Question 1

What action is most important for the nurse to teach the patient taking corticosteroids following a transplant?&#10;A) &#34;Combining the steroid with certain antibiotics can increase the risk of cardiac arrhythmias.&#34;&#10;B) &#34;While side effects are expected with the medication, none is life-threatening.&#34;&#10;C) &#34;Be sure to get all immunizations as recommended.&#34;&#10;D) &#34;You need to avoid pregnancy while taking this steroid.&#34;

Accepted Answer

Chronic corticosteroid therapy with macrolide antibiotics increases the risk of ventricular arrhythmias.Side effects are common,but some are serious and can be life-threatening (i.e.,anaphylaxis,heart failure).Transplant recipients taking corticosteroids should not receive live vaccines because their immune system may be inadequate.Caution is advised during pregnancy,especially in the first trimester or with long-term use,but pregnancy is not contraindicated.

Question 2

The patient on immunosuppressant medications is speaking to the nurse about appropriate activities.Which statement requires intervention?&#10;A) &#34;I am going to the state fair with my friends.&#34;&#10;B) &#34;I enjoy working in my garden to relax.&#34;&#10;C) &#34;I will brush my teeth after meals.&#34;&#10;D) &#34;It's OK to eat fresh fruits and vegetables.&#34;&#10;E) &#34;I should get a new glass, if the one I am drinking from has been sitting out.&#34;&#10;F) &#34;I should bath daily, using an antimicrobial soap.&#34;

Accepted Answer

Immunosuppressed patients should stay away from crowds and people who are sick.Fresh flowers,live plants,gardening,and standing water should be avoided.One should brush teeth at least twice a day with a soft toothbrush and bathe daily.In general,the patient should avoid activities that increase the risk of exposure to bacteria/germs.

Question 3

The nurse is teaching a patient who will begin taking basiliximab in conjunction with a kidney transplant.The patient asks why this therapy is needed.The nurse will explain that with this therapy&#10;A) the immune system is boosted.&#10;B) the drug is taken by mouth before and after the transplant surgery.&#10;C) nausea, vomiting, fever, and chills are common side effects.&#10;D) it is safe to become pregnant.

Accepted Answer

Nausea,vomiting,fever,and chills are common side effects.Basiliximab provides intense immunosuppression to reduce the risk for acute rejection during the initial transplant period.The drug is administered intravenously 2 hours before transplant surgery followed by a second dose 4 days after transplantation.No adequate well-controlled studies have been done on the drug's use in pregnancy; thus women should not get pregnant before,during,or up to 4 months after completion of therapy.

Question 4

The patient tells the nurse that he understands that transplant rejection may happen and asks what can be done to minimize that risk.What will the nurse include in the teaching?&#10;A) &#34;An anti-T-cell antibody is used in conjunction with corticosteroid therapy.&#34;&#10;B) &#34;ATG rabbit is used regardless of WBC count.&#34;&#10;C) &#34;Transplant rejection drugs have unwanted side effects, but none are deadly.&#34;&#10;D) &#34;Caution needs to be taken when other immunosuppressant drugs are administered.&#34;

Accepted Answer

Caution needs to be taken when other immunosuppressant drugs are administered because of the increased risk of serious infection.Treatment of rejection with an anti-T-cell antibody is used when corticosteroids have failed to reverse rejection or for treatment of a recurrent rejection.The dose of ATG rabbit is decreased when WBC levels fall and is discontinued when WBC levels are less than 2000.These drugs have unwanted side effects; muromonab-CD3 carries a warning about the risk of anaphylactic reaction.

Question 5

Your patient is taking belatacept and develops posttransplant lymphoproliferative disorder (PTLD).You would expect to see&#10;A) hypothermia.&#10;B) weight gain.&#10;C) hyperglycemia.&#10;D) general malaise.

Accepted Answer

Signs and symptoms of PTLD include general malaise,fever,unintentional weight loss,lymphadenopathy,gastrointestinal symptoms,including obstruction,and infectious mononucleosis-like symptoms,pulmonary symptoms,and CNS symptoms.

Question 6

A patient who has had an organ transplant is prescribed cyclosporine for maintenance therapy.Which statement by the patient indicates further teaching is needed?&#10;A) &#34;The provider may change the dose of the medication after getting the lab results.&#34;&#10;B) &#34;I can mix this medication with juice.&#34;&#10;C) &#34;I have to avoid getting the nasal spray FluMist.&#34;&#10;D) &#34;I will take the medication each morning at 8 A.M.&#34;

Accepted Answer

The daily dose of cyclosporine should always be given in two divided doses and on a consistent schedule with regard to time of day and relation to meals.Adjustments to drug dosing are based on therapeutic drug monitoring (TDM),with the desired level between 100 and 500 ng/mL,depending on the organ transplanted and the length of time posttransplant.Cyclosporine oral solution should be diluted with room-temperature apple or orange juice,and grapefruit juice must be avoided.Transplant recipients taking cyclosporine should not receive live vaccines because they may have inadequate immune response.

Deck 30: Transplant Drugs