Week 9: Pharmacology of the Immune System

Question 1

A patient is taking cyclosporine after a kidney transplant. Which lab value should the nurse monitor closely?
A) Hemoglobin levels
B) Serum potassium levels
C) Serum creatinine levels
D) Platelet count

Answer 1

Correct Answer: C) Serum creatinine levels
Rationale: Cyclosporine can cause nephrotoxicity, so monitoring serum creatinine levels is crucial to detect kidney impairment early.

Incorrect Answers:

A) Hemoglobin is not directly affected by cyclosporine.
B) Potassium levels are more relevant for hyperkalemia in tacrolimus therapy.
D) Platelet count is not a primary concern for cyclosporine therapy.

Question 2

Which is a key reason for tapering glucocorticoids instead of stopping them abruptly?
A) To prevent hypoglycemia
B) To prevent adrenal insufficiency
C) To avoid hypercalcemia
D) To reduce the risk of infection

Answer 2

Correct Answer: B) To prevent adrenal insufficiency
Rationale: Long-term glucocorticoid use suppresses adrenal gland activity. Abrupt discontinuation can lead to adrenal insufficiency, causing hypotension, fatigue, and hypoglycemia.
Incorrect Answers:

A) Hypoglycemia is not a major concern during glucocorticoid discontinuation.
C) Glucocorticoids cause hypocalcemia, not hypercalcemia.
D) Infection risk is related to immune suppression, not discontinuation.

Question 3

A patient on tacrolimus reports muscle weakness and fatigue. Which adverse effect is the most likely cause?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypoglycemia

Answer 3

Correct Answer: B) Hyperkalemia
Rationale: Tacrolimus can cause hyperkalemia due to its effects on kidney function, leading to electrolyte imbalances.
Incorrect Answers:

A) Hypokalemia is not a common side effect of tacrolimus.
C) Hyponatremia is not directly associated with tacrolimus use.
D) Tacrolimus does not typically cause hypoglycemia.

Question 4

A nurse is teaching a patient about the side effects of glucocorticoid therapy. Which of the following is the patient most at risk for?
A) Hypoglycemia
B) Osteoporosis
C) Weight loss
D) Hypotension

Answer 4

Correct Answer: B) Osteoporosis
Rationale: Long-term glucocorticoid therapy suppresses osteoblast activity, increases osteoclast activity, and reduces calcium absorption, leading to osteoporosis.
Incorrect Answers:

A) Glucocorticoids increase blood glucose, causing hyperglycemia, not hypoglycemia.
C) Weight gain is more likely due to fat redistribution.
D) Glucocorticoids can increase blood pressure through sodium and water retention.

Question 5

Which of the following is a major mechanism of action for cyclosporine?
A) Stimulates T-cell activation
B) Inhibits calcineurin
C) Blocks histamine release
D) Suppresses B-cell proliferation

Answer 5

Correct Answer: B) Inhibits calcineurin
Rationale: Cyclosporine inhibits calcineurin, preventing T-cell activation and reducing the immune response to prevent organ rejection.
Incorrect Answers:

A) Cyclosporine suppresses, not stimulates, T-cell activation.
C) Histamine release is not directly affected by cyclosporine.
D) The drug primarily affects T-cell activation rather than B-cell proliferation.

Question 6

A patient taking glucocorticoids reports stomach pain and dark stools. What condition should the nurse suspect?
A) Peptic ulcer disease
B) Pancreatitis
C) Hyperglycemia
D) Adrenal insufficiency

Answer 6

Correct Answer: A) Peptic ulcer disease
Rationale: Glucocorticoids inhibit prostaglandin production, reducing gastric mucosa protection and increasing the risk of ulcers and GI bleeding.
Incorrect Answers:

B) Pancreatitis is not a common side effect of glucocorticoids.
C) Hyperglycemia does not cause GI symptoms like dark stools.
D) Adrenal insufficiency presents differently, with fatigue and hypotension.

Question 7

Why are patients taking immunosuppressants at a higher risk for infections?
A) They cause high white blood cell counts.
B) They reduce the production of T and B cells.
C) They increase antibody production.
D) They prevent the development of memory cells.

Answer 7

Correct Answer: B) They reduce the production of T and B cells
Rationale: Immunosuppressants, like cyclosporine and tacrolimus, suppress T and B cell activity, weakening the immune response and increasing infection risk.
Incorrect Answers:

A) Immunosuppressants lower, not raise, white blood cell counts.
C) They do not increase antibody production; they suppress immune responses.
D) Memory cells are not directly affected by immunosuppressants.

Question 8

A patient taking cyclosporine should avoid which of the following beverages?
A) Milk
B) Coffee
C) Grapefruit juice
D) Green tea

Answer 8

Correct Answer: C) Grapefruit juice
Rationale: Grapefruit juice inhibits CYP3A4 enzymes, which metabolize cyclosporine. This can lead to increased drug levels and toxicity.
Incorrect Answers:

A) Milk does not interact with cyclosporine.
B) Coffee does not significantly affect cyclosporine levels.
D) Green tea is not known to interact with cyclosporine.

Question 9

Which of the following is a feature of specific acquired immunity?
A) Rapid response to any foreign antigen
B) Involves neutrophils and macrophages
C) Memory response upon re-exposure to the same antigen
D) Limited diversity of antigen recognition

Answer 9

Correct Answer: C) Memory response upon re-exposure to the same antigen
Rationale: Acquired immunity generates memory cells, allowing faster and stronger immune responses upon re-exposure to the same antigen.
Incorrect Answers:

A) Acquired immunity is not immediate; natural immunity is faster.
B) Neutrophils and macrophages are part of innate immunity.
D) Acquired immunity has high diversity in antigen recognition.

Question 10

What is the role of helper T cells (CD4+ cells) in the immune response?
A) Directly kill infected cells
B) Activate cytolytic T cells and B cells
C) Suppress antibody production
D) Engulf and destroy pathogens

Answer 10

Correct Answer: B) Activate cytolytic T cells and B cells
Rationale: Helper T cells play a central role in activating cytotoxic T cells (CD8+) and stimulating B cells to produce antibodies.
Incorrect Answers:

A) Cytotoxic T cells (CD8+) directly kill infected cells, not helper T cells.
C) Helper T cells stimulate, not suppress, antibody production.
D) Engulfing pathogens is the role of macrophages, not helper T cells.

Question 11

A patient is prescribed cyclosporine after a liver transplant. Which nursing intervention is most important to include in the care plan?
A) Encourage increased fluid intake to flush the medication.
B) Monitor liver function tests regularly.
C) Administer with meals to enhance absorption.
D) Educate the patient to avoid high-potassium foods.

Answer 11

Correct Answer: B) Monitor liver function tests regularly.
Rationale: Cyclosporine can cause hepatotoxicity, so monitoring liver enzymes (e.g., bilirubin) is essential to detect early signs of liver dysfunction.
Incorrect Answers:

A) Increased fluids are not required for cyclosporine use.
C) Food can reduce the bioavailability of cyclosporine and should be monitored carefully.
D) High potassium is more relevant for tacrolimus therapy, not cyclosporine.

Question 12

A nurse is preparing to administer tacrolimus to a patient. Which lab value requires the nurse to hold the medication and notify the provider?
A) Potassium level of 5.6 mmol/L
B) Hemoglobin of 12 g/dL
C) White blood cell count of 8,000/mm³
D) Blood glucose of 110 mg/dL

Answer 12

Correct Answer: A) Potassium level of 5.6 mmol/L
Rationale: Tacrolimus can cause hyperkalemia, and a potassium level of 5.6 mmol/L is elevated, requiring intervention.
Incorrect Answers:

B) Hemoglobin is normal.
C) White blood cell count is within the normal range.
D) Blood glucose is within the acceptable range.

Question 13

When educating a patient taking glucocorticoids for rheumatoid arthritis, the nurse should include which key teaching point?
A) Take the medication at bedtime for optimal effect.
B) Do not stop the medication abruptly.
C) Avoid foods high in calcium to prevent hypercalcemia.
D) Reduce physical activity to avoid joint strain.

Answer 13

Correct Answer: B) Do not stop the medication abruptly.
Rationale: Abrupt discontinuation of glucocorticoids can lead to adrenal insufficiency, so a tapering schedule is required.
Incorrect Answers:

A) Glucocorticoids should be taken in the morning to mimic natural cortisol secretion.
C) Patients should increase calcium intake to counteract osteoporosis risk.
D) Physical activity should be modified but not entirely avoided.

Question 14

A patient on immunosuppressive therapy develops a fever. What should the nurse do first?
A) Administer antipyretics as prescribed.
B) Notify the healthcare provider immediately.
C) Encourage increased fluid intake.
D) Document the temperature and recheck in 4 hours.

Answer 14

Correct Answer: B) Notify the healthcare provider immediately.
Rationale: Fever in a patient on immunosuppressants could indicate an infection due to immune suppression and requires immediate evaluation.
Incorrect Answers:

A) Fever should be investigated before giving antipyretics.
C) Fluids alone will not address the underlying cause of the fever.
D) Waiting could delay critical treatment for infection.

Question 15

A nurse is assessing a patient taking glucocorticoids long-term. Which finding is most concerning?
A) Glucose level of 140 mg/dL
B) Patient reports muscle weakness
C) Blood pressure of 150/90 mmHg
D) Unexplained weight gain

Answer 15

Correct Answer: D) Unexplained weight gain
Rationale: Unexplained weight gain may indicate fluid retention or Cushing’s syndrome, a serious adverse effect of long-term glucocorticoid use.
Incorrect Answers:

A) Mild hyperglycemia is expected with glucocorticoids.
B) Muscle weakness (myopathy) can occur but is less urgent.
C) Hypertension requires monitoring but is not immediately life-threatening

Question 16

A patient taking cyclosporine asks why grapefruit juice should be avoided. What is the nurse’s best response?
A) “It increases the risk of kidney damage.”
B) “It reduces the medication’s effectiveness.”
C) “It can cause dangerously high drug levels in your body.”
D) “It increases the risk of bleeding.”

Answer 16

Correct Answer: C) “It can cause dangerously high drug levels in your body.”
Rationale: Grapefruit juice inhibits CYP3A4 enzymes, slowing cyclosporine metabolism and increasing drug levels, which may lead to toxicity.
Incorrect Answers:

A) Grapefruit juice does not directly increase kidney damage.
B) It enhances, not reduces, drug levels.
D) Bleeding is not a known side effect of grapefruit juice with cyclosporine.

Question 17

Which of the following is the best indicator that tacrolimus therapy is effective in a liver transplant patient?
A) Serum creatinine levels are within normal limits.
B) Absence of jaundice or ascites.
C) Patient reports no pain at the surgical site.
D) White blood cell count is elevated.

Answer 17

Correct Answer: B) Absence of jaundice or ascites.
Rationale: Signs of liver rejection include jaundice and ascites. Their absence indicates the transplanted organ is functioning well.
Incorrect Answers:

A) Serum creatinine is related to kidney function, not liver function.
C) Pain at the surgical site is not directly related to organ rejection.
D) Elevated WBCs may indicate infection or inflammation.

Question 18

A nurse is teaching a patient about the adverse effects of glucocorticoids. Which condition should the patient report immediately?
A) Persistent fatigue
B) Sudden blurred vision
C) Mild headache
D) Increased appetite

Answer 18

Correct Answer: B) Sudden blurred vision
Rationale: Blurred vision can indicate cataracts or glaucoma, serious adverse effects of glucocorticoids, requiring prompt evaluation.
Incorrect Answers:

A) Fatigue is a common side effect but less urgent.
C) Headache is less concerning unless severe or persistent.
D) Increased appetite is expected and not an emergency.

Question 19

A patient taking tacrolimus reports tremors and difficulty sleeping. What is the most likely cause?
A) Neurotoxicity
B) Nephrotoxicity
C) Hepatotoxicity
D) Hyperkalemia

Answer 19

Correct Answer: A) Neurotoxicity
Rationale: Tacrolimus can cause neurotoxicity, leading to symptoms such as tremors, headaches, and insomnia.
Incorrect Answers:

B) Nephrotoxicity affects kidney function but does not cause tremors or insomnia.
C) Hepatotoxicity primarily affects liver enzymes and does not cause these symptoms.
D) Hyperkalemia does not typically cause tremors or insomnia.

Question 20

Which statement by a patient taking glucocorticoids indicates a need for further teaching?
A) “I will take this medication with food.”
B) “I can stop the medication as soon as I feel better.”
C) “I will report any signs of infection immediately.”
D) “I will monitor my blood sugar regularly.”

Answer 20

Correct Answer: B) “I can stop the medication as soon as I feel better.”
Rationale: Glucocorticoids should never be stopped abruptly due to the risk of adrenal insufficiency. They must be tapered off gradually under medical supervision.
Incorrect Answers:

A, C, and D are all appropriate patient actions while taking glucocorticoids.

Question 21

A nurse is administering cyclosporine to a patient post-kidney transplant. Which medication should be avoided due to increased risk of nephrotoxicity?
A) Acetaminophen
B) Ibuprofen
C) Metformin
D) Lisinopril

Answer 21

Correct Answer: B) Ibuprofen
Rationale: Ibuprofen is a nephrotoxic NSAID that increases the risk of kidney damage when combined with cyclosporine.
Incorrect Answers:

A) Acetaminophen is not nephrotoxic in therapeutic doses.
C) Metformin affects glucose metabolism, not kidneys directly.
D) Lisinopril can affect kidney function, but NSAIDs are more directly nephrotoxic.

Question 22

What is the primary reason tacrolimus is prescribed over cyclosporine in organ transplant patients?
A) It has fewer side effects.
B) It is more effective at preventing rejection.
C) It does not require monitoring of trough levels.
D) It can be administered without food restrictions.

Answer 22

Correct Answer: B) It is more effective at preventing rejection.
Rationale: Tacrolimus is more effective at preventing organ rejection than cyclosporine, though it has a higher toxicity risk.
Incorrect Answers:

A) Tacrolimus has more, not fewer, side effects.
C) Trough levels still need monitoring.
D) Food restrictions are similar for both drugs.

Question 23

A patient taking glucocorticoids reports severe abdominal pain and black stools. What complication does the nurse suspect?
A) Pancreatitis
B) Peptic ulcer disease
C) Cushing’s syndrome
D) Intestinal obstruction

Answer 23

Correct Answer: B) Peptic ulcer disease
Rationale: Glucocorticoids increase gastric acid secretion and reduce mucosal protection, leading to a high risk of peptic ulcer disease.
Incorrect Answers:

A) Pancreatitis is not common with glucocorticoids.
C) Black stools are not a symptom of Cushing’s syndrome.
D) Intestinal obstruction does not present with black stools.

Question 24

A patient is being educated about avoiding live vaccines while on immunosuppressants. Which vaccine should they avoid?
A) Influenza (inactivated)
B) Hepatitis B
C) MMR
D) COVID-19 mRNA

Answer 24

Correct Answer: C) MMR
Rationale: The MMR vaccine is live-attenuated and contraindicated in immunosuppressed patients due to the risk of infection.
Incorrect Answers:

A, B, and D are non-live vaccines and are generally safe for immunosuppressed patients.

Question 25

A nurse is administering tacrolimus to a patient. Which nursing action is most important?
A) Administer on an empty stomach.
B) Check blood glucose levels.
C) Monitor for signs of weight loss.
D) Administer with grapefruit juice to enhance absorption.

Answer 25

Correct Answer: A) Administer on an empty stomach.
Rationale: Food can affect the absorption of tacrolimus, so it is typically given on an empty stomach for consistent drug levels.
Incorrect Answers:

B) Blood glucose monitoring is important but not directly tied to administration.
C) Weight loss is not a key monitoring point for tacrolimus.
D) Grapefruit juice should be avoided as it increases drug levels and toxicity.

Question 26

A patient on glucocorticoids develops facial swelling, central obesity, and thin limbs. What condition does the nurse suspect?
A) Adrenal insufficiency
B) Iatrogenic Cushing’s syndrome
C) Addison’s disease
D) Hyperthyroidism

Answer 26

Correct Answer: B) Iatrogenic Cushing’s syndrome
Rationale: Long-term glucocorticoid use can cause symptoms of Cushing’s syndrome, including fat redistribution and muscle wasting.
Incorrect Answers:

A) Adrenal insufficiency involves fatigue and low cortisol levels.
C) Addison’s disease is characterized by cortisol deficiency, not excess.
D) Hyperthyroidism does not cause these symptoms.

Question 27

A nurse is teaching a patient about the adverse effects of cyclosporine. Which statement indicates the patient understands the teaching?
A) “I should report any signs of bleeding immediately.”
B) “I should monitor my blood pressure regularly.”
C) “I need to avoid foods rich in calcium.”
D) “I will monitor for signs of hyperglycemia.”

Answer 27

Correct Answer: B) “I should monitor my blood pressure regularly.”
Rationale: Cyclosporine can cause hypertension as a side effect, so regular monitoring is essential.
Incorrect Answers:

A) Bleeding is not a primary concern with cyclosporine.
C) Calcium is not directly affected by cyclosporine.
D) Hyperglycemia is more associated with glucocorticoids.

Question 28

Which of the following instructions is most important for a patient taking glucocorticoids long-term?
A) “Avoid taking calcium supplements.”
B) “Take your medication in the evening.”
C) “Increase your intake of potassium-rich foods.”
D) “Monitor for signs of infection closely.”

Answer 28

Correct Answer: D) “Monitor for signs of infection closely.”
Rationale: Glucocorticoids suppress the immune system, increasing the risk of infection. Patients must be vigilant about early signs of infection.
Incorrect Answers:

A) Calcium supplements should be encouraged to prevent osteoporosis.
B) Glucocorticoids should be taken in the morning.
C) Potassium management is not a primary concern.

Question 29

A patient taking cyclosporine reports dark urine and jaundice. What is the most likely cause?
A) Nephrotoxicity
B) Hepatotoxicity
C) Neurotoxicity
D) Hyperkalemia

Answer 29

Correct Answer: B) Hepatotoxicity
Rationale: Cyclosporine can cause liver damage, leading to signs like dark urine and jaundice.
Incorrect Answers:

A) Nephrotoxicity affects kidney function but does not cause jaundice.
C) Neurotoxicity involves symptoms like tremors or insomnia.
D) Hyperkalemia affects potassium levels but does not cause jaundice.

Question 30

A patient on tacrolimus develops gum overgrowth. What adverse effect is this known as?
A) Gingival hyperplasia
B) Glossitis
C) Periodontitis
D) Gingivitis

Answer 30

Correct Answer: A) Gingival hyperplasia
Rationale: Gingival hyperplasia (overgrowth of gum tissue) is a known side effect of tacrolimus.
Incorrect Answers:

B) Glossitis refers to inflammation of the tongue.
C) Periodontitis is gum disease but does not involve tissue overgrowth.
D) Gingivitis is gum inflammation, not overgrowth.

Question 31

A patient taking glucocorticoids reports new-onset insomnia and mood swings. What should the nurse consider as the cause?
A) Normal side effects of the medication
B) Signs of adrenal insufficiency
C) Symptoms of withdrawal
D) Unrelated to glucocorticoid therapy

Answer 31

Correct Answer: A) Normal side effects of the medication
Rationale: Insomnia and mood swings, including anxiety or euphoria, are common side effects of glucocorticoids, especially at higher doses.
Incorrect Answers:

B) Adrenal insufficiency would present with fatigue, hypotension, and hypoglycemia.
C) Symptoms of withdrawal occur with abrupt discontinuation.
D) These are directly related to glucocorticoid use.

Question 32

Which assessment finding would require the nurse to contact the provider for a patient taking tacrolimus?
A) Mild hand tremors
B) Blood pressure of 150/88 mmHg
C) Creatinine of 2.5 mg/dL
D) Fasting blood glucose of 105 mg/dL

Answer 32

Correct Answer: C) Creatinine of 2.5 mg/dL
Rationale: A creatinine level of 2.5 mg/dL is significantly elevated, suggesting nephrotoxicity, a known adverse effect of tacrolimus.
Incorrect Answers:

A) Mild tremors are a common side effect and not an emergency.
B) Elevated blood pressure is expected but not critical.
D) A fasting glucose of 105 mg/dL is slightly elevated but not alarming.

Question 33

A patient on cyclosporine asks why frequent blood draws are necessary. What is the best response by the nurse?
A) “To check for liver damage.”
B) “To ensure your immune system is fully suppressed.”
C) “To monitor the drug levels and prevent toxicity.”
D) “To assess for infection markers.”

Answer 33

Correct Answer: C) “To monitor the drug levels and prevent toxicity.”
Rationale: Cyclosporine has a narrow therapeutic index, so regular monitoring of blood levels is essential to avoid toxicity or subtherapeutic levels.
Incorrect Answers:

A) Liver damage monitoring is important but not the primary reason for blood draws.
B) The goal is effective immune suppression, not complete suppression.
D) Infection markers are monitored separately from drug levels

Question 34

A nurse is teaching a patient about tapering off glucocorticoids. What symptom should the patient report immediately?
A) Increased appetite
B) Joint pain
C) Fatigue and dizziness
D) Mild muscle cramps

Answer 34

Correct Answer: C) Fatigue and dizziness
Rationale: Fatigue and dizziness can indicate adrenal insufficiency during glucocorticoid tapering and should be addressed promptly.
Incorrect Answers:

A) Increased appetite is not a sign of withdrawal or adrenal insufficiency.
B) Joint pain may occur but is less critical.
D) Mild muscle cramps are not indicative of serious complications

Question 35

A patient on tacrolimus therapy develops persistent nausea and diarrhea. What is the priority nursing action?
A) Administer antiemetics as prescribed.
B) Monitor electrolyte levels and hydration status.
C) Document the findings and notify the provider during rounds.
D) Instruct the patient to avoid solid foods until symptoms resolve.

Answer 35

Correct Answer: B) Monitor electrolyte levels and hydration status.
Rationale: Tacrolimus can cause gastrointestinal symptoms, leading to dehydration and electrolyte imbalances, which must be monitored closely.
Incorrect Answers:

A) Antiemetics may alleviate symptoms but do not address the root cause.
C) Immediate action is required, not just documentation.
D) Adjusting diet does not directly resolve dehydration or electrolyte loss.

Question 36

A nurse is administering glucocorticoids to a patient with rheumatoid arthritis. Which lab result is most concerning?
A) Blood glucose of 160 mg/dL
B) Serum calcium of 8.0 mg/dL
C) Hemoglobin of 11 g/dL
D) White blood cell count of 10,000/mm³

Answer 36

Correct Answer: B) Serum calcium of 8.0 mg/dL
Rationale: Glucocorticoids can reduce calcium absorption, leading to hypocalcemia, which increases the risk for osteoporosis.
Incorrect Answers:

A) Mild hyperglycemia is expected.
C) Hemoglobin of 11 g/dL is slightly low but not critical.
D) A WBC count of 10,000/mm³ is within normal limits.

Question 37

A patient on cyclosporine reports swollen gums. How should the nurse respond?
A) “This is a serious side effect, and you should stop the medication.”
B) “This is a common side effect; maintain good oral hygiene.”
C) “Reduce your dose until the swelling subsides.”
D) “You may need to switch to a different immunosuppressant.”

Answer 37

Correct Answer: B) “This is a common side effect; maintain good oral hygiene.”
Rationale: Gingival hyperplasia is a common side effect of cyclosporine. Regular oral care can help manage the condition.
Incorrect Answers:

A) Stopping the medication abruptly is not advised.
C) Dose adjustments require provider approval.
D) Changing the medication is not the first intervention.

Question 38

A nurse is teaching a patient about the dietary restrictions while on tacrolimus. Which statement by the patient indicates a need for further teaching?
A) “I will avoid grapefruit juice.”
B) “I should eat high-potassium foods.”
C) “I will eat small, frequent meals to avoid nausea.”
D) “I will avoid alcohol to prevent liver damage.”

Answer 38

Correct Answer: B) “I should eat high-potassium foods.”
Rationale: Tacrolimus can cause hyperkalemia, so high-potassium foods should be avoided.
Incorrect Answers:

A, C, and D are correct dietary recommendations for patients on tacrolimus.

Question 39

A patient receiving glucocorticoid therapy is at risk for delayed wound healing. What is the underlying cause?
A) Increased blood sugar levels
B) Decreased inflammatory response
C) Reduced protein synthesis
D) Fluid and electrolyte imbalances

Answer 39

Correct Answer: B) Decreased inflammatory response
Rationale: Glucocorticoids suppress the immune and inflammatory responses, which are essential for proper wound healing.
Incorrect Answers:

A) While glucocorticoids increase blood sugar, it is not the primary cause of delayed wound healing.
C) Reduced protein synthesis contributes but is secondary.
D) Fluid and electrolyte imbalances are unrelated to wound healing delays.

Question 40

A nurse is reviewing the medications of a patient taking cyclosporine. Which medication raises concern?
A) Atorvastatin
B) Acetaminophen
C) Fluconazole
D) Furosemide

Answer 40

Correct Answer: C) Fluconazole
Rationale: Fluconazole inhibits CYP3A4, increasing cyclosporine levels and the risk of toxicity.
Incorrect Answers:

A) Atorvastatin does not significantly affect cyclosporine levels.
B) Acetaminophen is safe in therapeutic doses.
D) Furosemide does not interact with cyclosporine.

Question 41

What is the primary adverse effect of cyclosporine on the kidneys?

Answer 41

Nephrotoxicity

Rationale:
Cyclosporine can impair kidney function, making nephrotoxicity one of its most critical adverse effects.

Question 42

What lab test is used to monitor long-term use of glucocorticoids for potential bone complications?

Answer 42

Answer:
Bone mineral density

Rationale:
Long-term glucocorticoid use increases the risk of osteoporosis, so bone density tests help monitor for bone loss.

Question 43

Question:
What is the mechanism of action of cyclosporine?

Answer 43

Answer:
Inhibits calcineurin

Rationale:
Cyclosporine binds to cyclophilin and inhibits calcineurin, suppressing T-cell activation.

Question 44

What electrolyte imbalance is commonly associated with tacrolimus therapy?

Answer 44

Answer:
Hyperkalemia

Rationale:
Tacrolimus can increase potassium levels, leading to hyperkalemia.

Question 45

Which immune cell produces antibodies?

Answer 45

Answer:
B cells

Rationale:
B cells are responsible for humoral immunity by producing antibodies specific to antigens.

Question 46

What is the primary risk of administering live vaccines to a patient on immunosuppressants?

Answer 46

Answer:
Infection

Rationale:
Immunosuppressants weaken the immune system, making live vaccines dangerous due to the risk of developing the disease.

Question 47

What is the therapeutic use of glucocorticoids in premature infants?

Answer 47

Answer:
Treat acute respiratory distress syndrome (ARDS)

Rationale:
Glucocorticoids are used to enhance lung development and reduce inflammation in premature infants with ARDS.

Question 48

What is the main teaching point regarding food and cyclosporine?

Answer 48

Answer:
Avoid grapefruit juice

Rationale:
Grapefruit juice inhibits CYP3A4, leading to increased cyclosporine levels and potential toxicity.

Question 49

What condition must glucocorticoids be tapered to avoid?

Answer 49

Answer:
Adrenal insufficiency

Rationale:
Abrupt discontinuation of glucocorticoids suppresses adrenal gland activity, leading to adrenal insufficiency.

Question 50

Which lab value indicates nephrotoxicity in a patient taking tacrolimus?

Answer 50

Answer:
Elevated creatinine

Rationale:
Increased serum creatinine levels indicate impaired kidney function, a common adverse effect of tacrolimus.

Question 51

What is the primary therapeutic use of tacrolimus?

Answer 51

Answer:
Prevent organ rejection

Rationale:
Tacrolimus is an immunosuppressant primarily used to prevent organ rejection in transplant patients.

Question 52

What enzyme is inhibited by glucocorticoids to reduce inflammation?

Answer 52

Answer:
Phospholipase A2

Rationale:
Glucocorticoids inhibit phospholipase A2, reducing the production of inflammatory mediators like prostaglandins and leukotrienes.

Question 53

Which immune cell is targeted by cyclosporine to suppress the immune response?

Answer 53

Answer:
T cells

Rationale:
Cyclosporine suppresses T-cell activation by inhibiting the production of interleukin-2 (IL-2).

Question 54

What adverse effect of glucocorticoids can cause elevated blood sugar levels?

Answer 54

Answer:
Hyperglycemia

Rationale:
Glucocorticoids increase gluconeogenesis and insulin resistance, leading to hyperglycemia.

Question 55

What electrolyte imbalance should be monitored in patients taking glucocorticoids?

Answer 55

Answer:
Hypokalemia

Rationale:
Glucocorticoids can cause potassium excretion, leading to hypokalemia.

Question 56

What is a common dermatologic side effect of tacrolimus?

Answer 56

Answer:
Hirsutism

Rationale:
Tacrolimus can cause abnormal hair growth, known as hirsutism, particularly in women.

Question 57

What is the main contraindication for live vaccines in immunosuppressed patients?

Answer 57

Answer:
Immunosuppression

Rationale:
Live vaccines can cause infection in immunosuppressed patients because their immune system cannot adequately control the attenuated pathogen.

Question 58

Which lab value should be monitored to assess liver function in patients taking cyclosporine?

Answer 58

Answer:
Bilirubin

Rationale:
Elevated bilirubin levels may indicate hepatotoxicity, a potential adverse effect of cyclosporine.

Question 59

What condition is a patient at risk for if glucocorticoids are abruptly discontinued?

Answer 59

Answer:
Adrenal crisis

Rationale:
Abrupt glucocorticoid discontinuation can cause adrenal crisis due to suppressed endogenous cortisol production.

Question 60

What mechanism of action allows glucocorticoids to reduce swelling and redness?

Answer 60

Answer:
Inhibit prostaglandins

Rationale:
Glucocorticoids suppress prostaglandins, reducing vasodilation and capillary permeability, which decreases swelling and redness.

Question 61

Which of the following best describes the role of B cells (B lymphocytes) in the immune system?
A. They directly attack and kill infected cells.
B. They produce antibodies that are essential for humoral immunity.
C. They activate cytolytic T cells.
D. They mediate delayed hypersensitivity reactions.

Answer 61

Answer: B. They produce antibodies that are essential for humoral immunity.
Rationale:

B (Correct): B cells are responsible for producing antibodies, which are crucial for humoral immunity.
A (Incorrect): Directly attacking infected cells is the role of cytolytic T cells (CD8 cells).
C (Incorrect): Activating cytolytic T cells is a function of helper T cells (CD4 cells).
D (Incorrect): Delayed hypersensitivity reactions are mediated by helper T cells, not B cells.

Question 62

What is the primary function of cytolytic T cells (CD8 cells)?
A. To produce antibodies.
B. To directly attack and kill target cells.
C. To activate B cells.
D. To assist in delayed hypersensitivity reactions.

Answer 62

Answer: B. To directly attack and kill target cells.
Rationale:

B (Correct): Cytolytic T cells (CD8 cells) are responsible for directly attacking and killing infected or abnormal cells (e.g., virus-infected or cancer cells).
A (Incorrect): Producing antibodies is the role of B cells, not cytolytic T cells.
C (Incorrect): Activation of B cells is the role of helper T cells (CD4 cells).
D (Incorrect): Delayed hypersensitivity reactions are mediated by helper T cells, not cytolytic T cells.

Question 63

Helper T cells (CD4 cells) play a critical role in the immune system by:
A. Directly killing virus-infected cells.
B. Helping B cells produce antibodies.
C. Inhibiting cytolytic T cells.
D. Blocking delayed hypersensitivity reactions.

Answer 63

Answer: B. Helping B cells produce antibodies.
Rationale:

B (Correct): Helper T cells (CD4 cells) assist B cells in producing antibodies as part of humoral immunity.
A (Incorrect): Directly killing infected cells is the function of cytolytic T cells (CD8 cells), not helper T cells.
C (Incorrect): Helper T cells activate, not inhibit, cytolytic T cells.
D (Incorrect): Helper T cells facilitate, not block, delayed hypersensitivity reactions.

Question 64

The specificity of B cells and cytolytic T cells depends on:
A. The presence of helper T cells.
B. Antigens and receptors on their cell surfaces.
C. The number of antibodies they produce.
D. The activation of macrophages.

Answer 64

Answer: B. Antigens and receptors on their cell surfaces.
Rationale:

B (Correct): The specificity of B cells and cytolytic T cells is determined by the interaction between antigens and the receptors on their surfaces.
A (Incorrect): While helper T cells play a supportive role, specificity is determined by antigens and cell receptors.
C (Incorrect): Specificity is unrelated to the number of antibodies produced.
D (Incorrect): Macrophages are involved in phagocytosis and antigen presentation but do not determine B cell or T cell specificity.

Question 65

Which of the following functions is unique to helper T cells (CD4 cells)?
A. Producing antibodies to fight infections.
B. Directly attacking and killing infected cells.
C. Assisting with antibody production, activating cytolytic T cells, and mediating delayed hypersensitivity reactions.
D. Blocking antigens from attaching to target cells.

Answer 65

Answer: C. Assisting with antibody production, activating cytolytic T cells, and mediating delayed hypersensitivity reactions.
Rationale:

C (Correct): Helper T cells (CD4 cells) perform multiple functions: they help B cells produce antibodies, activate cytolytic T cells, and mediate delayed hypersensitivity reactions.
A (Incorrect): Producing antibodies is the role of B cells, not helper T cells.
B (Incorrect): Directly killing infected cells is the job of cytolytic T cells (CD8 cells).
D (Incorrect): Blocking antigens is not a primary function of helper T cells.

Question 66

What are the two primary functions of Glucocorticoid drugs?

Answer 66

Glucocorticoid drugs have two primary functions:​

Physiologic – low dose: maintain normal physiology (Normal level of glucocorticode In body)​

Pharmacologic - high-dose: suppress inflammation, cancers, immune response ​

Question 67

Question: A nurse is educating a patient who is prescribed glucocorticoids for chronic inflammation. Which of the following actions describes the mechanism by which glucocorticoids reduce inflammation in the body?

A) Glucocorticoids activate the transcription of pro-inflammatory genes and increase cytokine production.
B) Glucocorticoids bind to receptors in the cytoplasm, form a complex, and alter gene activity to decrease the production of anti-inflammatory proteins.
C) The glucocorticoid-receptor complex binds to chromatin on DNA to increase the production of anti-inflammatory proteins like lipocortin-1, inhibiting phospholipase A-2.
D) Glucocorticoids inhibit the transcription of pro-inflammatory genes but do not affect immune response or inflammation.

Answer 67

Answer: C) The glucocorticoid-receptor complex binds to chromatin on DNA to increase the production of anti-inflammatory proteins like lipocortin-1, inhibiting phospholipase A-2.

Rationales:

A) Incorrect: Glucocorticoids do not activate the transcription of pro-inflammatory genes. Instead, they decrease the transcription of pro-inflammatory genes and reduce the production of pro-inflammatory molecules like cytokines.

B) Incorrect: Glucocorticoids bind to receptors in the cytoplasm, but they activate the transcription of anti-inflammatory genes, not pro-inflammatory ones. The correct mechanism is a reduction in pro-inflammatory responses, not an increase in them.

C) Correct: Glucocorticoids form a receptor-glucocorticoid complex that moves to the nucleus and binds to chromatin on DNA. This action increases the transcription of anti-inflammatory genes, such as lipocortin-1, which inhibits phospholipase A-2, leading to a decrease in arachidonic acid and prostaglandin production.

D) Incorrect: Glucocorticoids do inhibit the transcription of pro-inflammatory genes, but they also decrease the immune response by inhibiting the activation of T cells, thus reducing both the immune and inflammatory responses.