Chapter 48: Immunosuppressant Drugs

Chapter 48: Immunosuppressant Drugs

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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

 

 

ANS:  B

Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                  REF:   p. 777

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

2. 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.

 

 

ANS:  A

Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                  REF:   p. 778

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

3. 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?

a.	Hold the dose until the prescriber makes rounds.
b.	Give the cyclosporine-modified drug.
c.	Double-check the order, and then give the cyclosporine-modified drug.
d.	Notify the pharmacy to obtain the Sandimmune form of the drug.

 

 

ANS:  D

The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Analyzing (Analysis)                     REF:   p. 778

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. 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?

a.	A nonsteroidal anti-inflammatory drug
b.	A benzodiazepine
c.	An opioid pain reliever
d.	A corticosteroid

 

 

ANS:  D

The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is recommended that an injection of a corticosteroid, such as methylprednisolone, be administered before the injection of monoclonal antibodies.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                  REF:   p. 773

TOP:   NURSING PROCESS: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential