PHARM. Chapter 17

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 of the following 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."

The client is a man 79 years of age admitted to the Cancer Treatment Center after chemotherapy for administration of colony-stimulating factors (CSFs). The client voices concern that the immunostimulant drugs will cause renal failure. The nurse knows that CSFs are used for both chronic renal failure and cancer treatment. How would the nurse explain the action of the drugs to calm the client's fears?

"Don't worry, the drugs you will receive today support what is called the hematopoietic system, which is composed of fluids and blood to support your body during chemotherapy and renal failure."

A client is experiencing flu-like symptoms related to immune stimulant therapy. Which of the following instructions would be most appropriate for the client?

"Drink plenty of fluids throughout the day."

A patient is administered mycophenolate (CellCept) to prevent rejection of his transplanted heart. It is recommended that he have a CBC drawn weekly. He asks the nurse the reason for the weekly CBC. Which of the following is the nurse's best response?

"The weekly CBC assesses for the development of infection."

After a client age 65 years diagnosed with vitamin B12 deficiency learns about the use of the vitamin, she asks the nurse what caused her B12 deficiency anemia. Which of the following statements would the nurse use when teaching the client about vitamin B12?

"You have a deficiency because you are on a strict vegan diet."

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 Cyclosporine is used as an adjunct treatment to prevent rejection in solid organ transplantation and to prevent graft-versus-host disease in allogeneic bone marrow or stem cell transplants. It is not used in the treatment of multiple myeloma, diabetes, or AIDS

A patient has been recovering in the transplant unit for several days following a successful heart-lung transplant. The patient has begun taking cyclosporine and the nurse has made necessary changes to the patient's nursing care plan. What nursing diagnosis is most relevant to this patient's current medication regimen?

Altered Tissue Perfusion related to hypertension

The nurse is teaching post-administration cardiovascular system reactions to the immunostimulant drug oprelvekin. The nurse would include which of the following cardiovascular system reactions in the client teaching plan?

Arrhythmia resulting in stroke and pulmonary edema

Immunosuppressant drugs are given after organ transplantation. For which of the following disorders will immunosuppressant agents also be prescribed?

Autoimmune disorders

Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what conditions?

Autoimmune disorders

A client is receiving oprelvekin. Which of the following would suggest that the client is experiencing a hypersensitivity reaction?

Chest tightness

Which of the following would the nurse expect to administer orally?

Cyclosporine

Which of the following would lead the nurse to suspect that a client receiving a monoclonal antibody is experiencing pulmonary edema?

Dyspnea

Abatacept is classified as an interleukin receptor antagonist.

False

Interleukins act to prevent virus particles from replicating inside the cells.

False Interferons prevent virus particles from replicating inside the cells. Interleukins communicate between lymphocytes stimulating cellular immunity and inhibiting tumor growth.

A patient has received a bone marrow transplant. What will occur if the patient receives inadequate immunosuppression after the transplant?

Graft-versus-host disease The goal after bone marrow transplantation is to provide adequate immunosuppression. If immunosuppression is inadequate, graft-versus-host disease will occur with bone marrow transplantation. The patient will not suffer from hepatic failure. The patient will not suffer from renal failure. Inadequate immunosuppression will not place the patient at risk for serious infection.

The physician is planning to prescribe mycophenolate mofetil for a 28-year-old woman. The nurse understands that the client is required to do what before receiving this prescription?

Have a negative pregnancy test

A patient is receiving omalizumab (Xolair) to treat allergic asthma, which is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab?

Have epinephrine available Health care providers should have medications and supplies available for treatment of anaphylaxis, should observe patients for at least 2 hours after an injection, and should teach patients how to self-administer emergency treatment. The patient will not require assessment for cancer with every dose administration. The patient will not need to avoid high-fat foods. The patient will not receive corticosteroid agents.

Which of the following statements indicates that your 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 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

Which agent would be classified as an immune stimulant?

Interferon alfa-2b

When describing the production of interferons, the instructor discusses recombinant DNA technology. Which of the following would the instructor include as being produced this way?

Interferon alfacon-1

The nurse educator is teaching an online pharmacology class. The topic of the online seminar is the contraindications for the use of colony stimulation factor. The nurse includes which of the following contraindications?

Known hypersensitivity to the drug or any component of the drug

A female client's physician prescribes leflunomide for her rheumatoid arthritis. Six months later, the client presents for routine laboratory testing. The physician would discontinue the medication if what laboratory test was abnormal?

LFT

A client is to receive erlotinib. The nurse would expect to administer this drug by which route?

Oral

The nurse is caring for a child who will be receiving a renal transplant. The physician orders cyclosporine. When teaching the parents and child about this drug, the nurse would include which of the following as the primary reason for the drug?

Prevention of rejection 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. The drug has no effect on metabolic processes

A client is receiving mycophenolate after undergoing a liver transplant. Which of the following would be a priority nursing diagnosis?

Risk for infection

A patient is receiving anakinra for treatment of rheumatoid arthritis. The patient is scheduled to have arthroscopic evaluation of the right knee. Which of the following nursing diagnoses would be a priority after the procedure?

Risk for infection

A patient is receiving immunosuppressant therapy. Which of the following adverse effects should the patient be educated regarding these effects?

Serious infection

Which of the following is an adverse effect of excessive immunosuppression?

Serious infection

The nurse closely monitors a client who is receiving anakinra and etanercept for which of the following?

Severe infection

Six months after undergoing transplantation, a female client asks her physician if it would be alright 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 physician suggests alternate volunteer options; what is he most likely concerned about?

She may develop an infectious process at the clinic.

Ms. Potter 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 a previously-optimistic person. How should the nurse best interpret the patient's statements?

The patient may be having psychological adverse effects of interferon alfa-2a.

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 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to

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

nephrotoxicity.

You are caring for a client following his organ transplant procedure. He complains that oral cyclosporine tastes awful and that he is unable to swallow it. You tell the client that he can make his medication more palatable by mixing it with

orange juice.