Chapter 30: Transplant Drugs McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition

Multiple Choice

1. The nurse is teaching a patient who will begin taking basiliximab in conjunction with a kidney transplant. Which of the following would be appropriate to include when counseling the patient?

a. The drug is used to boost the immune system.

b. The drug is taken by mouth before and after the transplant surgery.

c. Nausea, vomiting, fever, and chills are common side effects.

d. Basiliximab is primarily used for patients receiving a heart transplant.

ANS: C

Nausea, vomiting, fever, and chills are common side effects. Basiliximab provides intense immunosuppression to reduce the risk for acute rejection during the initial transplant period. The drug is administered intravenously 2 hours before transplant surgery followed by a second dose 4 days after transplantation. Basiliximab is approved for induction therapy in kidney transplant patients.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “I will have to have blood tests drawn regularly while taking this medication.” b. “I should avoid drinking grapefruit juice while on this medication.” c. “I have to avoid receiving live vaccines.” d. “Cyclosporine does not enter breast milk so there are no concerns with breast feeding.”

2. A patient who has had an organ transplant is prescribed cyclosporine for maintenance therapy. Which statement by the patient indicates further teaching is needed?

ANS: D

Cyclosporine is present in breast milk. Because of the potential for serious adverse drug reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Therapeutic drug monitoring and safety labs are required. Grapefruit juice can affect the metabolism of cyclosporine and should be avoided. Patients should not receive live vaccines while taking cyclosporine.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pathophysiology

3. Your patient is taking belatacept and develops posttransplant lymphoproliferative disorder (PTLD). PTLD primarily affects: a. the liver b. the heart c. the kidneys d. the nervous system

ANS: D

PTLD primarily affects the central nervous system.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Increased risk of QT prolongation and arrhythmias b. Increased risk of hypokalemia c. Increased risk of hyperglycemia d. Increased risk of ophthalmic toxicity

4. Combination of corticosteroids with certain antibiotics can result in which of the following?

ANS: A

Chronic corticosteroid therapy with macrolide antibiotics increases the risk of ventricular arrhythmias. Combination of corticosteroids with diuretics can increase the risk of hypokalemia. Corticosteroid use in general is associated with risk of hyperglycemia and ophthalmic toxicity.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The patient tells the nurse that he understands that transplant rejection may happen and asks what can be done to minimize risk of rejection and other negative outcomes. What will the nurse include in the teaching?

N a. “An anti-T-cell antibody should be used in conjunction with corticosteroid therapy for best results.” b. “ATG rabbit started immediately after transplant can help prevent rejection.” c. “Transplant rejection drugs can be used and while they have unwanted side effects, none are deadly.” d. “Caution needs to be taken when other immunosuppressant drugs are administered to avoid serious infections.”

ANS: D

Caution needs to be taken when other immunosuppressant drugs are administered because of the increased risk of serious infection. Treatment of rejection with an anti-T-cell antibody is used when corticosteroids have failed to reverse rejection or for treatment of a recurrent rejection. ATG rabbit is indicated to manage transplant rejection, but would not be used prophylactically to prevent rejection immediately after transplant. These drugs have unwanted side effects, some of which are serious and potentially deadly.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. The patient on immunosuppressant medications is speaking to the nurse about appropriate activities. Which statement requires intervention? (Select all that apply.)

a. “I am going to the state fair with my friends.” b. “I enjoy working in my garden to relax.” c. “I will brush my teeth after meals.” d. “It’s OK to eat fresh fruits and vegetables.” e. “I should get a new glass, if the one I am drinking from has been sitting out.” f. “I should bath daily, using an antimicrobial soap.”

ANS: A, B, D

Immunosuppressed patients should stay away from crowds and people who are sick. Fresh flowers, live plants, gardening, and standing water should be avoided. One should brush teeth at least twice a day with a soft toothbrush and bathe daily. In general, the patient should avoid activities that increase the risk of exposure to bacteria/germs.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pathophysiology