Chapter 30: Transplant Drugs

Chapter 30: Transplant Drugs

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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

a.	the immune system is boosted.
b.	the drug is taken by mouth before and after the transplant surgery.
c.	nausea, vomiting, fever, and chills are common side effects.
d.	it is safe to become pregnant.

 

 

ANS:   C

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.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 421

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. A patient who has had an organ transplant is prescribed cyclosporine for maintenance therapy. Which statement by the patient indicates further teaching is needed?

a.	“The provider may change the dose of the medication after getting the lab results.”
b.	“I can mix this medication with juice.”
c.	“I have to avoid getting the nasal spray FluMist.”
d.	“I will take the medication each morning at 8 A.M.”

 

 

ANS:   D

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.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 423

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pathophysiology

 

3. Your patient is taking belatacept and develops posttransplant lymphoproliferative disorder (PTLD). You would expect to see

a.	hypothermia.
b.	weight gain.
c.	hyperglycemia.
d.	general malaise.

 

 

ANS:   D

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.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 424

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. What action is most important for the nurse to teach the patient taking corticosteroids following a transplant?

a.	“Combining the steroid with certain antibiotics can increase the risk of cardiac arrhythmias.”
b.	“While side effects are expected with the medication, none is life-threatening.”
c.	“Be sure to get all immunizations as recommended.”
d.	“You need to avoid pregnancy while taking this steroid.”

 

 

ANS:   A

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.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 427

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies