Questions on Hematopoietic and immunosuppressants

Question 1

The nurse is monitoring a client who is receiving epoetin alfa (Epogen, Procrit) for adverse effects of the medication. Which finding indicates an adverse effect?

1. Diarrhea
2. Depression
3. Bradycardia
4. Hypertension

Answer 1

4. Hypertension

Question 2

The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa (Epogen, Procrit). When should the nurse expect to note a therapeutic effect of this medication?

1. Immediately
2. 3 days after therapy
3. 2 weeks after therapy
4. After 1 week of therapy

Answer 2

3. 2 weeks after therapy

Question 3

The nurse is preparing to administer filgrastim (Neupogen) to a client with a diagnosis of agranulocytosis. The client asks the nurse about the purpose of the medication. The nurse explains that this medication will have which action?

1. Prevent bleeding.
2. Prolong the clotting time.
3. Increase the red blood cell count.
4. Promote the growth of neutrophils.

Answer 3

4. Promote the growth of neutrophils

Question 4

A home care nurse is preparing to administer filgrastim (Neupogen) to a client. The nurse plans to administer the medication by which route?

1. Oral
2. Subcutaneous
3. Intramuscular
4. Intravenous bolus

Answer 4

2. Subcutaneous

Question 5

The nurse is reviewing the laboratory test results for a client who is receiving filgrastim (Neupogen). Which reported value would indicate an effective response to this medication?

1. Hematocrit of 42%
2. Blood glucose level of 120 mg/dL
3. Platelet count of 150,000 cells/mm3
4. Neutrophil count of 10,000 cells/mm3

Answer 5

4. Neutrophil count of 10,000 cells/mm3

Question 6

The nurse is preparing to administer filgrastim (Neupogen) by intravenous (IV) infusion. Which nursing action is appropriate for administering this medication?

1. Shake the solution before drawing it up.
2. Dilute the medication in normal (0.9%) saline.
3. Discard the medication if it has been refrigerated.
4. Dilute the medication in 5% dextrose in water (D5W).

Answer 6

4. Dilute the medication in 5% dextrose in water (D5W).

Question 7

A client with chronic kidney disease was started on epoetin alfa (Epogen, Procrit) 2 months earlier. In evaluating the therapeutic effectiveness of the medication, the nurse should expect the client to exhibit which finding?

1. A decrease in blood pressure
2. An increase in white blood cells
3. An increase in serum hematocrit
4. A decrease in serum creatinine levels

Answer 7

3. An increase in serum hematocrit

Question 8

Epoetin alfa (Epogen, Procrit) has been prescribed for a client with chronic kidney disease who is being cared for by a nursing student. The nursing instructor determines that the student understands the procedure for administering the medication when the student states that which route of administration is acceptable?

1. Oral
2. Z-track
3. Intramuscular
4. Subcutaneous

Answer 8

4. Subcutaneous

Question 9

Epoetin alfa (Epogen, Procrit) by the subcutaneous route is prescribed for a client. Which is the correct action for the nurse to implement?

1. Shake the vial before use.
2. Freeze the medication before use.
3. Refrigerate the medication until used.
4. Obtain syringes with 1½-inch needles from the pharmacy

Answer 9

3. Refrigerate the medication until used.

Question 10

The client in chronic kidney disease is receiving epoetin alfa (Epogen). The nurse should monitor this client for which adverse effect of this medication?

1. Fever
2. Depression
3. Bradycardia
4. Hypertension

Answer 10

4. Hypertension

Question 11

The nurse is caring for a patient with anemia related to chronic renal failure. Which agent below might be used to treat the anemia?

A. Filgrastim (Neupogen)
B. Sargramostim (Leukine)
C. Oprelvekin (Neumega)
D. Epoetin alfa (Procrit)

Answer 11

D. Epoetin alfa (Procrit)

Question 12

The nurse is administering epoetin alfa (Procrit) to a patient receiving chemotherapy. Which adverse effect below is a potential risk with this drug?

A. Accelerated tumor progression
B. Hypotension
C. Easy bruising
D. Bone pain

Answer 12

A. Accelerated tumor progression

Question 13

The nurse is caring for a patient undergoing cancer chemotherapy who presents with rash, bone pain, hypertension, and pedal edema. Which symptom is most likely an adverse reaction to the filgrastim (Neupogen) he is receiving?

A. Rash
B. Bone pain
C. Hypertension
D. Pedal edema

Answer 13

B. Bone pain

Question 14

The nurse is evaluating the effectiveness of the drug oprelvekin (Neumega) in a patient undergoing cancer chemotherapy. Which finding below is the most indicative that this drug is having its intended effect?

A.   Platelet count = 150 × 103/mm3  
B.   Hemoglobin = 13.2 g/dL  
C.   White blood cells = 5500/mm3  
D.   Total lymphocyte count = 1000/mm3

Answer 14

A. Platelet count = 150 × 103/mm3

Question 15

A transplant recipient patient is receiving cyclosporine (Sandimmune). Which of these responses should a nurse expect if the medication is having the desired effect?

A. Increased antibody response
B. Increased natural killer (NK) cellular activity
C. Suppression of T lymphocytes
D. Suppression of hepatic metabolism of steroids

Answer 15

C. Suppression of T lymphocytes

Question 16

A patient who is receiving cyclosporine (Sandimmune) is also receiving ketoconazole (Nizoral). The nurse should expect which of these therapeutic outcomes from the combined medications?

A. Improved glomerular filtration rate
B. Inhibition of cyclosporine metabolism
C. Decreased risk of lymphoma occurrence
D. Decreased risk of bacterial and viral infections

Answer 16

B. Inhibition of cyclosporine metabolism

Question 17

The nurse is caring for a postrenal transplantation client taking cyclosporine (Sandimmune). The nurse notes an increase in one of the client’s vital signs and the client is complaining of a headache. What vital sign is most likely increased?

1. Pulse
2. Respirations
3. Blood pressure
4. Pulse oximetry

Answer 17

. Blood pressure

Question 18

Tacrolimus (Prograf) is prescribed to a client for prevention of organ rejection after renal transplantation. Which prescription should the nurse anticipate to be prescribed, along with the tacrolimus, for this client?

1. Prednisone
2. Phenytoin (Dilantin)
3. Fluconazole (Diflucan)
4. Erythromycin (Erythrocin)

Answer 18

1. Prednisone

Question 19

Azathioprine (Imuran) is prescribed for a client to suppress rejection of a renal transplant. In planning for administration of the medication, the nurse understands that which description is the mechanism of action of this medication?

1. It cross-links DNA.
2. It blocks all T-cell functions.
3. It inhibits the proliferation of B and T lymphocytes.
4. It decreases the activity of thymus-derived lymphocytes.

Answer 19

3. It inhibits the proliferation of B and T lymphocytes

Question 20

The nurse is providing discharge instructions to a client who will be taking tacrolimus (Prograf) daily following allogenic liver transplantation. The nurse instructs the client that which is a frequent side effect related to this medication?

1. Diarrhea
2. Confusion
3. Loss of memory
4. A decrease in urine output

Answer 20

1. Diarrhea

Question 21

Cyclosporine (Sandimmune) is prescribed for a client who received a kidney transplant. The nurse would be most concerned if a review of the medical record revealed that the client currently is taking which prescribed medications?

1. Prednisone
2. Digoxin (Lanoxin)
3. Propranolol (Inderal)
4. Phenytoin (Dilantin)

Answer 21

4. Phenytoin (Dilantin)

Question 22

Cyclosporine (Sandimmune) is prescribed to be administered by the intravenous (IV) route. Which option indicates an inappropriate action in regard to preparing and administering this medication?

1. Mixing the solution and covering it with a paper bag
2. Administering the medication over a period of 2 to 6 hours
3. Mixing 1 mL of concentrate in 50 mL of 0.9% sodium chloride and administering by infusion
4. Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection

Answer 22

4. Mixing 1 mL of concentrate in 10 mL of 0.9% sodium chloride and administering by bolus injection

Question 23

The nurse is preparing to administer a prescribed dose of cyclosporine (Sandimmune) by intravenous (IV) administration. Which priority item would the nurse have available during administration of this medication?

1. A code cart
2. Oral airway
3. A suction catheter
4. Epinephrine (Adrenalin)

Answer 23

4. Epinephrine (Adrenalin)

Question 24

A nurse provides instructions to a client who will be taking cyclosporine (Sandimmune) oral solution. Which action should nurse tell the client to do?

1. Mix the concentrate with orange juice.
2. Mix the concentrate with grapefruit juice.
3. Avoid diluting the concentrate for administration.
4. Dilute the concentrate in a Styrofoam cup before administration.

Answer 24

1. Mix the concentrate with orange juice.

Question 25

A nurse is monitoring a client receiving cyclosporine (Sandimmune). Which sign or symptom should indicate to the nurse that the client is experiencing an adverse effect from this medication? 1. Nausea 2. Tremors 3. Alopecia 4. Hypotension

Answer 25

2. Tremors

Question 26

A client with a severe allergic reaction is prescribed intravenous corticosteroids. The nurse should expect that which desired effect will be achieved? 1. Decreased inflammation 2. Increased serum glucose 3. Enhanced immunity 4. Pain relief

Answer 26

1. Decreased inflammation

Question 27

A nurse reinforces medication instructions to a client who has received a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client would indicate a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider if my urine volume decreases or it becomes cloudy."

Answer 27

1. "I need to obtain a yearly influenza vaccine."

Question 28

A client who has received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client would indicate a need for further instruction? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4. "I need to call the health care provider if more than one dose is missed."

Answer 28

2. "I need to discontinue the medication after 14 days of use."

Question 29

A client who has undergone renal transplant is receiving ongoing therapy with cyclosporine (Sandimmune). The nurse would be sure to immediately report which abnormal finding? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Decreased white blood cell (WBC) count 4. Elevated blood urea nitrogen (BUN) level

Answer 29

4. Elevated blood urea nitrogen (BUN) level

Question 30

A client is receiving tacrolimus (Prograf) to prevent organ rejection. Which is a nursing consideration associated with this medication? 1. Assess for hypoglycemia. 2. Give with grapefruit juice. 3. Give with cyclosporine (Sandimmune). 4. Assess platelet count for thrombocytopenia.

Answer 30

4. Assess platelet count for thrombocytopenia.

Question 31

A nurse is collecting data from a client with a history of renal transplantation. The nurse understands that which medication is the medication of choice for preventing organ rejection? 1. Probenecid 2. Prednisone 3. Indomethacin (Indocin) 4. Cyclosporine (Sandimmune)

Answer 31

4. Cyclosporine (Sandimmune)

Question 32

Cyclosporine (Sandimmune) is prescribed for the client following allogenic kidney transplantation. The nurse should provide which instruction to the client regarding the medication? 1. There are no known adverse effects of the medication. 2. The medication will need to be taken for a period of 6 months. 3. Blood levels of the medication will need to be measured periodically. 4. The medication is administered by the intravenous (IV) route on a monthly basis.

Answer 32

3. Blood levels of the medication will need to be measured periodically.

Question 33

Blood work has been drawn on a client who has been taking cyclosporine (Sandimmune) following allogenic liver transplantation. The nurse should check the results of which test to determine the presence of an adverse effect related to this medication? 1. Hematocrit level 2. Cholesterol level 3. Hemoglobin level 4. Blood urea nitrogen (BUN) level

Answer 33

4. Blood urea nitrogen (BUN) level

Question 34

The nurse is providing patient education for patients preparing to receive renal transplants. The nurse discusses the pros and cons of using cyclosporine (Sandimmune) to prevent allograft rejection. Which statement by one of the patients best demonstrates understanding of cyclosporine? “Cyclosporine does not A. cause renal damage.” B. increase the risk of infection.” C. not suppress bone marrow.” D. cause hypertension.”

Answer 34

D. | NOT SURPRESS BONE MARROW

Question 35

The nurse is caring for a patient taking tacrolimus (Prograf) on a renal telemetry unit. Which adverse effect associated with this medication would most concern the nurse? a. Gingival hyperplasia b. Blood glucose level of 120 c. Risk of infection d. Tremors and insomnia

Answer 35

d. Tremors and insomnia

Question 36

The nurse is caring for a patient who received a transplant a few months ago. The patient has been taking azathioprine (Imuran) and comes to the clinic for laboratory work. Which laboratory test would the nurse anticipate for this patient? a. Bilirubin b. Blood urea nitrogen (BUN) c. Serum azathioprine levels d. Complete blood cell (CBC) count

Answer 36

d. Complete blood cell (CBC) count

Question 37

The nurse is caring for a patient who has been taking cyclosporine (Sandimmune). During a follow-up appointment, the patient starts making conversation. What comment by the patient would most concern the nurse? a. “I have coffee every morning.” b. “I enjoy tea in the afternoons.” c. “I drink grapefruit juice with my breakfast.” d. “I take aspirin for headaches.”

Answer 37

c. “I drink grapefruit juice with my breakfast.”

Question 38

The nurse is preparing to draw blood for measurement of a serum cyclosporine (Sandimmune) level. At what time should the serum cyclosporine level be drawn? a. Two hours after the dose is administered b. Just prior to the next dose c. Six hours after the dose is administered d. Timing of levels is irrelevant

Answer 38

b. Just prior to the next dose