Nokea
A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used?
- A. Azathioprine
- B. Glatiramer acetate
- C. Daclizumab
- D. Sirolimus
Correct Answer: B
Rationale: Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated for reduction of the frequency of relapses (exacerbations) in relapsing-remitting multiple sclerosis.
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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 who has had a recent organ transplant is taking sirolimus as part of the immunosuppressant therapy. Today, the patient realized that a dose was missed, and it is now time for the next dose. Which action is appropriate?
- A. Just take the dose that is now due, not both doses.
- B. Take the missed dose of sirolimus along with the next dose that is due.
- C. Take half of the missed dose along with the current dose that is due.
- D. Contact the transplant physician for instructions.
Correct Answer: D
Rationale: If a dose of sirolimus is missed, it should be taken as soon as the patient remembers, unless it is close to the time that the next dose is due. In this case, the patient must contact the transplant physician.
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.
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
Correct Answer: D
Rationale: Moderate hypertension may occur in patients taking cyclosporine.
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.