Nokea
A patient has started azathioprine 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
Correct Answer: B,D,E
Rationale: Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity.
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A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified product (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.
Correct Answer: D
Rationale: Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. The nurse must obtain the Sandimmune form of the drug from the pharmacy.
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.
Correct Answer: A
Rationale: 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.
When monitoring a patient who is on immunosuppressant therapy with azathioprine, 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
Correct Answer: B
Rationale: Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored.
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
Correct Answer: D
Rationale: The monoclonal antibodies such as basiliximab and daclizumab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. An injection of a corticosteroid, such as methylprednisolone, is recommended before the injection of monoclonal antibodies to avoid or alleviate this problem.
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
Correct Answer: B,D,E,F
Rationale: Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections.