Unit5: Chapter 17 (Karch 7th Ed) - Immune Modulators

Question 1

1. 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.

Answer 1

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.

Question 2

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)

Answer 2

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.

Question 3

3. 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

Answer 3

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.

Question 4

4. 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

Answer 4

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.

Question 5

5. 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)

Answer 5

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

Question 6

6. 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.

Answer 6

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.

Question 7

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

Answer 7

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.

Question 8

8. 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

Answer 8

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.

Question 9

9. 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.

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

11. 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.

Answer 11

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.

Question 12

12. 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

Answer 12

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.

Question 13

13. 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

Answer 13

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.

Question 14

14. 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

Answer 14

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.

Question 15

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

Answer 15

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.

Question 16

16. 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

Answer 16

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.

Question 17

17. What monoclonal antibody is used to prevent respiratory syncytial virus (RSV) in high risk children?
A) Palivizumab
B) Natalizumab
C) Belimumab
D) Eculizumab

Answer 17

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.

Question 18

18. 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

Answer 18

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.

Question 19

19. 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.

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

21. 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)

Answer 21

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.

Question 22

22. 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)

Answer 22

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.

Question 23

23. 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

Answer 23

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.

Question 24

24. 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

Answer 24

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.

Question 25

25. A 72-year-old male patient has arrived at the outpatient unit to receive an infusion of alemtuzumab
    (Compath). The patient tells the nurse this is the second time his chronic lymphocytic leukemia has
    relapsed and the second time he will receive this drug because he failed alemtuzumab therapy after
    being treated with an alkylating agent. What is the priority nursing action?
    A) Calling the physician and questioning the order
    B) Washing your hands
    C) Beginning an intravenous infusion
    D) Canceling the infusion

Answer 25

Ans: A
Feedback:
Monoclonal antibodies should be used cautiously in patients who have had previous administration of
the monoclonal antibody (serious hypersensitivity reactions can occur with repeat administration). The
nursing priority would be to question the order because the patient has already received alemtuzumab
(Compath) previously and if the order is verified, this patient should be monitored very carefully,
perhaps starting to infuse more slowly until the patient’s reaction can be determined. Only after
questioning the order and having it verified would the nurse perform hand hygiene and begin the
infusion.

Question 26

26. The nurse is writing a plan of care for a patient receiving immune suppressants for leukemia. What
    would be an appropriate nursing diagnosis for this patient?
    A) Anxiety related to diagnosis and drug therapy
    B) Acute pain related to central nervous system (CNS), gastrointestinal (GI), and flu-like effects
    C) Risk for infection related to immune stimulation
    D) Imbalanced nutrition: More than body requirements

Answer 26

Ans: B
Feedback:
Nursing diagnoses related to drug therapy might include: Acute pain related to CNS, GI, and flu-like
effects. Anxiety related to diagnosis and drug therapy is a nursing diagnosis for a patient on an immune
stimulant. There is no risk for infection related to immune stimulation unless an adverse effect occurs.
Imbalanced nutrition would be less than body requirements due to flu-like symptoms resulting in
diminished appetite

Question 27

27. The nurse is preparing a patient to receive immunosuppressant drugs on an outpatient basis. What is the
    priority for the nurse to arrange for this patient in the home environment?
    A) A caregiver who is skilled in cardiopulmonary resuscitation (CPR)
    B) A caregiver who will provide adequate nutrition
    C) Supportive care and comfort measures
    D) Arrange for a home care nurse to administer injections

Answer 27

Ans: C
Feedback:
Arrange for supportive care and comfort measures for flu-like symptoms (rest, environmental control,
acetaminophen) to decrease patient discomfort and increase therapeutic compliance. Patients may also
need support and comfort measures related to diagnosis and drug therapy. Although knowledge of CPR
and providing appropriate nutrition are always positive actions, they are not related to administration of
immunosuppressants. The patient or caregiver can be taught to administer injections unless the
medication is to be given IV, in which case the patient would go to an infusion center.

Question 28

28. The nurse is caring for a patient who has a diagnosis of chronic hepatitis B infection and has been
    prescribed an immune stimulant. After teaching the patient about the treatment plan, how might the
    nurse evaluate the effectiveness of teaching?
    A) The patient can state where to go to get the medication.
    B) The patient can state who will administer the medication.
    C) The patient can state what positive effects to watch for.
    D) The patient can state specific measures to avoid adverse effects.

Answer 28

Ans: D
Feedback: The nurse would evaluate that the teaching plan was successful if the patient can name drug, dosage,
adverse effects to watch for, and specific measures to avoid adverse effects. Knowing where to get the
medication, who will administer it, and the positive effects to watch for would not be an adequate
assessment of the teaching plan.

Question 29

29. The patient underwent an allograft renal transplant 48 hours earlier and is showing signs of rejection.
    What drug would the nurse expect the physician to order?
    A) Muromonab
    B) Anakinra
    C) Mycophenolate
    D) Sirolimus

Answer 29

Ans: A
Feedback:
Muromonab is indicated for the treatment of acute allograft rejection in patients undergoing renal
transplantation. It also is indicated for the treatment of steroid-resistant acute allograft rejection in those
receiving heart or liver transplants. Anakinra, mycophenolate, and sirolimus are useful for preventing
renal or liver transplant rejection.

Question 30

30. The nurse, working with a nursing student, is caring for a patient who is to receive interleukins. The
    student nurse asks you what happens physiologically when a patient receives interleukins. What is the
    nurse’s best response?
    A) It really helps the patient!
    B) The patient has increases in the number of natural killer cells.
    C) The patient has decreased cytokine activity.
    D) The patient gets really sick from flu-like symptoms and then they get better.

Answer 30

Ans: B
Feedback:
When interleukins are administered, there are increases in the numbers of natural killer cells and
lymphocytes, in cytokine activity, and in the number of circulating platelets. Options A, C, and D are
incorrect.

Question 31

31. The nurse is caring for a child requiring cyclosporine to prevent rejection. Cyclosporine is given to
    adults using a dosage of 15 mg/kg. The nurse calculates the child’s dosage is 20 mg/kg. What is the
    nurse’s priority action?
    A) Administer the drug.
    B) Hold the dose and question the ordering provider.
    C) Complete an incident report if this dosage has already been given before.
    D) Notify the nursing supervisor of the medication error.

Answer 31

Ans: A
Feedback:
The nurse would administer the medication as ordered because doses larger than those given to adults
are often needed when cyclosporine is administered to children. This is not an error so the nurse would
not hold the drug, question the provider, complete an incident report, or notify the nursing supervisor.

Question 32

32. When caring for older adults receiving immune modulators, what are the nurse’s priorities of care?
    (Select all that apply.)
    A) Assess carefully for infection.
    B) Obtain baseline liver function studies and monitor follow-up studies.
    C) Determine dosage based on renal and liver function.
    D) Minimize teaching to avoid causing confusion.
    E) Encourage the family to visit often, especially young children.

Answer 32

Ans: A, B, C
Feedback:
Older patients may be more susceptible to the effects of the immune modulators, partly because the
aging immune system is less efficient and less responsive. These patients need to be monitored closely
for infection, GI, renal, hepatic, and central nervous system effects. Baseline renal and liver function
tests can help to determine whether a decreased dosage will be needed before beginning therapy.
Because these patients are more susceptible to infection, they need to receive extensive teaching, not
less teaching, about ways to avoid infection and injury. Contact with young children and large groups
of people increase the risk of infection.

Question 33

33. The nurse teaches the female patient receiving immune modulating drugs about the need to use barrier contraceptives. The patient says, I hate using barrier contraceptives. Why can’t I just take oral
    contraceptives? What is the nurse’s best response?
    A) Effects of oral contraceptives may be altered by liver changes or changes in immune response.
    B) Oral contraceptives increase the action of immune modulating drugs so dosage needs to be
    reduced.
    C) Immune modulators make oral contraceptives ineffective because of hormonal impact of drugs.
    D) Oral contraceptives are acceptable if barrier contraceptives are distasteful, but only high-estrogen
    pills can be used.

Answer 33

Ans: A
Feedback:
The use of barrier contraceptives is advised because the effects of oral contraceptives may be altered by
liver changes or by changes in the body’s immune response, potentially resulting in unexpected
pregnancy. The other options conflict with this information and are incorrect.

Question 34

34. The nurse is caring for a young adult woman taking immune modulating medications who has been
    advised to use barrier contraceptives but she wants to start her family. What information can the nurse
    provide about these drugs to help this patient with her decision-making?
    A) Discuss the desire to start a family with the provider so risk can be minimized.
    B) Immune modulating drugs will need to be discontinued if pregnancy occurs.
    C) Immune modulating drugs have been proven to be highly teratogenic.
    D) Pregnancy is not an option when taking immune modulating drugs but adoption is an option.

Answer 34

Ans: A
Feedback:
If a patient taking immune modulators becomes pregnant or decides that she wants to become pregnant,
she should discuss this with her health care provider and review the risks associated with use of the
drug or drugs being taken. Monoclonal antibodies should be used with caution during pregnancy and
lactation. Because results of long-term studies of most of these drugs are not yet available, it may be
prudent to advise patients taking these drugs to avoid pregnancy if possible. Immune modulating drugs
do not need to be discontinued, but the safest drug should be prescribed. Most immune modulating
drugs have not been studied and there is not enough information to know whether they are teratogenic.
The nurse cannot tell a patient that pregnancy is not an option.

Question 35

35. The nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant. What immunosuppressant could this patient be prescribed that would treat both
diagnoses?
A) Anakinra (Kineret)
B) Adalimumab (Humira)
C) Sirolimus (Rapamune)
D) Cyclosporine (Sandimmune)

Answer 35

Ans: A
Feedback:
Anakinra is used to prevent rejection after kidney or liver transplantation and also reduces signs and
symptoms of RA in patients who have had inadequate response to other drugs. Adalimumab would be
effective for the patient’s RA but would not prevent rejection of the transplanted liver. Sirolimus is
used to prevent rejection of kidney transplants but would not be effective for either of the patient’s
diagnoses. Cyclosporine would be appropriate to prevent liver rejection but would not treat RA.