Chapter 68: Immunosuppressants

Chapter 68: Immunosuppressants

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. The nurse is providing patient education for patients preparing to receive renal transplants. The nurse discusses the pros and cons of using cyclosporine (Sandimmune) to prevent allograft rejection. Which statement by one of the patients best demonstrates understanding of cyclosporine? “Cyclosporine does not

a.	cause renal damage.”
b.	increase the risk of infection.”
c.	not suppress bone marrow.”
d.	cause hypertension.”

 

 

ANS:   C

Cyclosporine does not suppress bone marrow.

Cyclosporine may cause renal damage as a result of nephrotoxicity; further teaching is required.

An adverse effect of cyclosporine is an increased risk of infection, because the drug can suppress the immune system; further teaching is required.

Cyclosporine causes hypertension in 50% of patients; further teaching is required.

 

DIF:    Cognitive Level: Application             REF:    p. 814

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. The nurse is caring for a patient who has been taking cyclosporine for 9 months to prevent rejection of a renal allograft. Upon reviewing the patient’s laboratory results, the nurse notes that the blood urea nitrogen and serum creatinine have risen sharply in the past 2 weeks. The nurse should suspect __________ and assess the patient for other signs and symptoms related to ___________.

a.	leukocytosis; infection
b.	fluid volume overload; congestive heart failure
c.	hypotension; dehydration
d.	nephrotoxicity; organ rejection

 

 

ANS:   D

The nurse should suspect nephrotoxicity and investigate signs and symptoms related to organ rejection because of the rising creatinine and blood urea nitrogen.

Nothing indicates that the patient has an infection or leukocytosis.

Nothing indicates that the patient has a fluid volume overload or CHF.

Nothing indicates that the patient has hypotension or dehydration.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 815

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. The nurse is administering medications to a patient who is receiving cyclosporine (Sandimmune). Which medication, when administered concurrently with cyclosporine, would warrant a reduction in the dosage of cyclosporine?

a.	Phenytoin (Dilantin)
b.	Prednisone
c.	Ketoconazole (Nizoral)
d.	Trimethoprim/sulfamethoxazole (Bactrim)

 

 

ANS:   C

Use of ketoconazole would warrant a reduction in the dosage of cyclosporine. Ketoconazole often is given concurrently with cyclosporine so that the patient’s dosage of cyclosporine, which is costly, can be reduced.

Phenytoin would cause a decrease in the medication.

Prednisone often is given concurrently with cyclosporine to suppress the immune response.

Trimethoprim/sulfamethoxazole reduces levels of cyclosporine in the body.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 815

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. Which drug, when given concurrently with cyclosporine (Sandimmune), can inhibit hepatic microsomal enzymes and lead to toxic levels of cyclosporine?

a.	Phenytoin (Dilantin)
b.	Rifampin (Rifadin)
c.	Erythromycin
d.	Trimethoprim-sulfamethoxazole (Bactrim)

 

 

ANS:   C

Erythromycin can elevate microsomal enzymes, leading to increased levels of cyclosporine.

Phenytoin, rifampin, and trimethoprim-sulfamethoxazole reduce the levels of cyclosporine in the body.

 

DIF:    Cognitive Level: Application             REF:    p. 815

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies