Unit5: Chapter 17 (Karch 7th Ed) - Immune Modulators Flashcards
(35 cards)
- A patient has been diagnosed with hairy cell leukemia. The patient is to begin taking interferon alfa 2b.
What will the nurse include in her instructions to the patient concerning this drug?
A) Avoid drinking alcohol while taking the drug.
B) Continue to maintain maximal physical activity.
C) Increase fluid intake while taking the drug.
D) Treat constipation with over-the-counter laxatives.
Ans: C
Feedback:
Interferon alfa 2b is metabolized in the kidney so adequate fluid intake is needed to promote
metabolism and excretion of the drug as well as to minimize common adverse effects including dry
skin and dizziness. Maintaining maximal physical activity is a good idea but has no relationship to the
use of the drug. Fluids should be increased not decreased while taking the drug. Constipation is not an
associated adverse effect of this medication.
2. The health care provider plans to inject an interferon directly into the patient’s wart. What interferon will the nurse prepare? A) Interferon alfa 2a (Roferon-A) B) Interferon alfacon 1 (Infergen) C) Interferon alfa n3 (Alferon N) D) Interferon beta 1a (Avonex)
Ans: C
Feedback:
Interferon alf n3 is used for intralesional treatment of warts. Interferon alfa 2a is used in the treatment
of leukemia. Interferon alfacon 1 is used in the treatment of chronic hepatitis C infection in adults.
Interferon beta 1a is used to treat multiple sclerosis in adults.
- A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for
treatment. What will be important to discuss with the patient when the nurse provides patient teaching about her treatment?
A) The need to continue oral contraceptives
B) The need to use barrier contraceptives while taking the drug
C) The need to avoid sexual intercourse while taking the drug
D) The importance of taking an aspirin daily to decrease the adverse effects of the drug
Ans: B
Feedback:
A patient taking an immune modulator would be advised to use barrier contraceptives to prevent
pregnancy. The interaction of the immune modulator and the oral contraceptive may interfere with the
oral contraceptive’s ability to work properly. Asking patients to avoid sexual intercourse is not
necessary if barrier methods are properly used. Daily aspirin would not decrease adverse effects of this
drug.
- The nurse has an order to administer oprelvekin (Neumega) to a patient for the first time. Before
administering the drug, what allergy would the nurse want to specifically question the patient about?
A) Egg products
B) Escherichia coli produced products
C) Lactose intolerance
D) Penicillin
Ans: B
Feedback:
The interleukins are produced using deoxyribonucleic acid technology and E. coli bacteria. Patients
with known allergy to E. coli products should not receive oprelvekin. The allergies to penicillin, egg
products, or lactose intolerance would not be of concern with this drug.
- The physician has decided to prescribe T- and B-cell suppressors for a patient diagnosed with psoriasis.
What drug will be ordered for this patient?
A) Alefacept (Amevive)
B) Azathioprine (Imuran)
C) Cyclosporine (Neoral)
D) Glatiramer acetate (Copaxone)
Ans: A
Feedback: Alefacept is prescribed for patients with severe chronic plaque psoriasis. Cyclosporine is used to
suppress rejection in a variety of transplant situations. Azathioprine is used to treat patients with
rheumatoid arthritis and in prevention of rejection in renal homotransplants. Tacrolimus is used for
prevention of rejection after renal or liver transplantation
- A patient who is receiving an immune suppressant has been admitted to the unit. What would be a
priority action by the nurse?
A) Monitor nutritional status.
B) Provide patient teaching regarding the drug.
C) Protect the patient from exposure to infection.
D) Provide support and comfort measures in relation to adverse effects of the drug.
Ans: C
Feedback:
Patients taking immune suppressant drugs are more susceptible to infection because the patient’s
normal body defenses will be diminished. As a result, the priority action by the nurse would to protect
the patient from exposure to infection through room selection, good hand hygiene, and taking care to
avoid exposure to sick staff members. Teaching will need to include avoiding crowded places and
people with known infection and those working in soil. Nutritional status is important as are comfort
and support measures and other instructions concerning the drug. However, protecting the patient from
infection should be the priority action.
7. A nurse is discussing interferon alfa 2b with a patient. What will the nurse encourage the patient to do while taking this drug? A) To avoid crowds B) To increase salt intake C) To decrease milk intake D) To eat three meals a day
Ans: A
Feedback:
Potential adverse effects in addition to the types of conditions interferon alfa 2b is prescribed to
contribute to the need for the patient to take care to avoid people with infections so the patient should
be taught to avoid crowds whenever possible. Adverse effects include dizziness, confusion, rash, dry
skin, anorexia, nausea, bone marrow suppression, and flu-like syndrome. Salt, diet, and milk do not
interfere with this drug.
- A 70-year-old patient with acute myelocytic leukemia is receiving sargramostim (Leukine). What is a
priority nursing action for this patient?
A) Providing a quiet environment
B) Increasing fluids
C) Providing comfort measures related to nausea
D) Encouraging appropriate dietary intake
Ans: B
Feedback:
A common adverse effect of this drug is vomiting and diarrhea. Due to the patient’s age it would be
important to keep him hydrated. Vomiting and diarrhea can cause dehydration quickly in the elderly.
Providing a quiet environment and comfort measures for the nausea would be important but not as
critical as increasing fluids. Diet is very important to this patient; however, usually this drug causes a
loss of appetite. Therefore, increasing fluids would be extremely important to the patient’s nutritional
status.
- The nurse is caring for a patient in the immediate postoperative period following cardiac transplantation
who is receiving mycophenolate (CellCept) twice a day IV. What will the nurse teach the patient
regarding drug therapy? (Select all that apply.)
A) The drug will be given orally as soon as possible.
B) Take the medication three times a day.
C) Avoid people with contagious diseases.
D) Ask a pharmacist about drug drug interactions before taking any over-the-counter (OTC) drug.
E) Never miss a dose of medication.
Ans: A, C, D, E
Feedback:
The nurse will explain that the IV medication will be changed to oral therapy when the patient is able to
tolerate oral medications. The patient will take the medication twice a day, not three times a day. Care
should be taken to never miss a dose. The patient should avoid other medications that are hepatotoxic
or nephrotoxic due to a risk of increased toxicity so the patient should be taught to always consult a
doctor or pharmacist before beginning an OTC drug. Patients who have immune suppression must be
taught how to reduce risk of infection, including avoiding people with contagious diseases, such as
colds or viruses.
10. The nurse administers aldesleukin to a patient diagnosed with renal cell carcinoma. When assessing the patient a few days later, what abnormal findings would the nurse attribute to the medication? (Select all that apply.) A) Increased lymphocyte count B) Increased red blood cell count C) Increased platelet count D) Irregular pulse rate E) Increased blood pressure
Ans: A, C, D
Feedback:
Aldesleukin activates human cellular immunity and inhibits tumor growth through increases in
lymphocytes, platelets, and cytokines. Common adverse effects include hypotension, sinus tachycardia,
arrhythmias, as well as pruritus, nausea, vomiting, diarrhea, anorexia, GI bleeding, bone marrow
suppression, respiratory difficulties, fever, chills, pain, mental status changes, and dizziness. There is
no impact on red blood cell count. It does not raise blood pressure.
- While studying for a pharmacology test, a student asks his peers about interferons. What statement
about interferons is accurate?
A) They stimulate B-lymphocyte activity.
B) They interfere with multiplication of stem cells.
C) They stimulate growth and differentiation of lymphoid cells into lymphocytes.
D) They interfere with the ability of viruses in infected cells to replicate.
Ans: D
Feedback:
Interferons are substances naturally produced and released by human cells that have been invaded by
viruses. They may also be released from cells in response to other stimuli, such as cytotoxic T-cell
activity. Interferons do not stimulate B-lymphocyte activity, interfere with multiplication of stem cells,
nor do they stimulate growth and differentiation of lymphoid cells into lymphocytes.
- How do immune suppressants work when ordered for a patient who has had an organ transplant?
A) Blocking normal effects of the immune system
B) Stimulating immune system to fight off infection
C) Working with corticosteroids to enhance healing
D) Working with corticosteroids to promote suppressor cells
Ans: A
Feedback:
Immune suppressants are used to block the normal effects of the immune system in cases of organ
transplantation (in which non self-cells are transplanted into the body and destroyed by the immune
reaction) and in autoimmune disorders (in which the body’s defenses recognize self-cells as foreign and
work to destroy them) in some cancers. Options B, C, and D are distracters for this question.
- A patient has just been told that her cancer has metastasized to her right kidney. An interferon
(Aldesleukin) has been prescribed to treat this metastasis. The patient asks why this interferon is
ordered. What is the nurse’s best response?
A) Aldesleukin has been shown to protect autologous tumor cells.
B) Aldesleukin has been shown to inhibit tumor growth.
C) Aldesleukin has been shown to enhance allogeneic stem-cell transplantation.
D) Aldesleukin has been shown to have a direct proliferative effect on renal tumors
Ans: B
Feedback:
Aldesleukin is prescribed for metastatic renal cell carcinoma in adults and treatment of metastatic
melanomas (orphan drug use) working by activating human cellular immunity and inhibiting tumor
growth through increases in lymphocytes, platelets, and cytokines. Aldesleukin does not protect
autologous tumor cells, enhance allogeneic stem-cell transplantation, or have a direct proliferative
effect on renal tumors.
- The nurse admits a patient who was newly diagnosed with Kaposi’s sarcoma to the unit. The physician
has ordered an IV infusion of an interferon. What drug would be appropriate?
A) Interferon beta1a
B) Interferon gamma 1b
C) Interferon alfa 2b
D) Peginterferon alfa 2b
Ans: C
Feedback:
Interferon alfa 2b indications include hairy cell leukemia, melanoma, AIDS-related Kaposi’s sarcoma,
chronic hepatitis B and C infection, intralesional treatment of condyloma acuminatum in patients 18
years of age or older. No other interferons are indicated for treatment of Kaposi’s sarcoma.
15. The pharmacology instructor is talking about interferon. The instructor explains that agents, such as interferons, have more than one biologic function. What are the functions of interferons? (Select all that apply.) A) Antibacterial B) Antiviral C) Immunomodulatory D) Antiproliferative E) Anticancer
Ans: B, C, D
Feedback: Interferons act to prevent virus particles from replicating inside the cells. They also stimulate interferon
receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the
cell. In addition, interferons have been found to inhibit tumor growth and replication, to stimulate
cytotoxic T-cell activity, and to enhance the inflammatory response. Options A and E are incorrect.
- The nursing class is studying monoclonal antibodies. What monoclonal antibody reacts to human T
cells, disabling them and acting as an immune suppressor?
A) Adalimumab
B) Cetuximab
C) Rituximab
D) Muromonab-CD3
Ans: D
Feedback:
Muromonab-CD3, the first monoclonal antibody approved for use, is a T-cell specific antibody, that is
available as an IV agent. It reacts as an antibody to human T cells, disabling the T cells, acting as an
immune suppressor. Adalimumab is an antibody specific for human tumor necrosis factor. Cetuximab
is an antibody specific to epidermal growth factor receptor sites. Rituximab is an antibody specific to
sites on activated B lymphocytes.
17. What monoclonal antibody is used to prevent respiratory syncytial virus (RSV) in high risk children? A) Palivizumab B) Natalizumab C) Belimumab D) Eculizumab
Ans: A
Feedback:
Palivizumab is specific to the antigenic site on respiratory syncytial virus (RSV); it inactivates that
virus. It is used to prevent RSV disease in high-risk children. Natalizumab is an antibody specific to
surface receptors on all leukocytes except neutrophils. Belimumab is a specific inhibitor of Blymphocyte
stimulator that inhibits the survival of B-lymphocytes and their differentiation into
immune-globulin producing cells. Eculizumab binds to complement proteins and prevents the
formation of the complement complex.
- The nurse is caring for a patient with an allograft transplant. The physician orders a monoclonal
antibody to prevent rejection of the transplant. What monoclonal antibody would the nurse expect to be
ordered?
A) Alemtuzumab
B) Daclizumab
C) Erlotinib
D) Omalizumab
Ans: B
Feedback:
Daclizumab is specific to interleukin-2 receptor sites on activated T lymphocytes; it reacts with those
sites and blocks cellular response to allograft transplants. Alemtuzumab is an antibody specific for
lymphocyte receptor sites used to treat chronic lymphocytic leukemia patients who have been treated
with alkylating agents and have been failed by fludarabine therapy. Erlotinib is effective against
specific malignant receptor sites. Omalizumab is an antibody to immunoglobulin E, an important factor
in allergic reactions.
- The pharmacology instructor is explaining interleukins to the class. What would be the best definition
of interleukins?
A) They are substances naturally produced and released by human cells that have been invaded by
viruses.
B) They block the inflammatory reaction and decrease initial damage to cells.
C) They are chemicals used to communicate between leukocytes and stimulate immunity.
D) They attach to specific receptor sites and respond to very specific situations.
Ans: C
Feedback:
Interleukins are chemicals produced by T cells to communicate between leukocytes and stimulate
cellular immunity and inhibit tumor growth. Immune suppressants block the inflammatory reaction and
decrease initial damage to cells. Interferons are naturally produced and released by human cells that
have been invaded by viruses. Monoclonal antibodies attach to specific receptor sites and respond to
very specific situations.
20. The nurse is caring for a female patient, aged 62, who has been admitted for treatment of metastatic melanoma. What agent would the nurse anticipate the physician is likely to order? A) Aldesleukin B) Interferon alfa 2b C) Cyclosporine D) Ipilimumab
Ans: D
Feedback:
Ipilimumab is a human cytotoxic T-cell antigen-4 blocking antibody. By blocking this site, T cells are
activated and proliferate at a faster rate. It is used to treat patients with unresectable or metastatic
melanoma. Aldesleukin is an interleukin, used for metastatic renal cell carcinoma in adults; a treatment
of metastatic melanomas. Interferon alfa 2b is indicated for hairy cell leukemia, melanoma, AIDSrelated
Kaposi’s sarcoma, chronic hepatitis B and C infections, intralesional treatment of condyloma
acuminatum in patients 18 years of age or older. Cyclosporine is a T and B cell suppressor and is
indicated for prophylaxis for organ rejection in kidney, liver, and heart transplants (used with
corticosteroids); treatment of chronic rejection in patients previously treated with other
immunosuppressants; treatment of rheumatoid arthritis; and recalcitrant psoriasis.
- While studying the T- and B-cell immune suppressors, the nursing students learn that the most
commonly used immune suppressant is what?
A) Cyclosporine (Sandimmune)
B) Azathioprine (Imuran)
C) Pimecrolimus (Elidel)
D) Glatiramer (Copaxone)
Ans: A
Feedback:
Several T- and B-cell immune suppressors are available for use. Of the numerous agents available,
cyclosporine is the most commonly used immune suppressant. Options B, C, and D are all T- and Bcell
immune suppressors, they are simply not the most commonly prescribed.
- What interleukin receptor antagonist would the nurse anticipate is most likely to be ordered for a
patient, 25 years old, who has not responded to traditional antirheumatic drugs?
A) Natalizumab (Tysabri)
B) Anakinra (Kineret)
C) Eculizumab (Soliris)
D) Adalimumab (Humira)
Ans: B
Feedback:
Anakinra is used to reduce the signs and symptoms of moderately to severely active rheumatoid
arthritis in patients 18 years of age and older who have not responded to the traditional antirheumatic
drugs. Options A, C, and D are monoclonal antibodies, therefore they are incorrect answers.
- A patient with chronic hepatitis C has been prescribed peginterferon alfa 2b (PEG-INTRON). By what
route would the nurse administer this drug?
A) Subcutaneously (SQ)
B) Intramuscularly (IM)
C) Intralesionally (IL)
D) Orally
Ans: A
Feedback:
PEG-INTRON, like many of the interferons, is administered subcutaneously. Avonex is given
intramuscularly. Interferon alfa n3 is given intralesionally. There are no interferons given orally.
- The patient has arrived in the short stay unit for an infusion of tositumomab with 131 tositumomab
(Bexxar). Before beginning the infusion, the nurse assesses the patient’s vital signs and finds the patient
has a temperature of 101.5ºF, What is the nurse’s priority action?
A) Holding the infusion until patient is afebrile
B) Notifying the physician
C) Starting the infusion and inform the physician
D) Treating the fever before beginning the therapy
Ans: D
Feedback:
Monoclonal antibodies should be used cautiously with fever (treat the fever before beginning therapy).
This makes Options A, B, and C incorrect.
