Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 42-year-old male patient with a history
of severe chronic plaque psoriasis is scheduled to receive
his first subcutaneous dose of ustekinumab, a human
interleukin-12 and interleukin-23 antagonist. Prior to
administration, the clinical nurse reviews the patient’s
electronic health record and notices that the patient’s
baseline interferon-gamma release assay (IGRA) or
QuantiFERON-TB Gold test is missing, although the patient
claims, "I had a negative skin test about three years ago
when I started a new job."
• Question Stem: Which action should the nurse take first to
ensure patient safety and adhere to standard drug
approval and monitoring guidelines?
• Answer Options:
o A. Administer the medication as scheduled since the
patient reports a negative tuberculin skin test within
the past 3 years.
o B. Obtain a prescription for a prophylactic course of
isoniazid and rifampin, then administer the
ustekinumab.
, o C. Hold the administration of ustekinumab and
collaborate with the prescriber to ensure baseline
tuberculosis screening is performed and processed.
o D. Administer the subcutaneous injection and
schedule the patient for a QuantiFERON-TB Gold test
at their 4-week follow-up appointment.
• Correct Answer: C
• Comprehensive Rationale: Ustekinumab is a biologic
response modifier that selectively targets interleukins IL-12
and IL-23, effectively downregulating the T-helper cell
pathways ($Th1$ and $Th17$) responsible for chronic
inflammatory responses like psoriasis. However, these
identical pathways are indispensable for cell-mediated
immunity and granuloma formation, which contain latent
Mycobacterium tuberculosis infections. Administering a
biologic agent that inhibits these cytokines in a patient
with undiagnosed latent tuberculosis can cause rapid,
catastrophic reactivation and disseminated disease.
Standard drug guidelines mandated by regulatory bodies
require a documented, negative, current tuberculosis
screening (either IGRA or a two-step tuberculin skin test)
before initiating therapy. Relying on a patient’s verbal
history of a skin test performed three years prior
constitutes a severe medication safety violation. Holding
, the drug and ensuring the test is completed prevents a
potentially life-threatening adverse reaction.
• Distractor Analysis:
o Option A is incorrect: Verbal reports of historical
diagnostic tests are insufficient validation. The latent
tuberculosis status could have changed over three
years, exposing the patient to severe reactivation risks
if biologic immunosuppressants are introduced
without objective verification.
o Option B is incorrect: Prescribing and initiating highly
hepatotoxic antitubercular regimens without a
definitive positive screening test violates evidence-
based protocols and introduces unnecessary toxic
risks.
o Option D is incorrect: Administering the medication
before confirming tuberculosis status exposes the
patient to an immediate risk window where the
immune system is suppressed while a potential latent
infection remains unmitigated.
• Nursing Process Integration:
o Primary Component: Assessment (Validating
mandatory diagnostic baseline data prior to drug
administration).
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 42-year-old male patient with a history
of severe chronic plaque psoriasis is scheduled to receive
his first subcutaneous dose of ustekinumab, a human
interleukin-12 and interleukin-23 antagonist. Prior to
administration, the clinical nurse reviews the patient’s
electronic health record and notices that the patient’s
baseline interferon-gamma release assay (IGRA) or
QuantiFERON-TB Gold test is missing, although the patient
claims, "I had a negative skin test about three years ago
when I started a new job."
• Question Stem: Which action should the nurse take first to
ensure patient safety and adhere to standard drug
approval and monitoring guidelines?
• Answer Options:
o A. Administer the medication as scheduled since the
patient reports a negative tuberculin skin test within
the past 3 years.
o B. Obtain a prescription for a prophylactic course of
isoniazid and rifampin, then administer the
ustekinumab.
, o C. Hold the administration of ustekinumab and
collaborate with the prescriber to ensure baseline
tuberculosis screening is performed and processed.
o D. Administer the subcutaneous injection and
schedule the patient for a QuantiFERON-TB Gold test
at their 4-week follow-up appointment.
• Correct Answer: C
• Comprehensive Rationale: Ustekinumab is a biologic
response modifier that selectively targets interleukins IL-12
and IL-23, effectively downregulating the T-helper cell
pathways ($Th1$ and $Th17$) responsible for chronic
inflammatory responses like psoriasis. However, these
identical pathways are indispensable for cell-mediated
immunity and granuloma formation, which contain latent
Mycobacterium tuberculosis infections. Administering a
biologic agent that inhibits these cytokines in a patient
with undiagnosed latent tuberculosis can cause rapid,
catastrophic reactivation and disseminated disease.
Standard drug guidelines mandated by regulatory bodies
require a documented, negative, current tuberculosis
screening (either IGRA or a two-step tuberculin skin test)
before initiating therapy. Relying on a patient’s verbal
history of a skin test performed three years prior
constitutes a severe medication safety violation. Holding
, the drug and ensuring the test is completed prevents a
potentially life-threatening adverse reaction.
• Distractor Analysis:
o Option A is incorrect: Verbal reports of historical
diagnostic tests are insufficient validation. The latent
tuberculosis status could have changed over three
years, exposing the patient to severe reactivation risks
if biologic immunosuppressants are introduced
without objective verification.
o Option B is incorrect: Prescribing and initiating highly
hepatotoxic antitubercular regimens without a
definitive positive screening test violates evidence-
based protocols and introduces unnecessary toxic
risks.
o Option D is incorrect: Administering the medication
before confirming tuberculosis status exposes the
patient to an immediate risk window where the
immune system is suppressed while a potential latent
infection remains unmitigated.
• Nursing Process Integration:
o Primary Component: Assessment (Validating
mandatory diagnostic baseline data prior to drug
administration).
