Ch 34 Drugs Affecting The Immune Response

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  • 1/27 Questions

    Your patient is receiving interferon alfa-2a. As you prepare to give the patient diphenhydramine, the patient asks, "Why do I need that, and why do I get this medicine in the evening?" What is your best response?

    • "This is the way your doctor ordered it"
    • "It is given in the evening with something to help you sleep so you will not feel the minor discomforts that the drug can cause"
    • "It is for the possible allergic response that you might have. I just haven't had the time to give it to you sooner"
    • "It just came up from the pharmacy"
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About This Quiz

This quiz covers drugs affecting the immune response, focusing on interferon alfa-2a and rituximab. It includes administration routes, adverse effects, lab testing, and premedication protocols.

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  • 2. 

    Your patient is receiving abciximab after a PTCA procedure. The patient states, "My friend was taking rituximab for his cancer. They sure sound alike. Do I have a cancer they haven't told me about?" What is your best response?

    • "You need to ask your doctor that question"

    • "No, manufacturers just name the drugs any way they wish"

    • "They are both from the same class of drugs, so the names sound alike, but the drugs are not used for the same purposes"

    • "Ive never heard of that other drug"

    Correct Answer
    A. "They are both from the same class of drugs, so the names sound alike, but the drugs are not used for the same purposes"
    Explanation
    The correct answer is "They are both from the same class of drugs, so the names sound alike, but the drugs are not used for the same purposes." This response addresses the patient's concern by explaining that although the names of the drugs may sound similar, they belong to the same class of drugs but are used for different purposes. It reassures the patient that there is no indication of having cancer based solely on the similarity in drug names.

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  • 3. 

    Your patient had a heart transplant 6 mo ago. The patient is prescribed cyclosporine and prednisone daily. The patient comes to the clinic today for the lab tests and states, "I had a heart transplant; why are you guys so interested in my kidneys?" What is your best response?

    • "You know how doctors are-they want to check out everything"

    • "Cyclosporine can cause damage to your kidneys"

    • "Prednisone can stop your kidneys from working"

    • "I'll check-perhaps someone made a mistake"

    Correct Answer
    A. "Cyclosporine can cause damage to your kidneys"
    Explanation
    The correct answer is "Cyclosporine can cause damage to your kidneys." This response is the best because it directly addresses the patient's concern about why the clinic is interested in their kidneys. Cyclosporine is a medication commonly prescribed after organ transplantation to prevent rejection, but it can have side effects on the kidneys. By providing this information, the healthcare provider acknowledges the patient's concern and educates them about the potential risk associated with their medication.

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  • 4. 

    Your patient is receiving cyclosporine to prevent rejection of a heart transplant. Which of the following patient instructions is INCORRECT?

    • "Used a glass container, not plastic, to prevent possible chemical interactions."

    • "Mix the medication with grapefruit juice to disguise the taste"

    • "Measure the oral solution with the dosing syringe provided, not a tablespoon"

    • "You can mix this drug with chocolate milk"

    Correct Answer
    A. "Mix the medication with grapefruit juice to disguise the taste"
    Explanation
    Mixing cyclosporine with grapefruit juice is incorrect because grapefruit juice can interact with cyclosporine and increase its concentration in the blood, leading to potential toxicity. It is important to avoid grapefruit juice while taking cyclosporine to prevent adverse effects.

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  • 5. 

    Your patient is to receive interferon alfa-2a to treat Kaposi sarcoma related to AIDS. Patient teaching should include

    • How to give a SC injection

    • How to avoid infections

    • When to return for blood tests

    • All of the above

    • None of the above

    Correct Answer
    A. All of the above
    Explanation
    The patient teaching for a patient receiving interferon alfa-2a to treat Kaposi sarcoma related to AIDS should include all of the above options. Teaching the patient how to give a subcutaneous (SC) injection is important to ensure proper administration of the medication. Additionally, teaching the patient how to avoid infections is crucial as individuals with AIDS are more susceptible to infections. Lastly, instructing the patient on when to return for blood tests is necessary to monitor the effectiveness and potential side effects of the medication.

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  • 6. 

    Before administering rituximab (Rituxan), the nurse should check the prescriber's orders for

    • Premedications to reduce the severity of infusion reactions

    • Postmedications in increase the efficacy of the drug

    • Diabetic medication

    • Frequency of vital signs

    Correct Answer
    A. Premedications to reduce the severity of infusion reactions
    Explanation
    Before administering rituximab (Rituxan), the nurse should check the prescriber's orders for premedications to reduce the severity of infusion reactions. Infusion reactions are common with rituximab and can range from mild to severe. Premedications such as antihistamines, corticosteroids, and acetaminophen may be prescribed to help prevent or minimize these reactions. By checking the prescriber's orders for premedications, the nurse ensures that the patient receives the appropriate medications to reduce the severity of infusion reactions and promote a safer administration of rituximab.

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  • 7. 

    What is NOT an appropriate route of administration of interferon alfa-2a?

    • IV

    • IM

    • SC

    • PO

    Correct Answer
    A. PO
    Explanation
    Interferon alfa-2a is a protein-based medication that is not suitable for oral administration (PO) because it would be broken down by the digestive system before it can be absorbed into the bloodstream. Therefore, IV (intravenous), IM (intramuscular), and SC (subcutaneous) routes are more appropriate for administering interferon alfa-2a as they allow direct absorption into the bloodstream, ensuring its therapeutic effects.

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  • 8. 

    In addition to hairy cell leukemia, what other disorders may be treated with interferon alfa-2a (Roferon-A)?

    • Kaposi scarcoma

    • Breast cancer

    • Lung cancer

    • Hodgekin's disease

    Correct Answer
    A. Kaposi scarcoma
    Explanation
    Interferon alfa-2a (Roferon-A) is a medication that is commonly used to treat hairy cell leukemia. However, it can also be used to treat Kaposi sarcoma, a type of cancer that affects the skin and mucous membranes. This cancer is often seen in individuals with weakened immune systems, such as those with HIV/AIDS. Therefore, interferon alfa-2a may be prescribed to help manage the symptoms and progression of Kaposi sarcoma. It is not typically used as a treatment for breast cancer, lung cancer, or Hodgkin's disease.

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  • 9. 

    Your patient is receiving rituximab by IV infusion weekly to treat non-Hodgkin's lymphoma and is to begin taking cefamandole by IV every 6 h for an acute urinary tract infection today. You are to administer both drugs today and will be giving the first dose of the cefamandole. You should time the administration of these two drugs in this manner:

    • Infuse both drugs at the same time by piggybacking the cefamandole into the rituximab

    • Infuse both drugs at the same time but into two different IV insertion sites

    • Infuse the cefamandole either 2 h before or after the rituximab

    • Infuse the cefamandole and follow immediately with the rituximab

    Correct Answer
    A. Infuse the cefamandole either 2 h before or after the rituximab
    Explanation
    Rituximab is known to cause infusion-related reactions such as fever, chills, and hypotension. By administering the cefamandole either 2 hours before or after the rituximab, it helps to minimize the risk of potential drug interactions and infusion-related reactions. This allows for the safe administration of both drugs without compromising their effectiveness. Infusing both drugs at the same time or piggybacking the cefamandole into the rituximab may increase the risk of adverse reactions and should be avoided.

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  • 10. 

    A common yet serious adverse effect to cyclosporine affects the _________ system

    • Gastrointestinal

    • Genitourinary

    • Cardiovascular

    • Renal

    Correct Answer
    A. Renal
    Explanation
    Cyclosporine is known to have a common yet serious adverse effect on the renal system. This means that it can negatively affect the kidneys and their functions. It is important to monitor renal function closely when using cyclosporine to prevent any potential damage or complications in the kidneys.

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  • 11. 

    Patients receiving interferon-2a should have monthly lab testing including all of the following EXCEPT

    • Complete blood count (CBC)

    • White cell differential

    • Liver and kidney function

    • Urinalysis

    Correct Answer
    A. Urinalysis
    Explanation
    Patients receiving interferon-2a should have monthly lab testing to monitor their health and detect any potential side effects or complications. This includes a complete blood count (CBC) to assess red and white blood cell levels, a white cell differential to evaluate different types of white blood cells, and liver and kidney function tests to assess the functioning of these organs. However, urinalysis is not typically necessary for monitoring patients receiving interferon-2a, as it primarily focuses on assessing the urine for abnormalities and may not provide relevant information for this specific treatment.

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  • 12. 

    Your patient is receiving rituximab. The patient also has a history of hypertension. What special considerations should be made for this patient?

    • None

    • Administer any antihypertensive meds just before the rituximab

    • Add a 2nd type of antihypertensive medication to the patient's regimen until the rituximab therapy is complete

    • Do not administer the antihypertensive agent for 12 h before and 12-24 h after rituzimab administration

    Correct Answer
    A. Do not administer the antihypertensive agent for 12 h before and 12-24 h after rituzimab administration
    Explanation
    Patients receiving rituximab may experience infusion-related reactions, including hypertension. Therefore, it is important to avoid administering antihypertensive medication for 12 hours before and 12-24 hours after rituximab administration. This allows the patient's blood pressure to be monitored closely during the infusion and ensures that any potential hypertensive reactions can be managed effectively.

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  • 13. 

    The nurse should assess a patient who is receiving rituximab for symptoms of infusion reaction syndrome, which include

    • Ventricular tachycardia, supraventricular tachycardia, angina, hypotension, and hypertension

    • Profound bradychardia, pounding headache and hypotension

    • Cellulitis at the insertion site and fever

    • Increased respiratory rate, hypotension, and bradycardia

    Correct Answer
    A. Ventricular tachycardia, supraventricular tachycardia, angina, hypotension, and hypertension
    Explanation
    The correct answer is ventricular tachycardia, supraventricular tachycardia, angina, hypotension, and hypertension. These symptoms are indicative of infusion reaction syndrome, which can occur in patients receiving rituximab. Ventricular tachycardia and supraventricular tachycardia are abnormal heart rhythms that can be caused by the medication. Angina, hypotension, and hypertension are also potential side effects of rituximab infusion. It is important for the nurse to assess the patient for these symptoms in order to monitor their condition and provide appropriate interventions if necessary.

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  • 14. 

    To administer rituximab appropriately, the nurse should do all of the following EXCEPT

    • Mix the drug with normal saline

    • Hold administration of antihypersensitive medications for 12 h before rituximab administration

    • Administer antihypersensitive medications immediately after the rituximab infusion is completed

    • Stop the infusion if the patient experiences an adverse effect

    Correct Answer
    A. Administer antihypersensitive medications immediately after the rituximab infusion is completed
    Explanation
    The nurse should not administer antihypersensitive medications immediately after the rituximab infusion is completed. This is because rituximab is known to cause infusion-related reactions, such as hypersensitivity reactions. Administering antihypersensitive medications immediately after the infusion can mask the symptoms of these reactions and potentially delay appropriate treatment. It is important to closely monitor the patient during the infusion and hold administration of antihypersensitive medications for 12 hours before rituximab administration to minimize the risk of adverse reactions.

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  • 15. 

    A patient has been given instructions after administration of rituximab. Which of these responses, if made by the patient, would indicate that the patient correctly understood the instructions?

    • "I will have a glass of wine before I go to bed tonight"

    • "I will drink plenty of water"

    • "I will refrain from eating dairy products for the next 24 h"

    • "I will take my temperature every hour for the next 12 h"

    Correct Answer
    A. "I will drink plenty of water"
    Explanation
    The correct answer is "I will drink plenty of water" because rituximab is known to cause dehydration as a side effect. Drinking plenty of water can help prevent this side effect and maintain proper hydration levels. The other responses are unrelated to the instructions given after the administration of rituximab.

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  • 16. 

    Your patient received Sandimmune (cyclosporine) by IV just before a kidney transplant today. The dose was 5 mg/kg/day. The postoperative orders for this patient state to give 15 mg/kg/day PO beginning tomorrow. As the nurse, you should

    • Assume that this was a transcription error and administer 5 mg/kg/day PO

    • Contact the physician for a new order

    • Administer the 15 mg/kg/day as ordered

    • Request that the pharmacist dispense Neoral instead of Sandimmune

    Correct Answer
    A. Administer the 15 mg/kg/day as ordered
    Explanation
    The correct answer is to administer the 15 mg/kg/day as ordered. This is because the postoperative orders specifically state to give 15 mg/kg/day PO beginning tomorrow. It is important to follow the physician's orders and administer the correct dosage as prescribed. Assuming it was a transcription error or contacting the physician for a new order without clarification would not be appropriate in this situation. Requesting a different medication, Neoral, is also not necessary as the current medication, Sandimmune, is already being used.

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  • 17. 

    Your 27 year old patient is being treated for hairy cell leukemia with interferon alfa-2a. This patient should be monitored for

    • Hypothyroidism

    • Diabetes insipidus

    • Constipation

    • GI bleeding

    Correct Answer
    A. Hypothyroidism
    Explanation
    Patients being treated with interferon alfa-2a for hairy cell leukemia should be monitored for hypothyroidism. Interferon alfa-2a can affect the function of the thyroid gland, leading to reduced production of thyroid hormones. Hypothyroidism can cause symptoms such as fatigue, weight gain, cold intolerance, and dry skin. Monitoring for hypothyroidism allows for early detection and appropriate management of the condition.

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  • 18. 

    Cyclosporine, an immune modulator, has been prescribed for your patient after a bone marrow transplant. Which of these findings should concern you the most while this patient receives cyclosporine?

    • Slightly elevated serum potassium

    • Slightly low neutrophil count

    • Significantly elevated blood urea nitrogen

    • None of the above should cause concern, they are all normal findings

    Correct Answer
    A. Significantly elevated blood urea nitrogen
    Explanation
    A significantly elevated blood urea nitrogen (BUN) level should be the most concerning finding while the patient receives cyclosporine. Cyclosporine can have nephrotoxic effects, meaning it can cause damage to the kidneys. An elevated BUN level indicates impaired kidney function and can be a sign of kidney damage. Monitoring BUN levels is important to ensure the drug is not causing harm to the kidneys. Therefore, a significantly elevated BUN level should be a cause for concern and may require adjustments to the cyclosporine dosage or additional interventions to protect the kidneys.

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  • 19. 

    Cyclosporine works by suppressing

    • T lymphocytes

    • B lymphocytes

    • Cell-mediated immune reactions

    • Phagocytosis

    Correct Answer
    A. Cell-mediated immune reactions
    Explanation
    Cyclosporine is a medication that is known to suppress the immune system. It specifically targets and inhibits the activity of T lymphocytes, which are a type of white blood cell involved in cell-mediated immune responses. These responses are responsible for coordinating the immune system's attack on infected or abnormal cells. By suppressing cell-mediated immune reactions, cyclosporine helps to prevent the immune system from attacking healthy cells and tissues, making it an effective treatment for various autoimmune diseases and preventing organ rejection in transplant patients.

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  • 20. 

    Your 16 y o patient is receiving rituximab for the 1st time. After 1 h of the infusion, the patient reports fever, flushing, chills, and rigors. With your knowledge of the drug, you know

    • This is an unexpected reaction and you need to stop the drug immediately

    • This drug does not cause these symptoms, and the patient is just anxious

    • These are the expected symptoms that occur with approx 80% of patients

    • This is the beginning of a potentially life-threatening reaction

    Correct Answer
    A. These are the expected symptoms that occur with approx 80% of patients
    Explanation
    The correct answer is that these are the expected symptoms that occur with approximately 80% of patients. This is because rituximab, a monoclonal antibody used to treat certain types of cancer and autoimmune diseases, is known to cause infusion-related reactions. These reactions can include fever, flushing, chills, and rigors. It is important for healthcare providers to be aware of these potential side effects and to monitor patients closely during rituximab infusions. Stopping the drug immediately may not be necessary unless the reaction is severe or life-threatening.

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  • 21. 

    Which of the following are the most frequent adverse effects to interferon alfa-2a therapy?

    • Confusion, depression, hypothyroidism

    • Confusion, hypothyroidism, hypotension

    • Confusion, hypotension, flu-like symptoms

    • Confusion, lethargy, flu-like symptoms

    Correct Answer
    A. Confusion, lethargy, flu-like symptoms
    Explanation
    The most frequent adverse effects of interferon alfa-2a therapy are confusion, lethargy, and flu-like symptoms. These symptoms are commonly reported by patients undergoing this therapy. Confusion and lethargy can be attributed to the effects of interferon on the central nervous system, while flu-like symptoms such as fever, chills, muscle aches, and fatigue are typical side effects of interferon treatment.

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  • 22. 

    Which nursing assessment should assume priority for the patient receiving rituximab? Assessment of the 

    • Respiratory system

    • Gastrointestinal system

    • Central nervous system

    • Integumentary system

    Correct Answer
    A. Central nervous system
    Explanation
    The central nervous system should assume priority for the patient receiving rituximab because this medication has been associated with the development of serious central nervous system adverse reactions, including severe infections and progressive multifocal leukoencephalopathy. It is important to assess for any signs or symptoms of these adverse reactions, such as changes in mental status, confusion, difficulty speaking or understanding speech, weakness, or loss of coordination. Prompt recognition and management of these adverse reactions is crucial to ensure patient safety.

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  • 23. 

    During administration of aldesleukin the nurse should consistently monitor 

    • Blood pressure

    • Level of consciousness

    • Cardiac rhythm

    • Heart rate

    Correct Answer
    A. Level of consciousness
    Explanation
    During administration of aldesleukin, monitoring the level of consciousness is important because aldesleukin can cause central nervous system toxicity. This can manifest as confusion, disorientation, agitation, and even coma. Monitoring the level of consciousness allows the nurse to detect any changes and take appropriate action to prevent further complications. Monitoring blood pressure, cardiac rhythm, and heart rate are also important, but the level of consciousness is specifically mentioned as a priority in this case.

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  • 24. 

    Within 1 h of starting the rituximab infusion, the patient has a fever of 101.4 F, is flushed, and reports feeling cold. Your best initial response is to

    • Provide warm blankets and ice chips

    • Seek an order for acetaminophen

    • Turn down the rate of rituximab infusion

    • Turn off the rituximab infusion

    Correct Answer
    A. Turn off the rituximab infusion
    Explanation
    The patient's symptoms of fever, flushing, and feeling cold suggest an infusion reaction to rituximab. Turning off the infusion is the best initial response to prevent further adverse reactions and assess the patient's condition. Providing warm blankets and ice chips may help with comfort, but it does not address the underlying cause of the reaction. Seeking an order for acetaminophen may be appropriate to manage the fever, but it does not address the infusion reaction itself. Turning down the rate of infusion may not be sufficient to prevent or manage the reaction, so turning off the infusion is the most appropriate action.

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  • 25. 

    Because a patient is taking interferon alfa-2a, the patient should be carefully assessed for

    • Hypertension

    • Hypoglycemia

    • Depression

    • Electrolyte imbalance

    Correct Answer
    A. Depression
    Explanation
    Patients taking interferon alfa-2a should be carefully assessed for depression because this medication is known to have psychiatric side effects. Interferon alfa-2a can cause mood changes, including feelings of sadness, irritability, and even suicidal thoughts. Therefore, it is important to monitor patients closely for signs of depression and provide appropriate support and treatment if necessary.

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  • 26. 

    Which of the following monoclonal antibodies targets the protein responsible for stimulating new blood vessel formation?

    • Trastuzumab

    • Cetuximab

    • Bevacizumab

    • Panitumumab

    Correct Answer
    A. Bevacizumab
    Explanation
    Bevacizumab is a monoclonal antibody that targets the protein responsible for stimulating new blood vessel formation. This protein is called vascular endothelial growth factor (VEGF), and it plays a crucial role in angiogenesis, the process by which new blood vessels are formed. Bevacizumab binds to VEGF, preventing it from binding to its receptors on blood vessel cells and inhibiting the formation of new blood vessels. This can be beneficial in treating certain types of cancer, as tumors rely on the formation of new blood vessels to receive nutrients and oxygen for growth.

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  • 27. 

    You are to adminster the first dose of rituximab to a patient who has had a liver transplant. To minimize adverse effects from the rituxmab, you should

    • Administer antipyretics after the first dose, if needed

    • Administer the drug by IV infusion using a pump

    • Administer a high dose initally and then taper the dose

    • Do all of the above

    • Do none of the above

    Correct Answer
    A. Administer the drug by IV infusion using a pump
    Explanation
    Administering the drug by IV infusion using a pump is the correct answer because it allows for precise control of the infusion rate, which can help minimize adverse effects. Rituximab is known to cause infusion-related reactions such as fever, chills, and rigors. By using a pump, the drug can be delivered at a controlled rate, reducing the risk of these adverse effects. Antipyretics may be administered if needed to manage any fever that occurs during or after the infusion. There is no mention of administering a high dose initially and then tapering the dose, so this option can be ruled out.

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  • Mar 21, 2023
    Quiz Edited by
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  • Sep 06, 2009
    Quiz Created by
    Jmtruong1
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