Lecture 9: Immunosuppressents Flashcards
A patient is started on cyclosporine after a kidney transplant. What should the nurse include in the teaching plan?
A. Take the medication with grapefruit juice to enhance absorption.
B. Monitor for signs of infection and report them immediately.
C. Expect an increase in urine output as a side effect.
D. Avoid concurrent use of any other immunosuppressive drugs.
Answer: B
Rationale: Patients on cyclosporine are at an increased risk of infection due to immunosuppression and should report early signs such as fever or malaise. Grapefruit juice increases cyclosporine levels, leading to toxicity (A is incorrect). Cyclosporine does not increase urine output (C is incorrect). It is often combined with other immunosuppressive agents like glucocorticoids for efficacy (D is incorrect).
A patient with rheumatoid arthritis is prescribed glucocorticoids. Which side effect should the nurse prioritize monitoring for?
A. Hyperglycemia
B. Hypotension
C. Dehydration
D. Increased bone density
Answer: A
Rationale: Glucocorticoids can elevate blood glucose levels, requiring frequent monitoring, even in non-diabetic patients. They cause hypertension (not hypotension), fluid retention (not dehydration), and reduce bone density, increasing osteoporosis risk (B, C, and D are incorrect).
The nurse is caring for a patient receiving tacrolimus for liver transplant rejection prevention. Which adverse effect should the nurse report immediately?
A. Insomnia
B. Nausea
C. Hypertension
D. Tremors
Answer: D
Rationale: Tremors may indicate neurotoxicity, a serious side effect of tacrolimus requiring prompt intervention. While insomnia, nausea, and hypertension are adverse effects, they are not immediately life-threatening (A, B, and C are incorrect).
Which mechanism explains why glucocorticoids suppress inflammation?
A. Blocking prostaglandin synthesis and decreasing phagocyte activation.
B. Increasing T-cell proliferation and promoting cytokine production.
C. Enhancing neutrophil activity and increasing capillary permeability.
D. Promoting prostaglandin release to reduce vasodilation.
Answer: A
Rationale: Glucocorticoids inhibit prostaglandin and cytokine production while suppressing phagocytes, reducing inflammation. They suppress, rather than enhance, immune responses (B, C, and D are incorrect).
A patient is tapering off high-dose glucocorticoids. What sign of adrenal insufficiency should the nurse monitor for?
A. Hypertension
B. Hyperglycemia
C. Fatigue
D. Increased appetite
Answer: C
Rationale: Fatigue, along with hypotension, hypoglycemia, and myalgia, indicates adrenal insufficiency. Hyperglycemia and hypertension are side effects of glucocorticoid use, not adrenal insufficiency (A and B are incorrect). Increased appetite is not a sign of withdrawal (D is incorrect).
What is the primary reason patients require immunosuppressants after an allograft transplant?
A. To decrease the risk of infection.
B. To enhance antibody production.
C. To prevent the immune system from attacking the new organ.
D. To improve the healing of the transplanted tissue.
Answer: C
Rationale: Immunosuppressants like cyclosporine and tacrolimus are essential to prevent the immune system from rejecting the transplanted organ, considered a foreign tissue. These drugs increase infection risk, not decrease it (A is incorrect), and they do not enhance antibody production or healing (B and D are incorrect).
A nurse administers a live vaccine to a patient on high-dose glucocorticoids. What is the patient at risk for?
A. Severe infection
B. Ineffective vaccine response
C. Hyperglycemia
D. Cushing’s syndrome
Answer: A
Rationale: High-dose glucocorticoids suppress the immune response, putting the patient at risk for infection from live vaccines. The response to vaccines may also be diminished but is not the most immediate concern (B). Hyperglycemia and Cushing’s syndrome are unrelated to live vaccine administration (C and D are incorrect).
Which teaching point is most important for a patient taking cyclosporine?
A. Increase potassium intake to prevent hypokalemia.
B. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs).
C. Consume a low-protein diet to prevent nephrotoxicity.
D. Take the medication on an empty stomach.
Answer: B
Rationale: NSAIDs can exacerbate nephrotoxicity, a major side effect of cyclosporine. Cyclosporine does not cause hypokalemia (A). Protein intake does not directly influence nephrotoxicity (C). It is usually taken with food to enhance tolerability, not on an empty stomach (D).
A patient is prescribed glucocorticoids for severe asthma. The nurse should include which instruction in the patient’s education?
A. Avoid abrupt discontinuation of the medication.
B. Take the medication only during asthma exacerbations.
C. Expect an improvement in bone density with prolonged use.
D. Discontinue the medication if gastrointestinal upset occurs.
Answer: A
Rationale: Abrupt cessation of glucocorticoids can lead to adrenal insufficiency. Glucocorticoids are often taken daily for chronic conditions like asthma (B is incorrect). They decrease bone density (C is incorrect) and should not be stopped abruptly without consulting a healthcare provider (D is incorrect).
The nurse monitors a patient on glucocorticoids for signs of peptic ulcer disease. What finding requires further investigation?
A. Blood pressure of 140/90 mmHg
B. Black, tarry stools
C. Weight gain of 2 lbs in a week
D. Complaints of fatigue
Answer: B
Rationale: Black, tarry stools indicate gastrointestinal bleeding, a serious complication of peptic ulcer disease. Hypertension, weight gain, and fatigue are common but less concerning side effects of glucocorticoids (A, C, and D are incorrect).
A patient is receiving cyclosporine post-kidney transplant. The nurse understands that monitoring which laboratory test is a priority?
A. Serum potassium
B. Serum creatinine
C. Complete blood count (CBC)
D. Blood glucose
Answer: B
Rationale: Cyclosporine is nephrotoxic; therefore, monitoring serum creatinine levels is essential to detect kidney dysfunction early. Potassium levels (A) and blood glucose (D) are not directly impacted by cyclosporine. CBC (C) is important but less critical than monitoring kidney function.
Which statement by a patient taking glucocorticoids indicates the need for further teaching?
A. “I will take my medication with food to avoid stomach upset.”
B. “I should stop my medication if I start feeling better.”
C. “I need to monitor my blood sugar levels, even though I don’t have diabetes.”
D. “I will report any unusual weight gain or swelling to my provider.”
Answer: B
Rationale: Glucocorticoids must not be stopped abruptly due to the risk of adrenal insufficiency. Patients should taper their dose as directed by their healthcare provider. Taking medication with food (A), monitoring glucose (C), and reporting weight gain (D) are correct actions.
A nurse is teaching a patient about signs of adrenal insufficiency while tapering off glucocorticoids. Which symptom should the patient report immediately?
A. Excessive thirst
B. Persistent fatigue
C. Increased appetite
D. Elevated blood pressure
Answer: B
Rationale: Fatigue is a hallmark symptom of adrenal insufficiency. Excessive thirst (A) and increased appetite (C) are not typical signs of adrenal insufficiency. Elevated blood pressure (D) is more commonly seen with continued glucocorticoid use, not withdrawal.
A patient is receiving tacrolimus post-liver transplant. Which finding should the nurse report to the healthcare provider?
A. Blood pressure of 138/88 mmHg
B. Mild tremor in the hands
C. Serum potassium of 5.8 mEq/L
D. Occasional nausea after meals
Answer: C
Rationale: Hyperkalemia (potassium >5.5 mEq/L) is an adverse effect of tacrolimus and requires prompt intervention. A mild tremor (B) and nausea (D) are expected side effects. The blood pressure (A) is elevated but not critical.
The nurse knows that which immune system component is responsible for humoral immunity?
A. B cells
B. Killer T cells
C. Helper T cells
D. Phagocytes
Answer: A
Rationale: B cells produce antibodies, which are critical for humoral immunity. Killer T cells (B) and helper T cells (C) are involved in cell-mediated immunity. Phagocytes (D) are part of natural immunity.
Which immune response characteristic is demonstrated when memory B cells respond more rapidly to a second exposure to the same antigen?
A. Specificity
B. Diversity
C. Memory
D. Time-limited
Answer: C
Rationale: Memory is the characteristic of the immune response where re-exposure to an antigen results in a faster and stronger response. Specificity (A) refers to targeted responses, diversity (B) involves recognition of many antigens, and time-limited (D) describes the finite duration of immune responses.
A patient with an autoimmune disease is prescribed an immunosuppressant. The nurse explains that the purpose of the medication is to:
A. Increase the number of white blood cells.
B. Suppress the body’s ability to attack its own tissues.
C. Enhance the production of antibodies.
D. Prevent the development of infections.
Answer: B
Rationale: Immunosuppressants reduce the immune system’s activity to prevent it from attacking the body’s own tissues in autoimmune diseases. They do not increase WBCs (A), enhance antibody production (C), or directly prevent infections (D).
Which action by a nurse is most appropriate when administering glucocorticoids to a patient with chronic asthma?
A. Administering the medication in the evening to mimic the body’s natural rhythms.
B. Monitoring the patient’s blood glucose levels periodically.
C. Instructing the patient to abruptly stop the medication if symptoms resolve.
D. Advising the patient to avoid calcium-rich foods to prevent hypercalcemia.
Answer: B
Rationale: Glucocorticoids can cause hyperglycemia, even in non-diabetic patients, so glucose levels should be monitored. Glucocorticoids are typically given in the morning (A) and should not be stopped abruptly (C). Patients should consume calcium to prevent osteoporosis (D).
A patient receiving cyclosporine is advised to avoid which beverage?
A. Milk
B. Coffee
C. Grapefruit juice
D. Orange juice
Answer: C
Rationale: Grapefruit juice inhibits the enzyme CYP3A4, increasing cyclosporine levels and the risk of toxicity. Milk (A), coffee (B), and orange juice (D) do not have this interaction.
The nurse is teaching a patient about adverse effects of long-term glucocorticoid therapy. Which statement indicates understanding?
A. “I need to schedule regular eye exams to monitor for cataracts.”
B. “I can skip doses on days when I feel fine.”
C. “I should increase my protein intake to build muscle mass.”
D. “I do not need calcium supplements since glucocorticoids prevent bone loss.”
Answer: A
Rationale: Long-term glucocorticoid therapy increases the risk of cataracts, so regular eye exams are necessary. Skipping doses (B) can lead to adrenal insufficiency, and glucocorticoids cause muscle wasting and osteoporosis, not the reverse (C and D are incorrect).
The nurse explains that which immune cell is primarily responsible for directly killing pathogens?
A. B cells
B. CD4 helper T cells
C. CD8 killer T cells
D. Macrophages
Answer: C
Rationale: CD8 killer T cells (cytotoxic T cells) are responsible for directly attacking and killing pathogens. B cells (A) produce antibodies, CD4 cells (B) aid other immune cells, and macrophages (D) engulf pathogens rather than directly killing them.
A nurse is caring for a patient on glucocorticoids. What dietary modification should the patient follow?
A. Increase sodium intake.
B. Increase potassium and calcium intake.
C. Decrease protein intake.
D. Avoid vitamin D supplements.
Answer: B
Rationale: Glucocorticoids can cause hypokalemia and osteoporosis; increasing potassium and calcium intake helps mitigate these effects. Sodium (A) should not be increased as glucocorticoids can cause fluid retention. Protein (C) should not be restricted, and vitamin D (D) helps with calcium absorption.
A patient receiving glucocorticoids reports muscle weakness. The nurse suspects which side effect?
A. Hyperglycemia
B. Osteoporosis
C. Myopathy
D. Fluid retention
Answer: C
Rationale: Myopathy, or muscle weakness, is a potential side effect of glucocorticoids due to protein breakdown. Hyperglycemia (A) and osteoporosis (B) are also common but do not typically cause muscle weakness. Fluid retention (D) is unrelated to muscle strength.
Which immune response feature allows the body to distinguish between self and non-self?
A. Memory
B. Specificity
C. Recognition
D. Diversity
Answer: C
Rationale: Recognition, mediated by the Major Histocompatibility Complex (MHC), enables the immune system to differentiate self from non-self. Memory (A), specificity (B), and diversity (D) are other features but not responsible for self-recognition.
A patient with peptic ulcer disease is prescribed glucocorticoids. The nurse should monitor for which symptom?
A. Black, tarry stools
B. Weight gain
C. Increased appetite
D. Insomnia
Answer: A
Rationale: Black, tarry stools indicate gastrointestinal bleeding, a serious complication of peptic ulcer disease exacerbated by glucocorticoids. Weight gain (B), increased appetite (C), and insomnia (D) are common side effects but less critical.
Which statement best describes the role of helper T cells (CD4 cells)?
A. They kill infected cells directly.
B. They produce antibodies to fight infection.
C. They activate B cells and killer T cells.
D. They engulf and destroy pathogens.
Answer: C
Rationale: Helper T cells (CD4) assist in activating B cells to produce antibodies and killer T cells (CD8) to attack infected cells. They do not directly kill cells (A), produce antibodies (B), or engulf pathogens (D).
What is the primary purpose of administering tacrolimus to a post-transplant patient?
A. To prevent infection.
B. To boost antibody production.
C. To suppress organ rejection.
D. To enhance wound healing.
Answer: C
Rationale: Tacrolimus suppresses the immune response to prevent organ rejection. It does not prevent infection (A), boost antibody production (B), or directly promote wound healing (D).
Which immune cell is responsible for retaining memory of past infections to allow faster future responses?
A. Macrophages
B. Plasma cells
C. Memory B cells
D. Helper T cells
Answer: C
Rationale: Memory B cells retain information about past infections, enabling faster and stronger responses upon re-exposure. Plasma cells (B) produce antibodies but lack memory. Macrophages (A) and helper T cells (D) are not involved in long-term memory
What is the mechanism of action for cyclosporine in preventing organ rejection?
A. Enhances antibody production against foreign tissue.
B. Inhibits calcineurin, reducing T-cell activation.
C. Promotes phagocytosis of foreign cells.
D. Suppresses B-cell proliferation.
Answer: B
Rationale: Cyclosporine binds to cyclophilin and inhibits calcineurin, leading to reduced T-cell activation and suppression of the immune response. It does not enhance antibodies (A), promote phagocytosis (C), or directly suppress B cells (D).
When discontinuing long-term glucocorticoids, what should the nurse anticipate?
A. Rapid tapering over 2 days.
B. Gradual dose reduction to prevent adrenal insufficiency.
C. Abrupt discontinuation to minimize side effects.
D. A temporary increase in symptoms of the treated condition.
Answer: B
Rationale: Gradual tapering allows the adrenal glands to resume normal cortisol production, preventing adrenal insufficiency. Abrupt discontinuation (C) is dangerous, and a temporary increase in symptoms (D) is not a typical concern.
A patient receiving glucocorticoids reports blurry vision and frequent headaches. What complication should the nurse suspect?
A. Cataracts
B. Adrenal insufficiency
C. Glaucoma
D. Peptic ulcer disease
Answer: C
Rationale: Glaucoma, a potential side effect of glucocorticoids, can cause blurry vision and headaches. Cataracts (A) also affect vision but are painless. Adrenal insufficiency (B) and peptic ulcer disease (D) do not cause blurry vision.
What action should the nurse take for a patient on cyclosporine who develops a fever?
A. Increase the dose of cyclosporine.
B. Monitor for signs of infection and report to the provider.
C. Discontinue cyclosporine until the fever subsides.
D. Administer a live vaccine to boost immunity.
Answer: B
Rationale: Fever in a patient on cyclosporine could indicate infection due to immunosuppression and requires prompt evaluation. Increasing the dose (A), discontinuing the medication (C), or administering live vaccines (D) is inappropriate.
The nurse knows that the term “humoral immunity” refers to which immune response?
A. Attack by phagocytes on pathogens.
B. Production of antibodies by B cells.
C. Activation of cytotoxic T cells.
D. Release of histamines during inflammation.
Answer: B
Rationale: Humoral immunity is mediated by B cells that produce antibodies. Phagocytosis (A), cytotoxic T cell activation (C), and histamine release (D) are part of other immune mechanisms.
What is the role of glucocorticoids in the treatment of autoimmune diseases?
A. Stimulating the immune response.
B. Suppressing the inflammatory process.
C. Enhancing T-cell activity.
D. Increasing antibody production.
Answer: B
Rationale: Glucocorticoids reduce inflammation by suppressing the immune response. They do not stimulate the immune system (A), enhance T-cell activity (C), or increase antibody production (D).
A patient taking glucocorticoids is at risk for osteoporosis. What should the nurse recommend?
A. Limit calcium intake to reduce hypercalcemia risk.
B. Engage in weight-bearing exercises regularly.
C. Avoid exposure to sunlight to prevent skin damage.
D. Take glucocorticoids on an empty stomach.
Answer: B
Rationale: Weight-bearing exercises help strengthen bones and reduce osteoporosis risk. Calcium intake should be increased (A), sunlight exposure aids vitamin D synthesis (C), and glucocorticoids should be taken with food (D).
Which adverse effect is most concerning for a patient receiving tacrolimus?
A. Increased body hair (hirsutism)
B. Neurotoxicity
C. Nausea
D. Insomnia
Answer: B
Rationale: Neurotoxicity, which may present as tremors, headaches, or confusion, requires immediate attention. Hirsutism (A), nausea (C), and insomnia (D) are less critical side effects.
Which characteristic of the immune response ensures a faster response upon subsequent exposure to the same antigen?
A. Specificity
B. Diversity
C. Time-limited
D. Memory
Answer: D
Rationale: Memory enables the immune system to respond more rapidly to subsequent exposures. Specificity (A) targets individual antigens, diversity (B) involves responding to multiple antigens, and time-limited (C) indicates a finite immune response duration.
A nurse is teaching a patient about adverse effects of tacrolimus. Which symptom should be reported immediately?
A. Mild nausea
B. Excessive hair growth
C. Muscle tremors
D. Increased appetite
Answer: C
Rationale: Muscle tremors could indicate neurotoxicity, a serious adverse effect of tacrolimus. Mild nausea (A) and hair growth (B) are less critical. Increased appetite (D) is unrelated.
Which phase of the immune response involves antibodies multiplying to target an antigen?
A. Recognition
B. Activation
C. Effector
D. Memory
Answer: B
Rationale: During the activation phase, antibodies divide and amplify their response against the antigen. Recognition (A) involves initial antigen identification, effector (C) involves antibody-mediated destruction, and memory (D) stores the response for future use.
What dietary teaching should a nurse provide to a patient on cyclosporine?
A. Avoid foods high in potassium.
B. Avoid foods high in sodium.
C. Avoid consuming grapefruit juice.
D. Avoid consuming dairy products.
Answer: C
Rationale: Grapefruit juice inhibits cyclosporine metabolism, increasing the risk of toxicity. Foods high in potassium (A) and sodium (B), or dairy products (D), are not contraindicated.
A patient on glucocorticoids reports joint pain and fatigue after discontinuing the medication. What is the nurse’s priority intervention?
A. Reassure the patient that these symptoms will resolve on their own.
B. Notify the healthcare provider about potential adrenal insufficiency.
C. Restart glucocorticoids at the original dose immediately.
D. Advise the patient to increase fluid intake.
Answer: B
Rationale: Joint pain and fatigue after glucocorticoid discontinuation may indicate adrenal insufficiency, which requires immediate medical evaluation. Symptoms do not resolve spontaneously (A), and restarting the medication without guidance (C) is inappropriate. Fluid intake (D) does not address adrenal insufficiency.
Which factor distinguishes natural immunity from acquired immunity?
A. Natural immunity is slower to develop but long-lasting.
B. Acquired immunity includes barriers like skin and mucous membranes.
C. Natural immunity is present at birth without prior antigen exposure.
D. Acquired immunity does not involve antibody production.
Answer: C
Rationale: Natural immunity is innate and present at birth, providing initial protection against pathogens without prior exposure. Acquired immunity (A, B, and D) develops after exposure to antigens and involves antibodies.
When administering glucocorticoids, what is the best practice to reduce adverse effects?
A. Administer the full dose every evening.
B. Use the lowest effective dose for the shortest duration.
C. Give high doses immediately to control symptoms rapidly.
D. Alternate dosing between high and low doses daily.
Answer: B
Rationale: To minimize side effects, glucocorticoids should be given at the lowest effective dose for the shortest possible duration. Evening administration (A), high doses (C), or alternating doses (D) are less safe or effective practices.
Which adverse effect should the nurse monitor for in a patient on long-term glucocorticoid therapy?
A. Hyperkalemia
B. Hypernatremia
C. Hypoglycemia
D. Hypercalcemia
Answer: B
Rationale: Glucocorticoids can cause hypernatremia due to fluid retention. They cause hypokalemia (A), hyperglycemia (not hypoglycemia; C), and hypocalcemia (not hypercalcemia; D).
The nurse is caring for a patient on tacrolimus who reports persistent headaches. What should the nurse do next?
A. Reassure the patient that headaches are a common side effect.
B. Notify the provider as this may indicate neurotoxicity.
C. Discontinue the medication immediately.
D. Suggest the patient take over-the-counter pain relievers.
Answer: B
Rationale: Persistent headaches may indicate neurotoxicity, a serious side effect of tacrolimus, and require provider notification. Simply reassuring the patient (A), discontinuing the drug without orders (C), or recommending OTC pain relievers (D) is unsafe.
Which teaching point is essential for a patient taking glucocorticoids for rheumatoid arthritis?
A. “You may stop taking this medication as soon as your symptoms improve.”
B. “Take the medication with food to prevent stomach upset.”
C. “This medication will strengthen your bones over time.”
D. “Glucocorticoids will cure your condition permanently.”
Answer: B
Rationale: Glucocorticoids can cause gastrointestinal upset and should be taken with food. Stopping abruptly (A) can cause adrenal insufficiency. They weaken bones (C) and manage, but do not cure, conditions (D).
What immune response is triggered when the body recognizes foreign tissue after a transplant?
A. Natural immunity
B. Autoimmune reaction
C. Allograft rejection
D. Hypersensitivity reaction
Answer: C
Rationale: Allograft rejection occurs when the immune system attacks foreign tissue from a donor. Natural immunity (A) involves innate defenses, autoimmune reactions (B) target self-tissues, and hypersensitivity reactions (D) are allergy-related.
Why is tapering glucocorticoids necessary when discontinuing therapy?
A. To avoid a rebound inflammatory response.
B. To minimize risk of adrenal insufficiency.
C. To prevent hyperglycemia.
D. To decrease the risk of infection.
Answer: B
Rationale: Tapering glucocorticoids allows the adrenal glands to resume normal cortisol production, reducing the risk of adrenal insufficiency. While tapering may also reduce rebound inflammation (A), hyperglycemia (C), or infection (D), adrenal insufficiency is the primary concern.
A patient on cyclosporine reports unusual bruising. What is the nurse’s next action?
A. Discontinue the medication immediately.
B. Assess platelet count and coagulation studies.
C. Encourage the patient to avoid strenuous activity.
D. Increase the cyclosporine dose to improve immunity.
Answer: B
Rationale: Unusual bruising may indicate a clotting issue or drug interaction. Platelet and coagulation studies can help identify the cause. Discontinuing the drug (A) or increasing the dose (D) without orders is inappropriate. Avoiding activity (C) does not address the underlying problem.
A nurse is educating a patient taking glucocorticoids about infection prevention. Which statement indicates effective teaching?
A. “I should avoid crowded places and people who are sick.”
B. “It’s safe to receive live vaccines while on this medication.”
C. “If I feel fine, I don’t need to report a fever to my provider.”
D. “I should stop the medication immediately if I develop an infection.”
Answer: A
Rationale: Immunosuppression from glucocorticoids increases infection risk, so avoiding crowds and sick individuals is essential. Live vaccines (B) are contraindicated. Fevers (C) should always be reported, and glucocorticoids (D) should not be stopped abruptly.
What is a major adverse effect of cyclosporine that the nurse should monitor for?
A. Hyperkalemia
B. Nephrotoxicity
C. Hypoglycemia
D. Osteoporosis
Answer: B
Rationale: Nephrotoxicity is a common adverse effect of cyclosporine, necessitating kidney function monitoring. It does not typically cause hyperkalemia (A), hypoglycemia (C), or osteoporosis (D).
A patient receiving tacrolimus develops hyperkalemia. What dietary advice should the nurse provide?
A. Increase intake of bananas and oranges.
B. Avoid potassium-rich foods such as spinach and avocados.
C. Reduce fluid intake to prevent overhydration.
D. Add salt substitutes to the diet.
Answer: B
Rationale: Hyperkalemia requires reducing potassium intake. Foods like bananas, oranges, spinach, and avocados should be limited. Salt substitutes (D) often contain potassium and should be avoided. Fluid intake (C) does not affect potassium levels significantly.
The nurse explains to a patient that major histocompatibility complex (MHC) plays what role in the immune response?
A. Recognizing self from non-self cells.
B. Producing antibodies to target pathogens.
C. Triggering the production of memory cells.
D. Enhancing phagocyte activity.
Answer: A
Rationale: MHC molecules are essential for distinguishing self from non-self cells, a fundamental component of immune regulation. Antibody production (B), memory cell formation (C), and phagocyte activity (D) are unrelated to MHC.
A patient taking glucocorticoids experiences insomnia. What is the best nursing recommendation?
A. Take the medication at bedtime.
B. Reduce the dose without consulting the provider.
C. Take the medication in the morning.
D. Use over-the-counter sleep aids.
Answer: C
Rationale: Taking glucocorticoids in the morning mimics the body’s natural cortisol rhythm, reducing insomnia. Taking it at bedtime (A) exacerbates insomnia. Dose changes (B) and sleep aids (D) require provider consultation.
Which symptom suggests that a patient taking glucocorticoids may have developed adrenal insufficiency?
A. Elevated blood pressure
B. Hyperglycemia
C. Generalized weakness and fatigue
D. Fluid retention
Answer: C
Rationale: Weakness and fatigue are key signs of adrenal insufficiency. Elevated blood pressure (A), hyperglycemia (B), and fluid retention (D) are side effects of glucocorticoid use but not related to insufficiency.
What advice should the nurse provide to a patient taking cyclosporine about food interactions?
A. “You can consume grapefruit juice in moderation.”
B. “Take cyclosporine with high-fat meals to improve absorption.”
C. “Avoid grapefruit juice, as it can increase drug levels.”
D. “Eat a diet low in protein to prevent kidney damage.”
Answer: C
Rationale: Grapefruit juice increases cyclosporine levels, risking toxicity. High-fat meals (B) do not improve absorption, and protein intake (D) does not directly affect nephrotoxicity.
Which phase of the immune response involves phagocytes engulfing pathogens?
A. Recognition
B. Activation
C. Effector
D. Memory
Answer: C
Rationale: During the effector phase, immune cells like phagocytes act to destroy pathogens. Recognition (A) identifies the antigen, activation (B) amplifies the response, and memory (D) retains information for future exposures.
A patient is prescribed glucocorticoids and NSAIDs concurrently. What risk does this combination pose?
A. Increased risk of peptic ulcers
B. Severe hypoglycemia
C. Excessive weight gain
D. Immunosuppression
Answer: A
Rationale: Both glucocorticoids and NSAIDs increase the risk of gastrointestinal ulcers. Hypoglycemia (B), weight gain (C), and immunosuppression (D) are unrelated to NSAID use.
The nurse is educating a patient about glucocorticoids. Which statement requires correction?
A. “I should take this medication with food to prevent stomach upset.”
B. “I may need calcium and vitamin D supplements to protect my bones.”
C. “This medication can help my body fight infections more effectively.”
D. “I should report unusual mood changes to my provider.”
Answer: C
Rationale: Glucocorticoids suppress the immune system and reduce the body’s ability to fight infections, so this statement is incorrect. Taking the medication with food (A), supplementing calcium (B), and reporting mood changes (D) are correct actions
A nurse is reviewing the pharmacokinetics of tacrolimus. Which factor increases the risk of toxicity?
A. Decreased hepatic function
B. High-protein diet
C. Increased renal clearance
D. High bioavailability
Answer: A
Rationale: Tacrolimus is metabolized in the liver; decreased hepatic function can lead to toxicity. Protein intake (B) and renal clearance (C) have minimal impact, and tacrolimus has a narrow therapeutic index rather than high bioavailability (D).
Which symptom in a patient taking glucocorticoids should prompt immediate provider notification?
A. Mild headache
B. Low-grade fever
C. Increased appetite
D. Weight gain of 1 pound
Answer: B
Rationale: A low-grade fever in a patient on glucocorticoids may indicate an infection, which can progress rapidly due to immunosuppression. Headaches (A), increased appetite (C), and minor weight gain (D) are less concerning.
What is the primary function of antibodies in the immune system?
A. Destroy antigens directly.
B. Activate cytotoxic T cells.
C. Bind to antigens for neutralization or destruction.
D. Stimulate memory cell formation.
Answer: C
Rationale: Antibodies bind to antigens, neutralizing or marking them for destruction by other immune components. They do not directly destroy antigens (A) or activate T cells (B), although they contribute to memory indirectly (D).
A patient with adrenal insufficiency presents with hypotension and fatigue. What is the nurse’s priority intervention?
A. Administering glucocorticoids as prescribed.
B. Providing fluids and electrolytes.
C. Monitoring blood glucose levels.
D. Assessing dietary intake.
Answer: A
Rationale: Administering glucocorticoids restores cortisol levels and addresses adrenal insufficiency. Fluids (B) and monitoring glucose (C) may be secondary, while dietary assessment (D) is less critical.
Which nursing action is appropriate for a patient taking cyclosporine?
A. Administering the drug intravenously without dilution.
B. Monitoring serum potassium and magnesium levels.
C. Giving the medication on an empty stomach.
D. Advising the patient to discontinue use if mild side effects occur.
Answer: B
Rationale: Cyclosporine can cause electrolyte imbalances, so potassium and magnesium levels should be monitored. It is often taken orally with food (A, C), and discontinuation (D) should only be under provider supervision.
