Chapter 69: Immunosuppressants

Chapter 69: Immunosuppressants

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient has undergone liver transplantation. The provider orders cyclosporine [Sandimmune], prednisone, and sirolimus [Rapamune]. What will the nurse do?

ANS:  A

Sirolimus is given to prevent rejection in renal transplantation; it has no proof of efficacy in patients with heart, lung, or liver transplants. A serum glucose level is not indicated; patients taking repaglinide for diabetes should be monitored closely while taking cyclosporine. Although antibiotic prophylaxis may be necessary, macrolide antibiotics increase the level of cyclosporine. Tacrolimus is more toxic than cyclosporine.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 834 | pp. 836-837

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

2. A patient with a liver transplant has been receiving cyclosporine [Sandimmune] for 6 months. The nurse reviews this patient’s laboratory results and notes a sharp increase in the blood urea nitrogen (BUN) and serum creatinine. Vital signs are normal, and the patient reports no discomfort. What does the nurse suspect?

ANS:  D

An elevation of BUN and serum creatinine is an indication of nephrotoxicity, which occurs in 75% of patients taking cyclosporine. Hepatotoxicity would cause elevations in liver enzymes, not the BUN and creatinine. Infection would be associated with fever. Organ rejection of a renal transplant would cause elevation in the BUN and creatinine but also would cause tenderness at the graft site and fever.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 834-835

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

3. A nurse provides teaching to a patient who has undergone kidney transplantation and will begin taking cyclosporine [Sandimmune], a glucocorticoid, and sirolimus [Rapamune]. Which statement by the patient indicates understanding of the teaching?

ANS:  C

Immunosuppressant drugs increase the risk of infections, especially the BK virus, which can cause renal damage, and other organisms that cause lung infections. Patients taking these drugs must take antibiotics for the first 12 months to help prevent infection. Sirolimus and cyclosporine should be taken 4 hours apart. Patients with diabetes may have trouble with glucose tolerance and require monitoring. Taking cyclosporine and sirolimus increases the risk of renal damage.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 834-835 | pp. 836-837

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

4. A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine [Sandimmune], prednisone, and azathioprine [Imuran] for 8 months. The provider has ordered azithromycin [Zithromax] to treat the infection and acetaminophen [Tylenol] as needed for fever. The nurse will contact the provider to:

ANS:  A

Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to increased levels of the drug. This patient needs either a reduced dose of cyclosporine or a different antibiotic. There is no indication for discontinuing the prednisone during treatment. The dose of cyclosporine would need to be reduced, because azithromycin leads to increased drug levels. There is no contraindication to using acetaminophen.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 834-835

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies