Ch 13 Drug Therapy to Suppress Immunity
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 my medication for at least 1 year." "I know that I will need to stay on this medication for a few months." "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." Explanation: Infection is a major cause of morbidity and mortality, especially in patients who are neutropenic or who have had bone marrow or solid organ transplantation. For those with solid organ transplantation, who must continue lifelong immunosuppression to avoid graft rejection, serious infection is a constant hazard. If efforts to prevent infections are unsuccessful, infections may be fatal unless recognized promptly and treated aggressively.
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." "I need to take these drugs until my prescription runs out." "I should stop taking these drugs if I get sick." "I'm at risk for infection until my body accepts my new liver."
"I will always be at risk for serious infection." Explanation: Solid organ transplantation requires a lifelong regimen of immunosuppressant drugs to prevent graft rejection. The client receiving such a transplant will always be at risk for serious infection.
A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse providing care for the man is explaining that while unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching point should the nurse not teach to the patient? "Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix." "Inflammation will start your body on the path to growing new, healthy tissue at the site of infection." "Inflammation helps your body to produce the right antibodies to fight the infection." "Inflammation can help to remove the body tissue cells that have been damaged by infection."
"Inflammation helps your body to produce the right antibodies to fight the infection."
When explaining the risks of pretransplant immunosuppression, the nurse demonstrates understanding of the process when making which statement? "Once the transplant is completed, complications associated with immunosuppression are no longer a concern." "Serious complications can occur if you are not monitored carefully while you are immunosuppressed." "Inadequate immunosuppression increases your risk of developing an infection." "Excessive immunosuppression can be corrected fairly easily with other medications."
"Serious complications can occur if you are not monitored carefully while you are immunosuppressed."
A client who has recently been diagnosed with HIV is waiting for the results of lab work to determine their T-cell count. How should the nurse best explain a T cell to the client? "T cells are neutrophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." "T cells are monocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." "T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." "T cells are basophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."
"T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."
The nurse is caring for a client waiting for a heart transplant. The client's spouse asks the nurse, "Why don't they just choose any heart until the right heart can be found?" What is the nurse's best response? "Graft-versus-host disease would result making the client very ill." "The client would need to have suppressor T cells infused daily to maintain the heart." "When the body responds to specific self-antigens to produce antibodies against its own cells, a severe immune response results." "The more closely the new heart matches the client's tissue, the less aggressive the immune reaction will be."
"The more closely the new heart matches the client's tissue, the less aggressive the immune reaction will be." Explanation: Transplantation of foreign tissue (e.g., moving a heart from a donor to a sick client) results in an immune reaction. Matching a donor's human leukocyte antigen markers is important as closely as possible to those of the recipient because histocompatibility is essential. The more closely the transplanted heart matches the recipient, the less aggressive the immune response will be to the donated tissue. Graft versus host disease occurs only in stem cell or bone marrow donations, not organ transplantation. Suppressor T cells cannot be transfused like blood because they must be produced by the body to function appropriately.
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 assists and educates clients about the structure and function of the immune system. Both B cells and T cells derive from stem cells in the bone marrow. Based on this information, what is the best information for the nurse to provide the client on the function of B lymphocytes? 1. Help protect against viral infections 2. Can detect and destroy some cancer cells 3. Develop into cells that produce antibodies 4.Provide humoral immunity 1, 2 1, 3 2, 4 3, 4
3, 4 Explanation: B lymphocytes develop into cells that produce antibodies (plasma cells). These antibodies provide the form of immunity called humoral immunity. T lymphocytes help protect against viral infections and can detect and destroy some cancer cells. T cells, which proliferate at the direction of thymic hormones, attack infected cells and provide cell-mediated immunity.
The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosporine? A client being treated for active pulmonary tuberculosis A client who has multiple sclerosis and who has not responded to conservative treatment A client who has undergone treatment for malignant melanoma but who is now palliative 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 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: A mild viral infection A severe bacterial infection A mild parasitic infection A severe fungal infection
A severe bacterial infection Explanation: Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions; leukocytosis is also common but is a particular hallmark of bacterial infection. Neutrophilia also indicates a bacterial infection, whereas increased levels of other leukocytes would indicate other etiologies. The shift to the left--the presence of many immature neutrophils--indicates that the infection is severe, because the demand for neutrophils exceeds the supply of mature cells.
A client diagnosed with diabetes and currently prescribed prednisone reports blood sugar levels that are higher than normal. What is the nurse's best statement related to this change in glucose levels? A. ''Prednisone can cause increased blood sugar levels.'' B. ''Your disease is progressing rapidly.'' C. ''We need to decrease the number of calories you are getting each day.'' D. ''You need to be cautious that you are adhering to your diet restrictions.''
A. ''Prednisone can cause increased blood sugar levels.'' Prednisone has a number of serious side effects, including adrenal suppression, elevated blood glucose, mood disorders, peptic ulcers, electrolyte imbalances, and osteoporosis. This client's elevated blood sugar level is not an indication of disease status, and there is no evidence to suggest that it is attributable to dietary habits.
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? A. ''Take the pills on an empty stomach.'' B. ''Hold the pill under the tongue for 30 seconds before swallowing.'' C. ''Crush the pills and mix them with applesauce or jam.'' D. ''Take the pill only if there are early signs or symptoms of infection.''
A. ''Take the pills on an empty stomach.'' Clients should swallow oral tablets or capsules whole, without crushing or altering them. They should avoid inhaling the powder from the capsules. For best absorption, it is important to take oral mycophenolate on an empty stomach. Such drugs must be taken on a regular schedule, not in response to symptoms.
A client who underwent a solid organ transplant has been prescribed immunosuppressants. When providing education, the nurse informs the client of an increased risk of what disorder as a complication of long-term therapy? A. Cancer B. Renal failure C. Diabetes D. Heart disease
A. Cancer Cancer may result from immunosuppression. When T lymphocytes and NK cells are suppressed and unable to recognize and eliminate abnormal cells, the abnormal cells may undergo spontaneous malignant transformation and result in widespread and often aggressive malignancies. Immunosuppression does not increase the risk for heart disease, renal failure, or diabetes.
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
A. Chemotherapy-induced neutropenia
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
A. Difficulty swallowing B. Dyspnea
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
A. Fatigue B. Risk for infection C. Imbalanced nutrition
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
A. Increase in the number of lymphocytes
Colony-forming units and stem cells reproduce, grow, and differentiate into cell types as determined by hematopoietic growth factors or cytokines. In what responses are cytokines involved? Select all that apply. A. Inflammation B. Phagocytosis C. Allergic D. Cellular immunity E. Viral replication
A. Inflammation B. Phagocytosis C. Allergic D. Cellular immunity Cytokines are involved in numerous physiologic responses, including inflammation, wound healing, and cellular and humoral immunity, but not viral replication.
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
A. Interferon
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.
A. It is caused by a decrease in the number of RBCs.
The nurse closely monitors a client who is receiving anakinra and etanercept for: A. severe infection. B. anemia. C. bleeding. D. hypersensitivity.
A. severe infection.
The nurse is caring for an older adult receiving immune modulators. What are appropriate actions by the nurse? Select all that apply. Obtain baseline liver function studies and monitor follow-up studies. Determine dosage based on renal and liver function. Assess carefully for infection. Encourage the family to visit often, especially young children. Minimize teaching to avoid causing confusion.
Assess carefully for infection. Obtain baseline liver function studies and monitor follow-up studies. Determine dosage based on renal and liver function. Explanation: Older clients may be more susceptible to the effects of the immune modulators, partly because the aging immune system is less efficient and less responsive. These clients need to be monitored closely for infection, GI, renal, hepatic, and central nervous system effects. Baseline renal and liver function tests can help to determine whether a decreased dosage will be needed before beginning therapy. Because these clients are more susceptible to infection, they need to receive extensive teaching, not less teaching, about ways to avoid infection and injury. Contact with young children and large groups of people increase the risk of infection.
Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition? Autoimmune disorder Increased intracranial pressure Seizure disorder AIDS
Autoimmune disorder
The nurse is explaining to a client how an antigen previously encountered elicits a much faster immune response because the body's immune cells "remember" previous encounters with the antigen. The nurse is describing the function of what cells? lymphocytes B cells T cells monocytes
B cells Explanation: After being activated, the B cells form memory cells that will produce antibodies for immediate release in the future if the antigen is encountered again. Although lymphocytes, monocytes, and T cells will then join in the battle to destroy the antigen, they do not produce memory cells as the B cells do.
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."
B. "The drug is used to increase platelet count during chemotherapy."
The nurse is providing education to a client who has been prescribed immunosuppressant therapy following a solid organ transplant. What statement by the client indicates that teaching was successful? A. ''I will need to stay on my medication for at least 1 year.'' B. ''I will need to stay on this medication for the rest of my life.'' C. ''I do not need to worry about taking any special precautions.'' D. ''I will need to stay on this medication for a few months.''
B. ''I will need to stay on this medication for the rest of my life.'' For clients with solid organ transplantation, who must continue lifelong immunosuppression to avoid graft rejection, serious infection is a constant hazard. If efforts to prevent infections are unsuccessful, infections may be fatal unless recognized promptly and treated aggressively.
Several processes are induced via cytokines in inflammatory and immune responses. Which process is not a cytokine-induced process? A. Antibody production B. Chemotaxis C. Tissue repair D. Inflammation
B. Chemotaxis Chemotaxis is a process by which WBCs are attracted to an injury site to phagocytize tissue debris and causative agents. The remaining processes are cytokine induced.
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
B. 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? A. Mental depression B. Infection C. Severe diarrhea D. Respiratory distress
B. Infection
The nurse is caring for a client who is receiving immunosuppressant therapy. For what possible complication should the nurse monitor this client? A. Anemia B. Infection C. Bruising D. Hyperglycemia
B. Infection People taking medications that suppress the immune system are at high risk for development of infections. As a result, clients, caregivers, and others in the client's environment need to wash their hands often and thoroughly, practice meticulous personal hygiene, avoid contact with infected people, and practice other methods of preventing infection. Clients should report signs or symptoms of infection, such as sore throat or fever, to a health care provider. Therapy does not increase risk for bruising, hyperglycemia, or anemia.
DELETE 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
B. Nausea and changes in taste
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
B. Nephrotoxicity Explanation: Nephrotoxicity is a major adverse effect of cyclosporine. Other potential adverse effects include hypertension, hepatotoxicity, and various central nervous system effects (e.g., tremor, confusion).
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
B. Suppression of the normal effects of the immune system in the body Explanation: Cyclosporine acts as an immune suppressant, which blocks the normal effects of the immune system in the body. This action is beneficial in organ transplantation, in which the body destroys foreign tissue, and in autoimmune diseases, in which the body destroys its own cells.
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
B. White cell differential
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
B. the fact that the client is not pregnant
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."
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."
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."
C. "The weekly CBC assesses for the development of infection."
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
C. A client who has recently undergone bone marrow transplant to treat leukemia
DELETE 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
C. Arrhythmia
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
C. Dyspnea
When considering the immunosuppressed client, which assessment finding has the greatest significance? A. Nausea B. Ecchymosis C. Fever D. Constipation
C. Fever People taking medications that suppress the immune system are at high risk for development of infections that present with fever. None of the other assessment findings have greater significance since none are infection related.
What client assessment finding will have the greatest effect on the half-life of methotrexate therapy? A. History of peripheral vascular disease B. Presence of an active infection C. History of chronic renal impairment D. Inadequate fluid intake
C. History of chronic renal impairment Excretion of methotrexate is mainly in the urine, so the drug's half-life is prolonged in clients with renal impairment, with risks of accumulation to toxic levels and additional renal damage. Infection and fluid intake must be addressed in the client's plan of care, but neither factor directly increases the half-life of a drug. While a health factor, peripheral vascular disease will have little or no effect of the half-life of methotrexate.
DELETE 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
C. Interferon alfa-2b
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.
C. It stimulates growth and production of WBCs to fight off infection.
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
C. Known hypersensitivity
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
C. Oral
DELETE 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
C. Risk for 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.
C. Stop the drug immediately.
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
C. a condition when the neutrophil level is very low
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.
C. orange juice. Explanation: Cyclosporine may be added to orange juice to make it more palatable. Grapefruit juice should not be used because it affects metabolism of the drug.
Which would the nurse expect to administer orally? Abatacept Alefacept Glatiramer acetate Cyclosporine
Cyclosporine
While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is: Azathioprine (Imuran). Pimecrolimus . Cyclosporine . Glatiramer (Copaxone).
Cyclosporine
Which of the T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines? Memory T cells Cytotoxic T cells Regulatory T cells Helper T cells
Cytotoxic T cells
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."
D. "Drink plenty of fluids throughout the day."
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."
D. "Your body is going to have trouble fighting off infections on it's own. This medication will help with that."
While the nurse is providing education prior to an organ transplant, the client asks for an explanation of acute versus chronic rejection reactions. After completing education, what client statement would indicate that additional teaching is necessary? A. ''Acute reactions can lead to arterial narrowing or obliteration of blood flow to the organ.'' B. ''Characteristics of chronic reactions include fibrosis of blood vessels and progressive failure of the transplanted organ.'' C. ''Acute reactions may occur from 10 days to a few months after transplantation.'' D. ''Acute reactions may occur up to a few years after transplantation and years of normal function.''
D. ''Acute reactions may occur up to a few years after transplantation and years of normal function.'' Rejection reactions are acute or chronic. Acute reactions may occur from 10 days to a few months after transplantation. Characteristics include signs of organ failure and vasculitis lesions that often lead to arterial narrowing or obliteration. Treatment with immunosuppressant drugs is usually effective in ensuring short-term survival of the transplant but does not prevent chronic rejection. Chronic reactions occur after months or years of normal function, are caused by both cellular and humoral immunity, and do not respond to increased immunosuppressive drug therapy. Characteristics include fibrosis of blood vessels and progressive failure of the transplanted organ.
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
D. As soon as possible after the transplant
In addition to autoimmune disorders, immunosuppressant medications are used to treat which disorder? A. Osteoarthritis B. Multiple sclerosis C. Bone cancer D. Crohn's disease
D. Crohn's disease In general, autoimmune disorders share inflammation as a major mechanism of tissue damage. Allergic asthma, Crohn's disease, psoriasis, psoriatic arthritis, and RA are inflammatory disorders that may be treated with immunosuppressant drugs.
A client has been prescribed oral cyclosporine following successful liver transplant. When providing education, the nurse should advise the client to avoid mixing the drug with what liquid? A. Vegetable juices B. Milk C. Low-pH beverages D. Grapefruit juice
D. Grapefruit Juice Clients should be cautioned against mixing cyclosporine with grapefruit juice because it inhibits metabolism. Dairy, vegetable, and acidic beverages are not necessarily contraindicated.
A client admitted to the ICU with gunshot wounds in the chest and thigh is noted to have extensive edema present. Anticipating a generalized reaction to tissue damage, the nurse concludes that the client's edema is the result of what development? vasoconstriction. hypoxia. internal pathogenic control. inflammatory process.
D. Inflammatory process The cellular response to injury involves inflammation, a generalized reaction to any tissue damage, which attempts to remove the damaging agent and repair the damaged tissue. The hemodynamic aspect of inflammation includes vasodilation, which increases blood supply to the injured area, and increased capillary permeability, which allows fluid to leak into tissue spaces.
Which agent would be classified as an immune stimulant? A. Abatacept B. Sirolimus C. Mycophenolate D. Interferon alfa-2b
D. Interferon alfa-2b
DELETE 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
D. Interferon alfacon-1
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
D. Platelets
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
D. RBCs
The nurse is providing education for a client who has been scheduled for a kidney transplant. The nurse should inform the client that administration of antirejection drugs will be initiated when? A. As soon as possible B. 48 to 72 hours after surgery C. In postanesthesia recovery D. Several hours before the surgery
D. Several hours before the surgery It is necessary to initiate antirejection drugs several hours prior to the transplant procedure.
DELETE 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.
D. The patient may be having psychological adverse effects of interferon alfa-2a.
DELETE Oprelvekin is a drug that stimulates the process of making which blood cells? A. neutrophils B. monocytes C. lymphocytes D. platelets
D. platelets
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 Discontinue the medication Increase the dose Continue the current dose
Decrease the dose Explanation: Tacrolimus is metabolized in the liver by the cytochrome P450 enzyme system. Impaired liver function may decrease presystemic (first-pass) metabolism of oral tacrolimus and produce higher blood levels. Also, the elimination half-life is significantly longer. As a result, dosage must be decreased in clients with impaired liver function.
The nurse is caring for a client who has acquired immunodeficiency syndrome (AIDS) and whose CD4 (helper) T cell count is steadily decreasing. The nurse's assessment findings will reflect what pathophysiological process? Inadequate histamine release and delayed inflammation Absence of phagocytosis Decreased stimulation of B cells Increased levels of Hageman factor
Decreased stimulation of B cells Explanation: Helper T cells stimulate B cells to respond to infection and produce antibodies as needed. Phagocytosis will be decreased, but not absent. CD4 cells do not participate directly in the inflammatory process, which involves Hageman factor and histamine release.
A male client is prescribed cyclosporine after renal transplantation to prevent rejection. Initially, his BUN and creatinine levels were elevated; they diminished with medication adjustment and 3 weeks later are elevated again. What would the nurse expect the health care provider to do? Repeat the laboratory tests Order an electrolyte panel Evaluate the CBC Evaluate the client for transplant rejection
Evaluate the client for transplant rejection Explanation: Cyclosporine is nephrotoxic but is commonly used in clients with renal and other transplants. Nephrotoxicity usually subsides with decreased dosage or stopping the drug. In renal transplant recipients, when serum creatinine and blood urea nitrogen levels remain elevated, a complete evaluation of the client must be done to differentiate cyclosporine-induced nephrotoxicity from a transplant rejection reaction
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? Administer a corticosteroid prior to administration. Administer high-flow oxygen prior to administration. Avoid high-fat foods during the course of treatment. Have epinephrine available during administration.
Have epinephrine available during administration.
A client comes to the clinic asking what hematopoiesis means. How should the nurse explain this to the client? Hematopoiesis means undifferentiated stem cells are not stimulated to become specific blood cells. Hematopoiesis means undifferentiated stem cells are not stimulated to become nonspecific blood cells. Hematopoiesis means differentiated stem cells are not stimulated to become specific blood cells. Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells.
Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells. Explanation: Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells. Not stimulating the cell, stimulating undifferentiated cells, and stimulating the production of nonspecific blood cells would not produce a therapeutic effect.
A client has sought care because of seasonal allergies that are having a negative effect on the client's quality of life. The nurse should recognize the role of what immunoglobulin in this client's health problem? IgE IgM IgA IgG
IgE
A client is experiencing an allergy to a penicillin antibiotic. What immunoglobulin (Ig) will most directly relate to this immune response? IgA IgM IgE IgG
IgE Explanation: IgE seems to be related to allergic responses and activation of mast cells. IgG contains antibodies made by memory cells that circulate and enter the tissue. IgM is the first immunoglobulin released on first exposure to an antigen. IgA is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells.
A school-aged client was vaccinated against varicella several years ago according to the recommended immunization schedule. The client has now been exposed to the virus by a classmate with chickenpox. What immune response will prevent the client's infection? CD4 (helper) T cells will release the necessary antibodies Hageman factor will be activated and IgM released Circulating levels of IgA will form antigen-antibody complex IgG will be released by B memory cells
IgG will be released by B memory cells Explanation: Exposure to an antigen eventually causes memory B cells to produce IgG specific to that antigen, which can be released upon secondary exposure to the antigen. Hageman factor is involved with inflammation, not humoral immunity. CD4 T cells do not directly produce or release antibodies. IgA is a specific type of immunoglobulin that does not exist in general circulation.
The pathophysiology instructor is discussing phagocytosis. What types of responses would the instructor explain interact in complex ways and share a number of processes, including phagocytosis? Inflammatory and interferon Interleukin and interferon Immune and interleukin Inflammatory and immune
Inflammatory and immune Explanation: As active phagocytes, macrophages release chemicals that are necessary to elicit a strong inflammatory reaction. These cells also respond to chemical mediators released by other cells that are active in the inflammatory and immune responses to increase the intensity of a response and to facilitate the body's reaction.
A client has developed a wound infection and leukocytes are leaving the bloodstream to perform phagocytosis on pathogens. What white cells are most likely performing this function? Basophils Neutrophils Monocytes Eosinophils
Neutrophils
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
A client who is receiving an immune suppressant has been admitted to the hospital unit. What action should the nurse prioritize? OR A patient who is receiving an immune modulator has been admitted to the unit. What would be a priority action by the nurse? Monitor the client's nutritional status. Place the client on protective isolation. Provide client teaching regarding pharmacokinetics. Provide support and comfort measures related to adverse effects.
Place the client on protective isolation. (OR: Protect the patient from exposure to infection.) Explanation: Clients taking immune suppressant drugs are more susceptible to infection because the client's normal body defenses will be diminished. As a result, the priority action by the nurse would to protect the client from exposure to infection through room selection, good hand hygiene, and taking care to avoid exposure to sick staff members. Nutritional status is important, as are comfort and support measures and other instructions concerning the drug. However, protecting the client from infection should be the priority action because this involves client safety.
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? response to a cardiac nonstress test social support network history regarding depression Pregnancy status
Pregnancy status The FDA has issued a black box warning for mycophenolate mofetil regarding the risk of fetal loss and malformations. Women of childbearing age must use contraception, and a negative pregnancy test for such women is required prior to starting therapy. History of depression and the presence of a support network are relevant nursing considerations but neither relates directly to safety. Cardiac testing is not normally required.
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 Explanation: Cyclosporine is used to prevent or suppress rejection in a variety of transplant situations, such as renal transplantation. The drug is an immunosuppressant so it would increase the child's risk for infection. The drug has no effect on renal function or metabolic processes.
What disorder of the immune system may affect both the skin and the joints? Graft versus host disease Rheumatoid arthritis Crohn's disease Psoriasis
Psoriasis
What is an adverse effect of excessive immunosuppression? Serious infection Graft rejection Respiratory depression Graft-versus-host disease
Serious infection Explanation: Excessive immunosuppression significantly increases the risk of serious infection. Graft rejection and graft-versus-host disease result from inadequate immunosuppression.
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: It will increase the risk of rejection. She may develop an infectious process at the clinic. She may not have the stamina to work at the clinic. It is too soon to volunteer in a clinic setting.
She may develop an infectious process at the clinic. Explanation: Immunosuppressant drugs greatly increase risk of infection.
The nursing instructor is talking with the students about immunosuppressant therapy following transplant surgery. The instructor indicates that, in addition to drug-specific adverse effects, therapy presents the risk of infection and cancer. Which of the following are the most common malignancies among transplant recipients? Skin cancer and lymphomas Renal cell and liver cancer Cervical and vulvar cancer Lung and prostate cancer
Skin cancer and lymphomas Explanation: The most common malignancies among transplant recipients are skin cancers and lymphomas.
A client is experiencing an immune response and the only immunoglobulin that is currently in circulation is IgM. How should the nurse best interpret this fact? The client has very recently been exposed to the antigen The client has a very low CD4 count The client has neutropenia The client is experiencing an autoimmune disease
The client has very recently been exposed to the antigen Explanation: IgM is the first immunoglobulin released, so there could theoretically be a lag between IgM release and the release of other immunoglobulins. This phenomenon would be unrelated to low levels of neutrophils, low CD4 cells or an autoimmune process.
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. The severe adverse effects The rapid onset The long duration of action The delayed peak The long half life
The delayed peak The long duration of action The long half life
The health care provider changes a female client's immunosuppressant to a newer drug. The client asks why this is necessary. What is true about the newer immunosuppressants? They are less expensive. They have fewer severe adverse effects. They will enhance her health and well-being. They will prolong her life.
They have fewer severe adverse effects.
A client is receiving immunizations before traveling to a storm-stricken region of the tropics where cholera, typhoid, and malaria are in epidemic. While specific immunizations to combat specific diseases would be administered, why would an injection of IgA also be administered? To increase cellular response To increase humoral response To increase local antibody response To increase cellular stimulation
To increase local antibody response Explanation: Antibodies (mostly immunoglobulin A [IgA]) secreted at these sites act locally rather than systemically, combating foreign substances (especially pathogens) that are inhaled, swallowed, or otherwise come in contact with external body surfaces.
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
A nurse is caring for a patient who has just had a successful liver transplant. When facilitating the patient's treatment with cyclosporine, the nurse should anticipate that administration will consist of topical administration to the abdominal region. consist of daily intramuscular injections. involve daily IV administration via a central line. begin with IV administration and then change to the oral route.
begin with IV administration and then change to the oral route.
Tacrolimus belongs to what classification of medications? conventional antirejection agents antibody preparations tumor necrosis factor-alpha-blocking agents fusion protein inhibitors
conventional antirejection agents Tacrolimus is categorized as a conventional antirejection agent.
Which are the LEAST serious adverse effects associated with the use of monoclonal antibodies? Select all that apply. acute pulmonary edema diarrhea cytokine release syndrome fever malaise
fever malaise diarrhea
A client with human immunodeficiency virus has an impaired ability to stimulate lymphocytes to be aggressive and responsive during the immune response. This is primarily due to a deficiency in what cells? helper T cells neutrophils suppressor T cells cytotoxic T cells
helper T cells
The defense mechanism involving lymphoid cells, inflammatory cells, and hematopoietic cells stimulates production of antibodies and activated lymphocytes to destroy mutant body cells and pathogens is known as: phagocytosis. immune response. inflammatory response. cellular response.
immune response.
A 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to: infection. respiratory depression. nausea. dizziness.
infection.
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: gastritis. cardiac effects. hyperthyroidism. nephrotoxicity. OR 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.
Student nurses are discussing rheumatoid arthritis (RA) in their pathology class. The students learn that RA is treated with leflunomide because it relieves symptoms and controls pain. repairs joint tissue. builds muscle tissue. slows the progression of joint destruction.
slows the progression of joint destruction. Explanation: Because it has antiproliferative and anti-inflammatory activities, leflunomide relieves RA symptoms and slows the destruction of joint tissue.
A 56-year-old client, discharged from the hospital following a successful kidney transplant, is prescribed antirejection drug therapy. When performing health education with the client and the client's family, which topic should the nurse emphasize? strategies for reducing the client's risk of infection strategies for managing the client's energy and activity levels the role of nutrition in health maintenance and the prevention of rejection the safe use of any required assistive devices
strategies for reducing the client's risk of infection With clients who are taking immunosuppressant drugs, a major role of the home care nurse is to assess the environment for potential sources of infection, assist clients and other members of the household to understand the client's susceptibility to infection, and teach ways to decrease risks of infection. This is more important than activity management, mobility, and nutrition, though each of these subjects warrants education.
