NUR 411 Exam 3
A patient must be treated immediately for acute organ transplant rejection. The nurse
anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the
priority assessment before beginning drug therapy with muromonab-CD3?
a.
Serum potassium level
b.
Fluid volume status
c.
Electrocardiogram
d.
Blood glucose level - answerANS: B
Assess fluid volume status because muromonab-CD3 is contraindicated in the presence
of fluid overload. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p.
A patient is about to undergo a kidney transplant. She will be given an
immunosuppressant drug before, during, and after surgery to minimize organ rejection.
During the preoperative teaching session, which information will the nurse include about
the medication therapy?
a.
Several days before the surgery, the medication will be administered orally.
b.
The oral doses need to be taken 1 hour before meals to maximize absorption.
c.
Mix the oral liquid with juice in a disposable Styrofoam cup just before administration.
d.
Intramuscular injections of the medication will be needed for several days preceding
surgery. - answerANS: A
Several days before transplant surgery, immunosuppressant drugs need to be taken by
the oral route, if possible, to avoid intramuscular injections and the risk for infection
caused by the injections. Avoid Styrofoam containers because the medication may
adhere to the side of the container. These medications are taken with food to minimize
gastrointestinal upset.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778
TOP:NURSING PROCESS: Implementation
A patient has an order for cyclosporine (Sandimmune). The nurse finds that
cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which
action by the nurse is correct?
,a.
Hold the dose until the prescriber makes rounds.
b.
Give the cyclosporine-modified drug.
c.
Double-check the order, and then give the cyclosporine-modified drug.
d.
Notify the pharmacy to obtain the Sandimmune form of the drug. - answerANS: D
The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-
modified products (such as Neoral or Gengraf) are interchangeable with each other but
are not interchangeable with Sandimmune. In this case, the nurse must obtain the
Sandimmune form of the drug from the pharmacy. The other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 778
TOP:NURSING PROCESS: Implementation
The nurse is preparing to administer an injection of monoclonal antibodies. Which
additional drug will the nurse administer to minimize adverse reactions to the
monoclonal antibodies?
a.
A nonsteroidal anti-inflammatory drug
b.
A benzodiazepine
c.
An opioid pain reliever
d.
A corticosteroid - answerANS: D
The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the
allergy-like reaction known as cytokine release syndrome, which can be severe and
even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is
recommended that an injection of a corticosteroid, such as methylprednisolone, be
administered before the injection of monoclonal antibodies.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773
TOP:NURSING PROCESS: Implementation
When administering cyclosporine, the nurse notes that allopurinol is also ordered for the
patient. What is a potential result of this drug interaction?
a.
Reduced adverse effects of the cyclosporine
b.
Increased levels of cyclosporine and toxicity
c.
Reduced uric acid levels
d.
Reduced nephrotoxic effects of cyclosporine - answerANS: B
,The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The
other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 774
TOP: NURSING PROCESS: Planning
The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3)
after an organ transplant. Which effect is possible with muromonab-CD3 therapy?
a.
Chest pain
b.
Hypotension
c.
Confusion
d.
Dysuria - answerANS: A
Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal
disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The
other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773
TOP: NURSING PROCESS: Evaluation
When monitoring a patient who is on immunosuppressant therapy with azathioprine
(Imuran), the nurse will monitor which laboratory results?
a.
Serum potassium levels
b.
White blood cell (leukocyte) count
c.
Red blood cell count
d.
Serum albumin levels - answerANS: B
Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells
need to be monitored. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773
TOP:NURSING PROCESS: Evaluation
A patient with multiple sclerosis will be starting therapy with an immunosuppressant
drug. The nurse expects that which drug will be used?
a.
Azathioprine (Imuran)
b.
Glatiramer acetate (Copaxone)
c.
, Daclizumab (Zenapax)
d.
Sirolimus (Rapamune) - answerANS: B
Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated
for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis
known as relapsing-remitting multiple sclerosis.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 771
TOP:NURSING PROCESS: Planning
Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will
monitor the patient for which common adverse effect?
a.
Nausea and vomiting
b.
Fever and tremors
c.
Agitation
d.
Hypertension - answerANS: D
Moderate hypertension may occur in as much as 50% of patients taking cyclosporine.
The other options are potential adverse effects of other immunosuppressant drugs.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 777
TOP: NURSING PROCESS: Evaluation
The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select
all that apply.)
a.
Administering it as a single IV bolus injection to minimize adverse effects
b.
Using an infusion pump to administer this medication
c.
Monitoring the patient for potential delayed adverse effects, which may be severe
d.
Monitoring the patient closely for the first 30 minutes for severe adverse effects
e.
Checking blood levels periodically during cyclosporine therapy
f.
Performing frequent oral care during therapy - answerANS: B, D, E, F
Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor
the patient closely for the first 30 minutes for adverse effects, especially for allergic
reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of
the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent
infections.
A patient must be treated immediately for acute organ transplant rejection. The nurse
anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the
priority assessment before beginning drug therapy with muromonab-CD3?
a.
Serum potassium level
b.
Fluid volume status
c.
Electrocardiogram
d.
Blood glucose level - answerANS: B
Assess fluid volume status because muromonab-CD3 is contraindicated in the presence
of fluid overload. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p.
A patient is about to undergo a kidney transplant. She will be given an
immunosuppressant drug before, during, and after surgery to minimize organ rejection.
During the preoperative teaching session, which information will the nurse include about
the medication therapy?
a.
Several days before the surgery, the medication will be administered orally.
b.
The oral doses need to be taken 1 hour before meals to maximize absorption.
c.
Mix the oral liquid with juice in a disposable Styrofoam cup just before administration.
d.
Intramuscular injections of the medication will be needed for several days preceding
surgery. - answerANS: A
Several days before transplant surgery, immunosuppressant drugs need to be taken by
the oral route, if possible, to avoid intramuscular injections and the risk for infection
caused by the injections. Avoid Styrofoam containers because the medication may
adhere to the side of the container. These medications are taken with food to minimize
gastrointestinal upset.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778
TOP:NURSING PROCESS: Implementation
A patient has an order for cyclosporine (Sandimmune). The nurse finds that
cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which
action by the nurse is correct?
,a.
Hold the dose until the prescriber makes rounds.
b.
Give the cyclosporine-modified drug.
c.
Double-check the order, and then give the cyclosporine-modified drug.
d.
Notify the pharmacy to obtain the Sandimmune form of the drug. - answerANS: D
The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-
modified products (such as Neoral or Gengraf) are interchangeable with each other but
are not interchangeable with Sandimmune. In this case, the nurse must obtain the
Sandimmune form of the drug from the pharmacy. The other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 778
TOP:NURSING PROCESS: Implementation
The nurse is preparing to administer an injection of monoclonal antibodies. Which
additional drug will the nurse administer to minimize adverse reactions to the
monoclonal antibodies?
a.
A nonsteroidal anti-inflammatory drug
b.
A benzodiazepine
c.
An opioid pain reliever
d.
A corticosteroid - answerANS: D
The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the
allergy-like reaction known as cytokine release syndrome, which can be severe and
even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is
recommended that an injection of a corticosteroid, such as methylprednisolone, be
administered before the injection of monoclonal antibodies.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773
TOP:NURSING PROCESS: Implementation
When administering cyclosporine, the nurse notes that allopurinol is also ordered for the
patient. What is a potential result of this drug interaction?
a.
Reduced adverse effects of the cyclosporine
b.
Increased levels of cyclosporine and toxicity
c.
Reduced uric acid levels
d.
Reduced nephrotoxic effects of cyclosporine - answerANS: B
,The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The
other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 774
TOP: NURSING PROCESS: Planning
The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3)
after an organ transplant. Which effect is possible with muromonab-CD3 therapy?
a.
Chest pain
b.
Hypotension
c.
Confusion
d.
Dysuria - answerANS: A
Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal
disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The
other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773
TOP: NURSING PROCESS: Evaluation
When monitoring a patient who is on immunosuppressant therapy with azathioprine
(Imuran), the nurse will monitor which laboratory results?
a.
Serum potassium levels
b.
White blood cell (leukocyte) count
c.
Red blood cell count
d.
Serum albumin levels - answerANS: B
Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells
need to be monitored. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773
TOP:NURSING PROCESS: Evaluation
A patient with multiple sclerosis will be starting therapy with an immunosuppressant
drug. The nurse expects that which drug will be used?
a.
Azathioprine (Imuran)
b.
Glatiramer acetate (Copaxone)
c.
, Daclizumab (Zenapax)
d.
Sirolimus (Rapamune) - answerANS: B
Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated
for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis
known as relapsing-remitting multiple sclerosis.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 771
TOP:NURSING PROCESS: Planning
Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will
monitor the patient for which common adverse effect?
a.
Nausea and vomiting
b.
Fever and tremors
c.
Agitation
d.
Hypertension - answerANS: D
Moderate hypertension may occur in as much as 50% of patients taking cyclosporine.
The other options are potential adverse effects of other immunosuppressant drugs.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 777
TOP: NURSING PROCESS: Evaluation
The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select
all that apply.)
a.
Administering it as a single IV bolus injection to minimize adverse effects
b.
Using an infusion pump to administer this medication
c.
Monitoring the patient for potential delayed adverse effects, which may be severe
d.
Monitoring the patient closely for the first 30 minutes for severe adverse effects
e.
Checking blood levels periodically during cyclosporine therapy
f.
Performing frequent oral care during therapy - answerANS: B, D, E, F
Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor
the patient closely for the first 30 minutes for adverse effects, especially for allergic
reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of
the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent
infections.
