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NURSING 6005 CHAPTER 69: IMMUNOSUPPRESSANTS Test Bank
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NURSING 6005 CHAPTER 69: IMMUNOSUPPRESSANTSTest Bank
MULTIPLE CHOICE
1. A patient has undergone liver transplantation. The provider orders cyclosporine
(Sandimmune), prednisone, and sirolimus (Rapamune). What will the nurse do?
a. Question the order for sirolimus.
b. Request an order for a serum glucose level.
c. Request an order for a macrolide antibiotic.
d. Suggest changing the cyclosporine to tacrolimus.
ANS: A
Sirolimus is given to prevent rejection in renal transplantation; it has no proof of efficacy in
patients with heart, lung, or liver transplants. A serum glucose level is not indicated; patients
taking repaglinide for diabetes should be monitored closely while taking cyclosporine.
Although antibiotic prophylaxis may be necessary, macrolide antibiotics increase the level of
cyclosporine. Tacrolimus is more toxic than cyclosporine.
DIF: Cognitive Level: Application
REF: Calcineurin Inhibitors | Cyclosporine | Therapeutic Uses | Adverse Effects | Drug and Food
Interactions | Tacrolimus | Sirolimus | Actions and Therapeutic Use
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A patient with a liver transplant has been receiving cyclosporine (Sandimmune) for 6 months.
The nurse reviews this patient’s laboratory results and notes a sharp increase in the blood urea
nitrogen (BUN) and serum creatinine. Vital signs are normal, and the patient reports no
discomfort. What does the nurse suspect?
a. Hepatotoxicity
b. Infection
c. Organ rejection
d. Nephrotoxicity
ANS: D
An elevation of BUN and serum creatinine is an indication of nephrotoxicity, which occurs in
75% of patients taking cyclosporine. Hepatotoxicity would cause elevations in liver enzymes,
not the BUN and creatinine. Infection would be associated with fever. Organ rejection of a
renal transplant would cause elevation in the BUN and creatinine but also would cause
tenderness at the graft site and fever.
DIF: Cognitive Level: Application
REF: Cyclosporine | Adverse Effects | Nephrotoxicity | Summary of Major Nursing Implications |
Cyclosporine | Evaluating Therapeutic Effects | Minimizing Adverse Effects | Nephrotoxicity
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A nurse provides teaching to a patient who has undergone kidney transplantation and will
begin taking cyclosporine (Sandimmune), a glucocorticoid, and sirolimus (Rapamune). Which
statement by the patient indicates understanding of the teaching?
, a. “I should take sirolimus at the same time as the cyclosporine.”
b. “I will need to have my blood sugar checked regularly.”
c. “I will need to take an antibiotic to prevent lung infections.”
d. “Taking this combination of drugs lowers my risk of kidney damage.”
ANS: C
Immunosuppressant drugs increase the risk of infections, especially the BK virus, which can
cause renal damage, and other organisms that cause lung infections. Patients taking these
drugs must take antibiotics for the first 12 months to help prevent infection. Sirolimus and
cyclosporine should be taken 4 hours apart. Patients with diabetes may have trouble with
glucose tolerance and require monitoring. Taking cyclosporine and sirolimus increases the
risk of renal damage.
DIF: Cognitive Level: Application
REF: Cyclosporine | Therapeutic Uses | Adverse Effects | Drug and Food Interactions | Sirolimus |
Adverse Effects | Drug and Food Interactions | Preparations, Dosage, and Administration
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
4. A patient with a history of lung transplantation is admitted for treatment for a respiratory
infection. The patient has been taking cyclosporine (Sandimmune), prednisone, and
azathioprine (Imuran) for 8 months. The provider has ordered azithromycin (Zithromax) to
treat the infection and acetaminophen (Tylenol) as needed for fever. The nurse will contact the
provider to:
a. ask whether a different antibiotic can be used.
b. ask that the prednisone be discontinued until the infection clears.
c. suggest increasing the dose of cyclosporine.
d. suggest using ibuprofen instead of acetaminophen.
ANS: A
Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to
increased levels of the drug. This patient needs either a reduced dose of cyclosporine or a
different antibiotic. There is no indication for discontinuing the prednisone during treatment.
The dose of cyclosporine would need to be reduced, because azithromycin leads to increased
drug levels. There is no contraindication to using acetaminophen.
DIF: Cognitive Level: Application
REF: Cyclosporine | Therapeutic Uses | Adverse Effects | Drug and Food Interactions | Azathioprine |
Adverse Effects and Drug Interactions
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A patient is taking cyclosporine (Sandimmune) and prednisone to prevent organ rejection
after right renal transplantation. The patient is febrile and complains of right-sided flank pain.
The nurse reviews the patient’s chart and finds that the patient’s BUN and serum creatinine
are elevated. The cyclosporine trough is 150 ng/mL. What will the nurse do?
a. Be concerned that the left kidney is failing.
b. Expect the provider to order intravenous methylprednisolone.
c. Request an order for a urine culture.
d. Suspect nephrotoxicity secondary to an elevated cyclosporine level.
ANS: B
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