Prep you Chapter 17
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 client has a low white blood cell count and is concerned about acquiring an infection. The client will not sign the informed consent due to a knowledge deficit about the CSF. How should the nurse respond?
"Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage, so that the cells can go to work to help protect you from infection."
A client is experiencing flu-like symptoms related to immune stimulant therapy. Which instructions would be most appropriate for the client?
"Drink plenty of fluids throughout the day."
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."
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."
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 discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan?
Arrhythmia
A client is scheduled for renal transplantation. At what point in the client's care should the first dose of sirolimus (Rapamune) be given?
As soon as possible after the transplant
Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition?
Autoimmune disorder
55s 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
Which would the nurse expect to administer orally?
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
A client with renal cancer is prescribed aldesleukin. What action should then nurse perform?
Ensure the client has adequate intravenous access
The nurse is administering cyclosporine. The nurse should anticipate the client may report which adverse reaction?
Excessive hair growth
The nurse administered oprelvekin to a client diagnosed with a chemotherapy-induced bleeding disorder. The nurse plans to teach the client the expected adverse reactions to watch for and report. The nurse will include which reactions in the client teaching session?
Fluid retention
Which adverse reactions should the nurse discuss with a client prior to the administration of oprelvekin (Neumega)? (Select all that apply.)
Fluid retention Syncope Fever
A male client is status post-kidney transplantation; he also has impaired liver function. What would the nurse expect the health care provider to do regarding the loading dose of sirolimus?
Follow existing dosing guidelines
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?
Have epinephrine available during administration.
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
Which agent would be classified as an immune stimulant?
Interferon alfa-2b
A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's <b>best</b> response?
It is caused by a decrease in the number of RBCs.
A nurse is teaching a client about an iron supplement. Which should be included in the teaching a client about this medication?
It should be taken on an empty stomach.
What assessment should the nurse perform when monitoring for the most serious adverse effects that can occur with the use of monoclonal antibodies?
Lung auscultation
A client is being treated for malignant melonoma 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 client is to receive erlotinib. The nurse would expect to administer this drug by which route?
ORAL
An adult male client experienced a kidney transplant 2 days ago, and his 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 client is to receive oprelvekin after chemotherapy. What is the priority nursing assessment to evaluate the drug's effectiveness?
Platelet count
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?
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?
Prevention of organ rejection
The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues?
RBCs
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
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:
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?
Suppression of the normal effects of the immune system in the body
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.
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. T/F
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 <b>best</b> response?
a condition when the neutrophil level is very low
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:
hepatotoxicity
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 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:
increased risk of infections.
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
Which is the most likely indication for the use of immunosuppressant agents?
organ transplantation
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
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."
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."
What client assessment finding will have the greatest effect on the half-life of methotrexate therapy?
History of chronic renal impairment
A client is prescribed filgrastim. Which is the nurse's <b>best</b> explanation of how this drug works?
It stimulates growth and production of WBCs to fight off infection.
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
Most of the drugs that affect the immune system are not recommended for use in children or have not been tested in children. T/F
TRUE
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. (T/F)
TRUE
The health care provider is planning to prescribe mycophenolate mofetil for a 28-year-old woman. The nurse understands that before receiving this prescription, the client is required to have:
a negative pregnancy test.
A client has a successful liver transplant. The nurse should advise the client prescribed oral cyclosporine to avoid mixing the drug with what form of liquid?
any type of grapefruit juice
Which intervention regarding the oral administration of mycophenolate should the nurse encourage the client to implement to minimize the risk of undesired effects?
taking the pills on an empty stomach
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?
the fact that the client is not pregnant
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