NR 293 Exam 1 - All chapters test bank Ch: 2 3
m m m m m m m m m m m
7 38 39 40 41 45 46 47 48 LATEST VERSION
m m m m m m m m m m
100% PASS m
1.mAmpatientmmustmbemtreatedmimmediatelymformacutemorganmtransplantmrejection.mThemnursemant
icipatesmthatmmuromonab-
CD3m(OrthoclonemOKT3)mwillmbemordered.mWhatmismthemprioritymassessmentmbeforembeginning mdr
ugmtherapymwithmmuromonab-CD3?
a. Serummpotassiummlevel
b. Fluidmvolumemstatus
c. Electrocardiogram
d. Bloodmglucosemlevel
ANS:mB
Assessmfluidmvolumemstatusmbecausemmuromonab-
CD3mismcontraindicatedminmthempresencemofmfluidmoverload.mThemother moptionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
77mTOP:mNURSINGmPROCESS:mAssessment
2.mAmpatientmismaboutmtomundergomamkidneymtransplant.mShemwillmbemgivenmanmimmunosuppressant
m drug mbefore,mduring,m andmafter m surgerymtom minimizemorganm rejection.mDuring mthempreoperative
m teaching m session,m whichm informationm will m them nursem includem aboutm them medicationm therapy?
a. Severalmdaysmbeforemthemsurgery,mthemmedicationmwillmbemadministeredmorally.
b. Themoralmdosesmneedmtombemtakenm1mhourmbeforemmealsmtommaximizemabsorption.
c. MixmthemoralmliquidmwithmjuiceminmamdisposablemStyrofoammcupmjustmbeforemadministration.
d. Intramuscular minjectionsmofmthemmedicationmwillmbemneededmformseveralmdaysmpreceding msurgery.
ANS:mA
Severalmdaysmbeforemtransplantmsurgery,mimmunosuppressantmdrugsmneedmtombemtakenmbymthemor
almroute,mifmpossible,mtomavoidmintramuscular minjectionsmandmthemriskmforminfectionmcausedmbymth
e
injections.mAvoidmStyrofoammcontainersmbecausemthemmedicationmmaymadheremtomthemsidemofmthemcon
tainer.mThesemmedicationsmaremtakenmwithmfoodmtomminimizemgastrointestinal mupset.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
78mTOP:mNURSINGmPROCESS:mImplementation
,3.mAmpatientmhasmanmorder mformcyclosporinem(Sandimmune).mThemnursemfindsmthatmcyclosporine-
mmodifiedm(Neoral)mismavailableminmthemautomatedmmedicationmcabinet.mWhichmactionmbymthemnurs
emismcorrect?
a. Holdmthemdosemuntilmthemprescriber mmakesmrounds.
b. Givemthemcyclosporine-modifiedmdrug.
c. Double-checkmthemorder,mandmthenmgivemthemcyclosporine-modifiedmdrug.
d. NotifymthempharmacymtomobtainmthemSandimmunemformmofmthemdrug.
ANS:mD
Themnursemmustmdouble-checkmthemformulationmbeforemgiving mcyclosporine.mCyclosporine-
modifiedmproductsm(suchmasmNeoralmormGengraf)mareminterchangeablemwithmeachmother mbutmaremnot
interchangeablemwithmSandimmune.mInmthismcase,mthemnursemmustmobtainmthemSandimmunemform
mofm them drug m from m them pharmacy.m Them other m optionsm arem incorrect.
DIF:mCOGNITIVEmLEVEL:mAnalyzing m(Analysis)mREF:mp.m7
78mTOP:mNURSINGmPROCESS:mImplementation
4. Themnursemismpreparingmtomadministermanminjectionmofmmonoclonalmantibodies.mWhichmadditio
nalmdrug mwillmthemnursemadminister mtomminimizemadversemreactionsmtomthemmonoclonal mantibo
dies?
a. Amnonsteroidalmanti-inflammatorymdrug
b. Ambenzodiazepine
c. Anmopioidmpainmreliever
d. Amcorticosteroid
ANS:mD
Themmonoclonalmantibodiesmbasiliximabmandmdaclizimabmhavemamtendencymtomcausemthemallergy-
likemreactionmknownmasmcytokinemreleasemsyndrome,mwhichmcanmbemseveremandmevenminvolvemanaphyl
axis.
Inmanmeffortmtomavoidmormalleviatemthismproblem,mitmismrecommendedmthatmanminjectionmofma
corticosteroid,msuchmasmmethylprednisolone,mbemadministeredmbeforemtheminjectionmofmmonoclonalma
ntibodies.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
73mTOP:mNURSINGmPROCESS:mImplementation
5. Whenmadministering mcyclosporine,mthemnursemnotesmthatmallopurinolmismalsomorderedmform
thempatient.mWhatmismampotentialmresultmofmthismdrug minteraction?
a. Reducedmadversemeffectsmofmthemcyclosporine
b. Increasedmlevelsmofmcyclosporinemandmtoxicity
c. Reducedmuricmacidmlevels
d. Reducedmnephrotoxicmeffectsmofmcyclosporine
,ANS:mB
Themallopurinolmmaymcausemincreasedmlevelsmofmcyclosporine,mandmtoxicitymmaymresult.mThemotherm
optionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
74mTOP:mNURSINGmPROCESS:mPlanning
Wemhavemanmexpert-written msolution mtomthismproblem!
6. Themnursemismmonitoring mampatientmwhomismreceiving mmuromonab-
CD3m(OrthoclonemOKT3)mafter manmorganmtransplant.mWhichmeffectmismpossiblemwithmmuromonab-
CD3mtherapy?
a. Chestmpain
b. Hypotension
c. Confusion
d. Dysuria
ANS:mA
Muromonab-
CD3mmaymcausemchestmpain,mfever,mchills,mtremor,mgastrointestinal mdisturbancesm(nausea,mvomiti
ng,mdiarrhea),mandmother meffectsmasmnotedminmTablem48-2.mThemother moptionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
73mTOP:mNURSINGmPROCESS:mEvaluation
7. Whenmmonitoring mampatientmwhomismonmimmunosuppressantmtherapymwithmazathioprinem(Imura
n),mthemnursemwillmmonitor mwhichmlaboratorymresults?
a. Serummpotassiummlevels
b. Whitembloodmcellm(leukocyte)mcount
c. Redmbloodmcellmcount
d. Serummalbuminmlevels
ANS:mB
Leukopeniamismampotentialmadversemeffectmofmazathioprinemtherapy,msomwhitembloodmcellsmneedmtom
bemmonitored.mThemother moptionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
73mTOP:mNURSINGmPROCESS:mEvaluation
, 8. Ampatientmwithmmultiplemsclerosismwillmbemstarting mtherapymwithmanmimmunosuppressantmdrug.m
Themnursemexpectsmthatmwhichmdrug mwillmbemused?
a. Azathioprinem(Imuran)
b. Glatiramer macetatem(Copaxone)
c. Daclizumabm(Zenapax)
d. Sirolimusm(Rapamune)
ANS:mB
Glatiramer macetatemandmfingolimodmaremthemonlymimmunosuppressantsmcurrentlymindicatedmf
ormreductionmofmthemfrequencymofmrelapsesm(exacerbations)minmamtypemofmmultiplemsclerosismkn
ownmasmrelapsing-remitting mmultiplemsclerosis.
DIF:mCOGNITIVEmLEVEL:mUnderstanding m(Comprehension)mREF:mp.m771mT
OP:mNURSINGmPROCESS:mPlanning
9. Cyclosporinemismprescribedmformampatientmwhomhadmanmorganmtransplant.mThemnursemwillmmon
itormthempatientmformwhichmcommonmadversemeffect?
a. Nauseamandmvomiting
b. Fevermandmtremors
c. Agitation
d. Hypertension
ANS:mD
Moderatemhypertensionmmaymoccur minmasmmuchmasm50%mofmpatientsmtakingmcyclosporine.mThemoth
ermoptionsmarempotentialmadversemeffectsmofmother mimmunosuppressantmdrugs.
DIF:mCOGNITIVEmLEVEL:mUnderstanding m(Comprehension)mREF:mp.m777mT
OP:mNURSINGmPROCESS:mEvaluation
1. Themnursemfollowsmwhichmproceduresmwhenmgivingmintravenousm(IV)mcyclosporine?m(Selectmallmt
hatmapply.)
a. Administering mitmasmamsinglemIVmbolusminjectionmtomminimizemadversemeffects
b. Using manminfusionmpumpmtomadminister mthismmedication
c. Monitoring mthempatientmformpotentialmdelayedmadversemeffects,mwhichmmaymbemsevere
d. Monitoring mthempatientmcloselymformthemfirstm30mminutesmformseveremadversemeffects
e. Checking mbloodmlevelsmperiodicallymduring mcyclosporinemtherapy
f. Performing mfrequentmoralmcaremduring mtherapy
ANS:mB,mD,mE,mF
Cyclosporinemisminfusedmintravenouslymwithmanminfusionmpump,mnotmasmanmIVmbolus.mMonitor mthe
m m m m m m m m m m m
7 38 39 40 41 45 46 47 48 LATEST VERSION
m m m m m m m m m m
100% PASS m
1.mAmpatientmmustmbemtreatedmimmediatelymformacutemorganmtransplantmrejection.mThemnursemant
icipatesmthatmmuromonab-
CD3m(OrthoclonemOKT3)mwillmbemordered.mWhatmismthemprioritymassessmentmbeforembeginning mdr
ugmtherapymwithmmuromonab-CD3?
a. Serummpotassiummlevel
b. Fluidmvolumemstatus
c. Electrocardiogram
d. Bloodmglucosemlevel
ANS:mB
Assessmfluidmvolumemstatusmbecausemmuromonab-
CD3mismcontraindicatedminmthempresencemofmfluidmoverload.mThemother moptionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
77mTOP:mNURSINGmPROCESS:mAssessment
2.mAmpatientmismaboutmtomundergomamkidneymtransplant.mShemwillmbemgivenmanmimmunosuppressant
m drug mbefore,mduring,m andmafter m surgerymtom minimizemorganm rejection.mDuring mthempreoperative
m teaching m session,m whichm informationm will m them nursem includem aboutm them medicationm therapy?
a. Severalmdaysmbeforemthemsurgery,mthemmedicationmwillmbemadministeredmorally.
b. Themoralmdosesmneedmtombemtakenm1mhourmbeforemmealsmtommaximizemabsorption.
c. MixmthemoralmliquidmwithmjuiceminmamdisposablemStyrofoammcupmjustmbeforemadministration.
d. Intramuscular minjectionsmofmthemmedicationmwillmbemneededmformseveralmdaysmpreceding msurgery.
ANS:mA
Severalmdaysmbeforemtransplantmsurgery,mimmunosuppressantmdrugsmneedmtombemtakenmbymthemor
almroute,mifmpossible,mtomavoidmintramuscular minjectionsmandmthemriskmforminfectionmcausedmbymth
e
injections.mAvoidmStyrofoammcontainersmbecausemthemmedicationmmaymadheremtomthemsidemofmthemcon
tainer.mThesemmedicationsmaremtakenmwithmfoodmtomminimizemgastrointestinal mupset.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
78mTOP:mNURSINGmPROCESS:mImplementation
,3.mAmpatientmhasmanmorder mformcyclosporinem(Sandimmune).mThemnursemfindsmthatmcyclosporine-
mmodifiedm(Neoral)mismavailableminmthemautomatedmmedicationmcabinet.mWhichmactionmbymthemnurs
emismcorrect?
a. Holdmthemdosemuntilmthemprescriber mmakesmrounds.
b. Givemthemcyclosporine-modifiedmdrug.
c. Double-checkmthemorder,mandmthenmgivemthemcyclosporine-modifiedmdrug.
d. NotifymthempharmacymtomobtainmthemSandimmunemformmofmthemdrug.
ANS:mD
Themnursemmustmdouble-checkmthemformulationmbeforemgiving mcyclosporine.mCyclosporine-
modifiedmproductsm(suchmasmNeoralmormGengraf)mareminterchangeablemwithmeachmother mbutmaremnot
interchangeablemwithmSandimmune.mInmthismcase,mthemnursemmustmobtainmthemSandimmunemform
mofm them drug m from m them pharmacy.m Them other m optionsm arem incorrect.
DIF:mCOGNITIVEmLEVEL:mAnalyzing m(Analysis)mREF:mp.m7
78mTOP:mNURSINGmPROCESS:mImplementation
4. Themnursemismpreparingmtomadministermanminjectionmofmmonoclonalmantibodies.mWhichmadditio
nalmdrug mwillmthemnursemadminister mtomminimizemadversemreactionsmtomthemmonoclonal mantibo
dies?
a. Amnonsteroidalmanti-inflammatorymdrug
b. Ambenzodiazepine
c. Anmopioidmpainmreliever
d. Amcorticosteroid
ANS:mD
Themmonoclonalmantibodiesmbasiliximabmandmdaclizimabmhavemamtendencymtomcausemthemallergy-
likemreactionmknownmasmcytokinemreleasemsyndrome,mwhichmcanmbemseveremandmevenminvolvemanaphyl
axis.
Inmanmeffortmtomavoidmormalleviatemthismproblem,mitmismrecommendedmthatmanminjectionmofma
corticosteroid,msuchmasmmethylprednisolone,mbemadministeredmbeforemtheminjectionmofmmonoclonalma
ntibodies.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
73mTOP:mNURSINGmPROCESS:mImplementation
5. Whenmadministering mcyclosporine,mthemnursemnotesmthatmallopurinolmismalsomorderedmform
thempatient.mWhatmismampotentialmresultmofmthismdrug minteraction?
a. Reducedmadversemeffectsmofmthemcyclosporine
b. Increasedmlevelsmofmcyclosporinemandmtoxicity
c. Reducedmuricmacidmlevels
d. Reducedmnephrotoxicmeffectsmofmcyclosporine
,ANS:mB
Themallopurinolmmaymcausemincreasedmlevelsmofmcyclosporine,mandmtoxicitymmaymresult.mThemotherm
optionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
74mTOP:mNURSINGmPROCESS:mPlanning
Wemhavemanmexpert-written msolution mtomthismproblem!
6. Themnursemismmonitoring mampatientmwhomismreceiving mmuromonab-
CD3m(OrthoclonemOKT3)mafter manmorganmtransplant.mWhichmeffectmismpossiblemwithmmuromonab-
CD3mtherapy?
a. Chestmpain
b. Hypotension
c. Confusion
d. Dysuria
ANS:mA
Muromonab-
CD3mmaymcausemchestmpain,mfever,mchills,mtremor,mgastrointestinal mdisturbancesm(nausea,mvomiti
ng,mdiarrhea),mandmother meffectsmasmnotedminmTablem48-2.mThemother moptionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
73mTOP:mNURSINGmPROCESS:mEvaluation
7. Whenmmonitoring mampatientmwhomismonmimmunosuppressantmtherapymwithmazathioprinem(Imura
n),mthemnursemwillmmonitor mwhichmlaboratorymresults?
a. Serummpotassiummlevels
b. Whitembloodmcellm(leukocyte)mcount
c. Redmbloodmcellmcount
d. Serummalbuminmlevels
ANS:mB
Leukopeniamismampotentialmadversemeffectmofmazathioprinemtherapy,msomwhitembloodmcellsmneedmtom
bemmonitored.mThemother moptionsmaremincorrect.
DIF:mCOGNITIVEmLEVEL:mApplying m(Application)mREF:mp.m7
73mTOP:mNURSINGmPROCESS:mEvaluation
, 8. Ampatientmwithmmultiplemsclerosismwillmbemstarting mtherapymwithmanmimmunosuppressantmdrug.m
Themnursemexpectsmthatmwhichmdrug mwillmbemused?
a. Azathioprinem(Imuran)
b. Glatiramer macetatem(Copaxone)
c. Daclizumabm(Zenapax)
d. Sirolimusm(Rapamune)
ANS:mB
Glatiramer macetatemandmfingolimodmaremthemonlymimmunosuppressantsmcurrentlymindicatedmf
ormreductionmofmthemfrequencymofmrelapsesm(exacerbations)minmamtypemofmmultiplemsclerosismkn
ownmasmrelapsing-remitting mmultiplemsclerosis.
DIF:mCOGNITIVEmLEVEL:mUnderstanding m(Comprehension)mREF:mp.m771mT
OP:mNURSINGmPROCESS:mPlanning
9. Cyclosporinemismprescribedmformampatientmwhomhadmanmorganmtransplant.mThemnursemwillmmon
itormthempatientmformwhichmcommonmadversemeffect?
a. Nauseamandmvomiting
b. Fevermandmtremors
c. Agitation
d. Hypertension
ANS:mD
Moderatemhypertensionmmaymoccur minmasmmuchmasm50%mofmpatientsmtakingmcyclosporine.mThemoth
ermoptionsmarempotentialmadversemeffectsmofmother mimmunosuppressantmdrugs.
DIF:mCOGNITIVEmLEVEL:mUnderstanding m(Comprehension)mREF:mp.m777mT
OP:mNURSINGmPROCESS:mEvaluation
1. Themnursemfollowsmwhichmproceduresmwhenmgivingmintravenousm(IV)mcyclosporine?m(Selectmallmt
hatmapply.)
a. Administering mitmasmamsinglemIVmbolusminjectionmtomminimizemadversemeffects
b. Using manminfusionmpumpmtomadminister mthismmedication
c. Monitoring mthempatientmformpotentialmdelayedmadversemeffects,mwhichmmaymbemsevere
d. Monitoring mthempatientmcloselymformthemfirstm30mminutesmformseveremadversemeffects
e. Checking mbloodmlevelsmperiodicallymduring mcyclosporinemtherapy
f. Performing mfrequentmoralmcaremduring mtherapy
ANS:mB,mD,mE,mF
Cyclosporinemisminfusedmintravenouslymwithmanminfusionmpump,mnotmasmanmIVmbolus.mMonitor mthe
