Question 1

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?&#10;A) Chest pain&#10;B) Hypotension&#10;C) Confusion&#10;D) Dysuria

Accepted Answer

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.

Question 2

A patient will be on a tacrolimus (Prograf)infusion after receiving a liver transplant.The order reads,&#34;Give 0.03 mg/kg/day as a continuous IV infusion.&#34; The patient weighs 159 pounds,and the medication injection solution is available in a 5-mg/mL strength.Identify how many milliliters will the nurse draw up for this infusion.(record answer using two decimal places)_______

Accepted Answer

0.43 ML

Question 3

When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran),the nurse will monitor which laboratory results?&#10;A) Serum potassium levels&#10;B) White blood cell (leukocyte)count&#10;C) Red blood cell count&#10;D) Serum albumin levels

Accepted Answer

When a patient is on immunosuppressant therapy with azathioprine (Imuran), they are at risk for leukopenia (low white blood cell count) due to the drug's effect on bone marrow suppression. Therefore, it is important to monitor the patient's white blood cell count regularly to ensure they are not becoming immunocompromised. Serum potassium levels, red blood cell count, and serum albumin levels are not specifically impacted by azathioprine therapy.

Question 4

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?&#10;A) Hold the dose until the prescriber makes rounds.&#10;B) Give the cyclosporine-modified drug.&#10;C) Double-check the order,and then give the cyclosporine-modified drug.&#10;D) Notify the pharmacy to obtain the Sandimmune form of the drug.

Accepted Answer

Cyclosporine (Sandimmune) and cyclosporine-modified (Neoral) are not interchangeable due to differences in bioavailability. The nurse should notify the pharmacy to obtain the specific form ordered by the prescriber.

Question 5

Cyclosporine is prescribed for a patient who had an organ transplant.The nurse will monitor the patient for which common adverse effect?&#10;A) Nausea and vomiting&#10;B) Fever and tremors&#10;C) Agitation&#10;D) Hypertension

Accepted Answer

Cyclosporine commonly causes hypertension as a side effect. It does not typically cause nausea and vomiting, fever and tremors, or agitation.

Question 6

A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug.The nurse expects that which drug will be used?&#10;A) Azathioprine (Imuran)&#10;B) Glatiramer acetate (Copaxone)&#10;C) Daclizumab (Zenapax)&#10;D) Sirolimus (Rapamune)

Accepted Answer

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.

Question 7

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.

Accepted Answer

Immunosuppressants are typically administered orally, but the timing and specific instructions may vary depending on the medication. It is important for the nurse to provide accurate and individualized information to the patient based on their prescribed medication. Option B is incorrect as the timing of doses may vary and should be based on the medication's instructions. Option C is incorrect as using disposable Styrofoam cups can potentially interact with the medication, and proper medication administration equipment should be used. Option D is incorrect as most immunosuppressants are not typically administered through intramuscular injections.

Question 8

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

Accepted Answer

Before beginning drug therapy with muromonab-CD3, the priority assessment should be the patient's fluid volume status. Muromonab-CD3 has a known side effect of causing fluid retention and potentially leading to pulmonary edema. Therefore, it is important for the nurse to assess the patient's fluid volume status to identify any potential risks or complications associated with the medication. Serum potassium level, electrocardiogram, and blood glucose level may be important assessments for the patient, but they are not the priority before beginning muromonab-CD3 therapy.

Question 9

When administering cyclosporine,the nurse notes that allopurinol is also ordered for the patient.What is a potential result of this drug interaction?&#10;A) Reduced adverse effects of the cyclosporine&#10;B) Increased levels of cyclosporine and toxicity&#10;C) Reduced uric acid levels&#10;D) Reduced nephrotoxic effects of cyclosporine

Accepted Answer

Allopurinol inhibits the metabolism of cyclosporine, which can lead to increased levels and potential toxicity. This drug interaction requires close monitoring of cyclosporine levels and adjusting the dosage as needed.

Question 10

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?&#10;A) A nonsteroidal anti-inflammatory drug&#10;B) A benzodiazepine&#10;C) An opioid pain reliever&#10;D) A corticosteroid

Accepted Answer

Corticosteroids are commonly administered with monoclonal antibodies to minimize adverse reactions such as fever, chills, and skin reactions. Nonsteroidal anti-inflammatory drugs, benzodiazepines, and opioid pain relievers are not typically used for this purpose.

Deck 48: Immunosuppressant Drugs