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1. After receiving an allograft liver transplant, a patient is prescribed cyclosporine
[Sandimmune] oral solution. What is the most critical component of patient teaching
that the nurse should stress?
A. The medication will help prevent transplant rejection.
B. The oral solution can be mixed with orange juice.
C. The medication will be taken every day for life.
D. The medication causes reversible increase of hair growth. - Correct Answer: The
medication will be taken every day for life.
Allograft recipients must take immunosuppressants for life to prevent transplant rejection. The
other concepts are important to teach the patient but are not as high a priority.
2. A patient is prescribed sirolimus [Rapamune] and cyclosporine [Sandimmune] after
renal transplantation. It is most important for the nurse to closely monitor which value?
A. Serum creatinine
B. Aspartate aminotransferase
C. Serum potassium
D. Partial thromboplastin time - Correct Answer: Serum creatinine
Sirolimus combined with cyclosporine poses a significant risk of renal injury. Renal function
(serum creatinine, serum blood urea nitrogen, and urinary creatinine clearance) should be
monitored.
3. When caring for a 21-year-old female patient, post kidney transplantation, who is taking
cyclosporine [Sandimmune] and repaglinide [Prandin], what should the nurse do?
,A. Administer the medication with grapefruit juice.
B. Monitor the patient for hyperglycemia.
C. Encourage the patient to take an oral contraceptive.
D. Assess the patient for signs and symptoms of infection. - Correct Answer: D. Assess the
patient for signs and symptoms of infection.
Cyclosporine increases the risk of infections, which develop in 74% of those treated. Activation
of latent infection with the BK virus can result in kidney damage, primarily in kidney recipients.
Patients should be warned about early signs of infection (fever, sore throat) and instructed to
report them immediately.
4. A patient who takes over-the counter-diphenhydramine [Benadryl] for seasonal allergy
symptoms complains of drowsiness. What should the nurse do?
A. Instruct the patient to drink caffeinated beverages.
B. Recommend taking the medication with meals.
C. Ask the patient's health care provider to prescribe hydroxyzine [Vistaril].
D. Tell the patient to take cetirizine [Zyrtec] instead of diphenhydramine. - Correct Answer:
D. Tell the patient to take cetirizine [Zyrtec] instead of diphenhydramine.
Second-generation antihistamines, such as cetirizine, cross the blood-brain barrier poorly and
hence produce much less sedation than first-generation antihistamines.
5. A patient has chronic idiopathic urticaria. Which medication would be appropriate for
the nurse to administer for this condition?
A. Fexofenadine [Allegra]
B. Loratadine [Claritin]
C. Azelastine [Astelin]
D. Diphenhydramine [Benadryl] - Correct Answer: A. Fexofenadine [Allegra]
, Fexofenadine [Allegra] is approved for chronic idiopathic urticaria. Diphenhydramine is
approved for acute urticaria.
6. Which statement regarding antihistamine administration to older adults does the nurse
identify as true?
A. Antihistamines cause CNS excitation in older adults.
B. Larger doses of antihistamines are needed for older adults.
C. Antihistamines can be used to reduce intraocular pressure.
D. Older men with benign prostatic hypertrophy can experience worse symptoms when taking
antihistamines. - Correct Answer: D. Older men with benign prostatic hypertrophy can
experience worse symptoms when taking antihistamines.
When used in older adults, antihistamines can cause sedation; smaller doses should be used
initially and titrated up if needed. Also, these medications can worsen glaucoma or benign
prostatic hyperplasia.
7. A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should
monitor the patient for what?
A. Renal toxicity
B. Bleeding
C. Stroke symptoms
D. Dysrhythmias - Correct Answer: B. Bleeding
Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.
8. A patient drinks five to six alcoholic beverages per day and takes acetaminophen
[Tylenol] for pain relief. The nurse should caution the patient to do what?