Deck 48: Immunosuppressant Drugs

Question 1

The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.)

A) Administering it as a single IV bolus injection to minimize adverse effects
B) Using an infusion pump to administer this medication
C) Monitoring the patient for potential delayed adverse effects, which may be severe
D) Monitoring the patient closely for the first 30 minutes for severe adverse effects
E) Checking blood levels periodically during cyclosporine therapy
F) Performing frequent oral care during therapy

Answer 1

Using an infusion pump to administer this medication
Monitoring the patient closely for the first 30 minutes for severe adverse effects
Checking blood levels periodically during cyclosporine therapy
Performing frequent oral care during therapy

Question 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.

Answer 2

Several days before the surgery, the medication will be administered orally.

Question 3

A patient will be on a tacrolimus (Prograf) infusion after receiving a liver transplant. The order reads, "Give 0.03 mg/kg/day as a continuous IV infusion." The patient weighs 159 pounds, and the medication injection solution is available in a 5-mg/mL strength. How many milliliters will the nurse draw up for this infusion? (Record answer using two decimal places.)

Answer 3

0.43 mL
Convert pounds to kilograms: 159 ¸ 2.2 = 72.27 kg
Calculate the mg/kg/day dosage in milligrams:
0.03 mg/kg/day × 72.27 kg = 2.1681, rounded to 2.17 mg
Calculate the mL to administer:
5 mg : 1 mL :: 2.17 mg : x mL
(5 × x) = (1 × 2.17); 5x = 2.17; x = 0.434 rounded to 0.43 mL

Question 4

A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used?

A) azathioprine (Imuran)
B) glatiramer acetate (Copaxone)
C) daclizumab (Zenapax)
D) sirolimus (Rapamune)

Question 5

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 antiinflammatory drug ( NSAID )
B) A benzodiazepine
C) An opioid pain reliever
D) A corticosteroid

Question 6

A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.)

A) Tremors
B) Leukopenia
C) Diarrhea
D) Thrombocytopenia
E) Hepatotoxicity
F) Fluid retention

Question 7

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.

Question 8

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

Question 9

When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results?

A) Serum potassium levels
B) White blood cell (leukocyte) count
C) Red blood cell count
D) Serum albumin levels

Question 10

Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect?

A) Nausea and vomiting
B) Fever and tremors
C) Agitation
D) Hypertension

Question 11

The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy?

A) Chest pain
B) Hypotension
C) Confusion
D) Dysuria

Question 12

When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction?

A) Reduced adverse effects of the cyclosporine
B) Increased levels of cyclosporine and toxicity
C) Reduced uric acid levels
D) Reduced nephrotoxic effects of cyclosporine