient when the nurse provides patient teaching about her treatment? The need to use barrier contraceptives while taking the drug The need to avoid sexual intercourse while taking the drug The need to continue oral contraceptives The importance of taking an aspirin daily to decrease the adverse effects of the drug
The need to use barrier contraceptives while taking the drug
The nurse is administering etanercept (Enbrel). Which administration technique would be considered appropriate? The nurse administers the medication orally with other drugs. The nurse administers the medication IV. The nurse administers the medication topically on the abdomen. The nurse administers the medication subcutaneously weekly.
The nurse administers the medication subcutaneously weekly.
The nurse is obtaining nutritional information prior to the patient beginning methotrexate therapy for psoriatic arthritis. What information obtained by the nurse would be of greatest concern? The patient drinks two glasses of wine once every 2 weeks. The patient eats two eggs daily for breakfast. The patient drinks six cups of coffee daily. The patient eats three fruits per day.
The patient drinks six cups of coffee daily.
Which patient should not receive their 8 a.m. medication as scheduled? The patient receiving glucocorticoid therapy who has decreased urination The patient receiving etanercept (Enbrel) who has increased WBCs The patient receiving cyclosporine (Neural) who has a cold The patient receiving cyclophosphamide (Cytoxan) with neutropenia
The patient receiving cyclophosphamide (Cytoxan) with neutropenia
What factor has primarily led to the increased use of biologic modulators? The ability to produce mass quantities of the drug The ability to identify the cytotoxin in the cell structure The identification of genes responsible for certain diseases The refinement of recombinant DNA technology
The refinement of recombinant DNA technology
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. They stimulate growth and differentiation of lymphoid cells into lymphocytes. They stimulate B lymphocyte activity. They interfere with multiplication of stem cells.
They interfere with the ability of viruses in infected cells to replicate.
Danny has been diagnosed with rheumatoid arthritis and begins methotrexate drug therapy. Why should the nurse document the severity of joint inflammation and any restriction in the range of motion when assessing Danny's health status? To minimize the adverse effects of methotrexate therapy To later compare and assess the efficacy of methotrexate therapy To maximize the therapeutic effects of methotrexate therapy To identify the signs of hepatic or renal insufficiency
To minimize the adverse effects of methotrexate therapy
What is chrysotherapy? Treatment with anti-malerials Treatment with salicylates Treatment with DMARDs Treatment with gold salts
Treatment with gold salts
Most of the drugs that affect the immune system are not recommended for use in children or have not been tested in children. True False
True
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction. True False
True
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. True False
True
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 history of multiple myeloma diabetes mellitus AIDS.
a previous organ transplant
A nurse has to administer 0.06 ml/kg of hepatitis B immune globulin IM to a patient. The total body weight of the patient is 50 kg. How many ml of the drug should be administered to the patient? a. 2 ml b. 3 ml c. 4 ml d. 5 ml
b. 3 ml
