Question 1

A 24-year-old client will be starting drug therapy with azathioprine (Imuran).Which of the following instructions related to reproduction would the nurse share with the client?&#10;A) Use contraception during drug use and for 4 months after completion&#10;B) Use only oral contraception rather than barrier methods&#10;C) Try to avoid sexual activity as much as possible&#10;D) Explain to the partner risks of contact during azathioprine therapy&#10;

Accepted Answer

Azathioprine can cause birth defects and should not be used during pregnancy. Clients should use contraception during drug use and for 4 months after completion to avoid unplanned pregnancy. Barrier methods such as condoms may not be as effective as oral contraceptives, so the nurse may recommend oral contraception as a preferred method. Avoiding sexual activity altogether is not necessary unless the client chooses to do so, and explaining the risks to the partner is not the client's responsibility but rather the responsibility of the healthcare provider.

Question 2

Which nursing diagnosis would be appropriate for a client who is receiving immunosuppressive agents?&#10;A) Constipation related to adverse drug effects&#10;B) Imbalanced nutrition,greater than body requirements&#10;C) Grieving related to permanent hair loss&#10;D) Anxiety related to actual or perceived threat to biologic integrity&#10;

Accepted Answer

Immunosuppressive agents can pose a threat to the body's natural defense mechanisms, leaving the client vulnerable to infections, illnesses, and other biologic threats. Therefore, anxiety related to actual or perceived threat to biologic integrity is an appropriate nursing diagnosis for clients receiving these medications. Constipation related to adverse drug effects and imbalanced nutrition, greater than body requirements, are not directly related to the effects of immunosuppressive agents. Grieving related to permanent hair loss may be a concern for clients receiving chemotherapy, but it is not applicable to individuals receiving immunosuppressive agents.

Question 3

The nurse includes in client teaching related to cyclosporine (Sandimmune)therapy that the client should have dental checkups at what intervals to detect gingival hyperplasia?&#10;A) Monthly&#10;B) Every other month&#10;C) Every 3 months&#10;D) Every 6 months&#10;

Accepted Answer

Clients on cyclosporine (Sandimmune) therapy should have dental checkups every 3 months to detect gingival hyperplasia which is a possible side effect of the medication.

Question 4

The nurse would take which of the following actions to safely provide care to a client receiving immunosuppressant drugs?&#10;A) Wash hands with at least every other contact with client&#10;B) Cleanse the skin for 10 seconds before giving an injection&#10;C) Ensure that water in the client's pitcher is fresh&#10;D) Provide careful skin,mouth,and perianal care&#10;

Accepted Answer

Providing careful skin, mouth, and perianal care is crucial for clients on immunosuppressant drugs to prevent infections, as their immune systems are compromised.

Question 5

The nurse contacts the physician after noting that the leukocyte count in a client taking azathioprine (Imuran)has dropped below which of the following levels? A) 100,000/mm³ B) 50,000/mm³ C) 10,000/mm³ D) 3000/mm³

Accepted Answer

Azathioprine (Imuran) can cause bone marrow suppression, leading to leukopenia. A leukocyte count below 3000/mm^3 is considered critically low and warrants immediate contact with a physician due to the increased risk of infection.

Question 6

The nurse would assess for which of the following symptoms if a client is suspected of having an opportunistic infection?&#10;A) Nausea&#10;B) Flushing face&#10;C) Oral candidiasis&#10;D) Seizures&#10;

Accepted Answer

Oral candidiasis is a common opportunistic infection seen in immunocompromised clients. Nausea and flushing face are not directly related to opportunistic infections, and seizures may be a symptom of a variety of conditions but not specific to opportunistic infections.

Question 7

After preparing a dose of basiliximab (Simulect)for a client at 08:00,the nurse determines that it needs to be administered by which of the following times?&#10;A) 09:00&#10;B) 10:00&#10;C) 12:00&#10;D) 16:00&#10;

Accepted Answer

Basiliximab (Simulect) is a medication used as an immunosuppressant to prevent organ rejection after transplantation. It is administered as an IV infusion over 20-30 minutes. The first dose is usually given within 2 hours before transplantation surgery, and the second dose is given 4 days after the surgery. Therefore, if the nurse prepared the dose of basiliximab at 08:00, it needs to be administered at 12:00, which is 4 hours after preparation. Choices A, B, and D are incorrect as they are not 4 hours after preparation.

Question 8

The nurse working on a transplant unit notes a drug order for basiliximab (Simulect)on a newly admitted client.The nurse expects to read in the medical record that the client underwent transplant of which organ?

A) Kidney
B) Liver
C) Heart
D) Lung

Accepted Answer

Basiliximab (Simulect) is a monoclonal antibody that is used as an immunosuppressant to prevent rejection in organ transplantation. It is most commonly used in kidney transplant patients. Therefore, the nurse can expect that the client underwent kidney transplantation.

Question 9

The nurse would assess for which priority adverse effect in a client receiving daclizumab (Zenapax)?&#10;A) Hypersensitivity&#10;B) Hypertension&#10;C) Shortness of breath&#10;D) Tremors&#10;

Accepted Answer

Hypersensitivity is the priority adverse effect to assess for with daclizumab because it can lead to an anaphylactic reaction. Symptoms of hypersensitivity can include itching, hives, or respiratory distress. The other options listed are potential adverse effects but are not the priority to assess for.

Question 10

The nurse advises the client to avoid eating which of the following fruits while taking cyclosporine (Sandimmune)?&#10;A) Apples&#10;B) Oranges&#10;C) Peaches&#10;D) Grapefruit&#10;

Accepted Answer

Grapefruit can interact with cyclosporine and increase its toxicity, leading to serious side effects. Therefore, it is important to avoid consuming grapefruit or drinking grapefruit juice while taking cyclosporine. The other fruits listed do not have a significant interaction with cyclosporine.

Question 11

The nurse understands that a client's immunocompromised state may be the result of which of the following?&#10;A) Excessive granulocyte formation&#10;B) Artificial stimulation of macrophages and T cells&#10;C) The enhancement of complement synthesis&#10;D) The loss of mucocutaneous barriers&#10;

Accepted Answer

The answer of The nurse understands that a client's immunocompromised...

Question 12

The nurse would administer the oral solution of cyclosporine (Neoral)by mixing it with which of the following beverages?&#10;A) Orange juice&#10;B) Herbal tea&#10;C) Chocolate milk&#10;D) Carbonated cola&#10;

Accepted Answer

The answer of The nurse would administer the oral solution...

Question 13

The nurse has an order to begin drug therapy with cyclosporine for a client who has undergone transplant surgery.The nurse looks for a corresponding order for which of the following that is usually given with this drug?

A) Antipyretic
B) Antihistamine
C) Corticosteroid
D) Cytoprotective agent

Accepted Answer

The answer of The nurse has an order to begin...

Question 14

The nurse would look to the results of which of the following laboratory studies when monitoring the nutritional status of a client receiving immunosuppressant drugs?&#10;A) Serum electrolytes&#10;B) Serum glucose and hemoglobin A1c&#10;C) Serum protein and albumin&#10;D) Serum creatinine and blood urea nitrogen&#10;

Accepted Answer

The answer of The nurse would look to the results...

Question 15

The nurse suspects that a client taking azathioprine (Imuran)who has not had an organ transplant will have which of the following health problems documented on the medical record?&#10;A) Addison's disease&#10;B) Rheumatoid arthritis&#10;C) Kaposi's sarcoma&#10;D) Systemic lupus erythematosus&#10;

Accepted Answer

The answer of The nurse suspects that a client taking...

Question 16

A client who will be taking cyclosporine (Neoral)at home after transplant surgery indicates an understanding of self-administration by stating to do which of the following?&#10;A) Mix the drug in a plastic cup&#10;B) Take the dose,then rinse the cup with additional liquid and drink it&#10;C) Wash the measuring device carefully after use&#10;D) Shake the measuring device to dry it thoroughly&#10;

Accepted Answer

The answer of A client who will be taking cyclosporine...

Question 17

Which of the following would not be included by the nurse when teaching a client about the adverse effects associated with the use of azathioprine (Imuran)?&#10;A) Megaloblastic anemia&#10;B) Increased appetite&#10;C) Nausea&#10;D) Vomiting&#10;

Accepted Answer

The answer of Which of the following would not be...

Question 18

The nurse would interpret that serum levels of cyclosporine could be low if the client starts to exhibit which of the following?&#10;A) Signs of organ rejection&#10;B) Nausea and vomiting&#10;C) Rising blood urea nitrogen and creatinine levels&#10;D) Lethargy and weakness&#10;

Accepted Answer

The answer of The nurse would interpret that serum levels...

Question 19

The nurse would include in client teaching that the most frequently reported adverse effect of cyclosporine is&#10;A) hair loss.&#10;B) hypotension.&#10;C) hirsutism.&#10;D) hypokalemia.&#10;

Accepted Answer

The answer of The nurse would include in client teaching...

Question 20

The nurse explains to a client going home on immunosuppressant drug therapy that the client and anyone living in the household should not have which of the following vaccinations?&#10;A) Hepatitis B&#10;B) Measles/mumps/rubella&#10;C) Diphtheria/pertussis/tetanus&#10;D) Oral polio&#10;

Accepted Answer

The answer of The nurse explains to a client going...

Question 21

To prevent the cytokine release syndrome associated with muromonab-CD3 (Orthoclone),the nurse anticipates that which of the following drugs will be administered intravenously before the first dose?&#10;A) Dexamethasone (Decadron)&#10;B) Methylprednisolone (Solu Medrol)&#10;C) Ranitidine (Zantac)&#10;D) Cimetidine (Tagamet)&#10;

Accepted Answer

The answer of To prevent the cytokine release syndrome associated...

Question 22

Because of the differences between mycophenolate mofetil (CellCept)and other immunosuppressant drugs,the nurse places additional emphasis on assessing the client for which adverse drug effect?&#10;A) Nausea and vomiting&#10;B) Edema&#10;C) Infection&#10;D) Shortness of breath&#10;

Accepted Answer

The answer of Because of the differences between mycophenolate mofetil...

Question 23

The nurse recognizes that which of the following is not an FDA-approved use of intravenous immune globulin?&#10;A) Congenital agammaglobulinemia&#10;B) Idiopathic thrombocytopenic purpura&#10;C) Kawasaki syndrome&#10;D) Guillain-Barr&#233; syndrome&#10;

Accepted Answer

The answer of The nurse recognizes that which of the...

Question 24

The nurse plans to remain at the bedside and monitor a client for hypersensitivity for how long after the client begins intravenous drug therapy with tacrolimus (Prograf)?&#10;A) 10 minutes&#10;B) 15 minutes&#10;C) 30 minutes&#10;D) 60 minutes&#10;

Accepted Answer

The answer of The nurse plans to remain at the...

Question 25

A client who underwent organ transplantation has been started on drug therapy with tacrolimus (Prograf).The nurse assesses this client for which of the following adverse changes in laboratory test results?

A) Hyperglycemia
B) Hypokalemia
C) Hypermagnesemia
D) Hypouricemia

Accepted Answer

The answer of A client who underwent organ transplantation has...

Deck 63: Immunosuppressants and Immunomodulators