Chapter 54: Drugs Affecting the Immune Response
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? Asthma Food allergies Known hypersensitivity to the drug or any component of the drug Rash
Known hypersensitivity to the drug or any component of the drug
The nurse educator is teaching a class of RN to BSN online learners about different types of immunostimulant drugs. A student asks about the goal of hematopoietic drugs. The nurse knows it is important to explain about stimulation of the body in order to make more of the specific cell. Which of the following cell counts would the nurse want to emphasize when the topic is chemotherapy? Abnormal partial thromboplastin and white blood cell count. Bleeding times and low white blood cell count. Fibrinogen levels and white blood cell count. Low platelet and low white blood cell count.
Low platelet and low white blood cell count.
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." "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 that puts you at risk for bleeding, and without the drug you will bleed to death tonight." "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."
The client is a woman, 42 years of age, admitted after breast cancer chemotherapy. The client has a low white blood cell count and is concerned about acquiring an infection. The client will not sign the informed consent because she doesn't understand the drug action. What explanation would the nurse give for how a CSF increases white blood cell production? "Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. These cells are called white blood cells that grow in stages but are not effective until the cell is in the immature stage. A colony-stimulating drug acts on the cell to stimulate growth to the immature white blood cell stage so the cells can help protect you from infection." "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." "Chemotherapy kills cancer cells but has no effect on white cells that fight infection. A colony-stimulating drug acts on white cells to stimulate growth to the mature adult stage to help protect you from infection." "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, mature stage. But a colony-stimulating drug has no affect on white cell stimulation in the body. "
"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."
The nurse is teaching a novice nurse hire how to administer colony-stimulating factors. It is important to include which of the following information? "Colony-stimulating factors are stable and can be mixed and stored on ice for up to 72 hours before administration." "Colony-stimulating factors are stable and come from the pharmacy premixed before administration." "Colony-stimulating factors are fragile and must be mixed before administration." "Colony-stimulating factors are fragile and can evaporate quickly, so the drug is only given intravenously after mixing."
"Colony-stimulating factors are fragile and must be mixed before administration."
The nurse is teaching a novice nurse hire how to administer colony-stimulating factors. It is important to include which of the following information? "Colony-stimulating factors are stable and come from the pharmacy premixed before administration." "Colony-stimulating factors are fragile and must be mixed before administration." "Colony-stimulating factors are fragile and can evaporate quickly, so the drug is only given intravenously after mixing." "Colony-stimulating factors are stable and can be mixed and stored on ice for up to 72 hours before administration."
"Colony-stimulating factors are fragile and must be mixed before administration."
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." "I know that I will need to stay on my medication for at least 1 year." "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 this medication for the rest of my life."
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? "I will always be at risk for serious infection." "I should stop taking these drugs if I get sick." "I need to take these drugs until my prescription runs out." "I'm at risk for infection until my body accepts my new liver."
"I will always be at risk for serious infection."
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 fluoroquinolone 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 tetracycline 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."
The nurse is preparing an immunostimulant drug called oprelvekin to administer to a client 32 years of age who is diagnosed with a chemotherapy-induced bleeding disorder. The nurse plans to teach the client about why the provider ordered the drug. What reason will the nurse give the client? "The drug is used to increase platelet count associated with immunosuppression during chemotherapy." "The drug is used to increase platelet count associated with low red blood cell count during chemotherapy." "The drug is used to increase platelet count and dehydration associated with chemotherapy." "The drug is used to increase platelet count and treat influenza virus infection."
"The drug is used to increase platelet count associated with immunosuppression during chemotherapy."
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? "It really helps the patient!" "The patient gets really sick from flu-like symptoms and then they get better." "The patient has increases in the number of natural killer cells." "The patient has decreased cytokine activity."
"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 weeks." "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 months." "The prescribed diet and drug are necessary to correct anemia associated with folic acid deficiency."
"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 development of bleeding." "The weekly CBC assesses for the development of infection." "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 infection."
Sirolimus is the most commonly used immune suppressant. False True
False
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 enhance allogeneic stem-cell transplantation. Aldesleukin has been shown to protect autologous tumor cells. Aldesleukin has been shown to inhibit tumor growth. Aldesleukin has been shown to have a direct proliferative effect on renal tumors.
Aldesleukin has been shown to inhibit tumor growth.
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? Fainting resulting in falls with injury Arrhythmia resulting in stroke and pulmonary edema Bone loss Vomiting resulting in dehydratio
Arrhythmia resulting in stroke and pulmonary edema
Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition? Seizure disorder Increased intracranial pressure Autoimmune disorder AIDS
Autoimmune disorder
A nurse is discussing interferon alfa-2b with a patient. What will the nurse encourage the patient to do while taking this drug? Eat 3 meals a day Decrease milk intake Avoid alcohol Increase salt intake
Avoid alcohol
The nurse is preparing to administer a client's prescribed dose of immune sera. How should the nurse describe this treatment to the client? A viral protein coat Weakened bacterial cell membrane Chemically weakened actual virus Bacterial antibodies in serum
Bacterial antibodies in serum
Immunosuppressants often are used in conjunction with corticosteroids, which block the inflammatory reaction and decrease initial damage to cells. They are especially beneficial in cases of organ transplantation and in the treatment of autoimmune diseases. How do they work when ordered for a patient who has had an organ transplant? Block normal effects of the immune system Stimulate immune system to fight off infection Work with corticosteroids to strengthen immune system Work with corticosteroids to enhance healing
Block normal effects of the immune system
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? Yeast infections Fungal infections Bone pain, nausea and vomiting, alopecia, and hypertension Fluid retention and peripheral edema
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? Chickenpox Mumps Measles HSV-1
Chickenpox
A client is receiving cyclosporine as an oral solution. What would the nurse mix this drug with to make it easy to administer to children? (Select all that apply.) Water Milk Chocolate milk Soda Orange juice
Chocolate milk Orange juice Milk
The physician has decided to prescribe T- and B-cell suppressors for a patient diagnosed with psoriasis. What drug will be ordered for this patient? Alefacept (Amevive) Tacrolimus (Prograf) Cyclosporine (Neoral) Azathioprine (Imuran)
Cyclosporine (Neoral)
While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is: Glatiramer (Copaxone). Azathioprine (Imuran). Cyclosporine (Sandimmune). Pimecrolimus (Elidel).
Cyclosporine (Sandimmune). Several T- and B-cell immune suppressors are available for use. Of the numerous agents available, cyclosporine is the most commonly used immune suppressant. The other options are all T- and B-cell immune suppressors; they are just not the most commonly prescribed.
A client with renal cancer is prescribed aldesleukin. What action should then nurse perform? Assess whether the client can sit upright after taking oral medications Ensure that the client is able to adhere to the prescribed treatment Assess the integrity of the client's oral mucosa Ensure the client has adequate intravenous access
Ensure the client has adequate intravenous access
A patient has received a bone marrow transplant. What will occur if the patient receives inadequate immunosuppression after the transplant? Renal failure Hepatic failure Graft-versus-host disease Serious infection
Graft-versus-host disease
The nurse has been administering interleukins to a client. What change in the client's health status would indicate successful therapy? Increase in the number of lymphocytes Decrease in number of natural killer cells Decrease in inflammation Maintenance of adequate circulating platelets
Increase in the number of lymphocytes
A client has been diagnosed with Kaposi sarcoma and admitted to the unit. The physician has order an IV infusion of an interferon. What drug has the physician ordered? Interferon beta-1a Interferon gamma-1b Interferon alfa-2b Peginterferon alfa-2b
Interferon alfa-2b Interferon alfa-2b indications include hairy cell leukemia, malignant melanoma, AIDS-related Kaposi sarcoma, chronic hepatitis B and C, and intralesional treatment of condylomata acuminata in clients 18 years of age or older.
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? Significant weight loss Dry skin Changes in blood pressure Nausea and changes in taste
Nausea and changes in taste
A patient is administered cyclosporine (Sandimmune, Neoral) to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine? Anaphylaxis Respiratory arrest Nephrotoxicity Congestive heart failure
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? Graft rejection Bone marrow depression Hypotension Nephrotoxicity
Nephrotoxicity
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 Prevention of organ rejection Preservation of remaining renal function Slowing of metabolic processes postoperatively to prevent an immune response
Prevention of organ rejection
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 Slowing of metabolic processes postoperatively to prevent an immune response Prevention of infection due to immunocompromised status Preservation of remaining renal function
Prevention of organ rejection
A female client has completed immunosuppressive therapy in preparation for transplantation. When explaining the risks of immunosuppression, the nurse would state: Once the transplant is completed, complications with immunosuppression are no longer a concern. Excessive immunosuppression can be corrected easily with other medications. Serious complications can occur if you are not monitored carefully. Taking both of the medications together will make her periods lighter and shorter duration.
Serious complications can occur if you are not monitored carefully.
A patient is receiving immunosuppressant therapy. Which adverse effects should the patient be educated about regarding these effects? Liver failure Respiratory depression Myocardial infarction Serious infection
Serious infection
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? Serum antibody levels Client does not develop hepatitis B AST is within normal limits Liver is not palpable
Serum antibody levels In many cases, antibody titers (levels of the antibody in the serum) can be used to evaluate a person's response to an immunization and determine the need for a booster dose.
A client is receiving an IV immune stimulant and develops a cardiac arrhythmia. What is the nurse's priority action? Stop the drug immediately. Notify the prescriber that the client is experiencing an adverse effect. Reposition the client Auscultate the client's apical heart rate for 2 minutes.
Stop the drug immediately.
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects. True False
True
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 Increased stimulation of the normal effects of the immune system in the body Targeting of various receptor sites of cells Targeting of specific receptor sites of cells
Suppression of the normal effects of the immune system in the body
While caring for Mr. Egelton, the nurse develops a teaching plan regarding proper administration and storage of interferon alfa-2a, which instruction is important to include? The drug should be administered in the same site daily. The reconstituted drug can be stored at room temperature. It is not necessary to report any change in temperature to the provider; this is an expected adverse reaction. The drug is good for only 30 days once reconstituted.
The drug is good for only 30 days once reconstituted.
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 importance of taking an aspirin daily to decrease the adverse effects of the drug The need to avoid sexual intercourse while taking the drug The need to continue oral contraceptives The need to use barrier contraceptives while taking the drug
The need to use barrier contraceptives while taking the drug
The nurse is caring for a client who has a diagnosis of chronic hepatitis B and has been prescribed an immune stimulant. The client provides patient education. How would the nurse evaluate the effectiveness of the teaching plan? The patient can state specific measures to avoid adverse effects. The patient can state who will administer their medication. The patient can state where to get their medication. The patient can state what positive effects to watch for.
The patient can state specific measures to avoid adverse effects.
The pharmacology instructor is explaining interleukins to the class. What would be the best definition of interleukins? They are chemicals used to communicate between leukocytes and are produced by T cells. They attach to specific receptor sites and respond to very specific situations. They are substances naturally produced and released by human cells that have been invaded by viruses. They block the inflammatory reaction and decrease initial damage to cells.
They are chemicals used to communicate between leukocytes and are produced by T cells.
While studying for a pharmacology test, a student asks peers about interferons. What statement about interferons is true? They stimulate B lymphocyte activity. They stimulate growth and differentiation of lymphoid cells into lymphocytes. They interfere with multiplication of stem cells. They interfere with the ability of viruses in infected cells to replicate.
They interfere with the ability of viruses in infected cells to replicate.
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
Which are used to produce active immunity? (Select all that apply.) Antibodies Immune globulin Vaccines Antigens Toxoids
Vaccines Toxoids
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. AIDS. diabetes mellitus.
a previous organ transplant.
