Nokea
The nurse is monitoring a patient who is receiving mycophenolate after an organ transplant. Which adverse effect is possible with mycophenolate therapy?
- A. Constipation
- B. Hypertension
- C. Confusion
- D. Dysuria
Correct Answer: B
Rationale: Common adverse effects of mycophenolate include hypertension, hypotension, peripheral edema, tachycardia, chest pain, and other effects.
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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.
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.
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 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.