Nokea
A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that mycophenolate will be ordered. What is the priority assessment before beginning drug therapy?
- A. Serum potassium level
- B. Fluid volume status
- C. Electrocardiogram
- D. Pregnancy test
Correct Answer: D
Rationale: Mycophenolate has a black box warning for the association with an increased risk for congenital malformations and spontaneous abortions when used during pregnancy.
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A patient will be on a tacrolimus infusion after receiving a liver transplant. The order reads, 'Give 0.03 mg/kg/day as a continuous IV infusion.' The patient weighs 211 pounds, and the medication injection solution is available in a 5 mg/mL strength. Identify how many milliliters will the nurse draw up for this infusion. (Record answer using two decimal places.)
Correct Answer: 0.58 mL
Rationale: Convert pounds to kilograms: 211 ?· 2.2 = 95.91 kg. Calculate dose: 0.03 mg/kg/day ?? 95.91 kg = 2.8773 mg/day. Calculate volume: 2.8773 mg ?· 5 mg/mL = 0.57546 mL, rounded to 0.58 mL.
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.
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.
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.