immune modulators
Q1. A patient is starting interferon alfa-2b therapy. Which baseline lab is most important before treatment?
A. Thyroid function
B. CBC with differential
C. Lipid panel
D. Hemoglobin A1C
Answer: B
Rationale: Interferons affect bone marrow; monitoring CBC ensures early detection of bone marrow suppression.
. Bevacizumab is best identified as which type of drug?
A. Colony-stimulating factor
B. Interleukin
C. Monoclonal antibody
D. Interferon
Answer: C
Rationale: The suffix “-mab” identifies monoclonal antibodies.
. Which drug requires liver function monitoring during therapy?
A. Aldesleukin
B. Filgrastim
C. Rituximab
D. Tacrolimus
Answer: D
Rationale: Tacrolimus is hepatotoxic and requires liver function testing.
Q2. A nurse is caring for a patient on aldesleukin. Which assessment finding is most concerning?
A. Mild nausea
B. Elevated creatinine
C. Fatigue
D. Decreased appetite
Answer: B
Rationale: Aldesleukin can cause renal, cardiac, and hepatic toxicity; elevated creatinine suggests renal impairment.
A nurse should withhold mycophenolate if which lab value is abnormal?
A. ALT/AST
B. Hemoglobin
C. Creatinine
D. Sodium
Answer: C
Rationale: Immune suppressants require renal monitoring; elevated creatinine indicates renal dysfunction.
Which is the nurse’s PRIORITY in a patient receiving cyclosporine?
A. Monitor for infection
B. Prevent constipation
C. Encourage exercise
D. Assess skin integrity
Answer: A
Rationale: Cyclosporine suppresses immune function; infection prevention is priority.
. A patient on filgrastim reports bone pain. What is the best nursing action?
A. Hold the next dose
B. Report as expected effect
C. Administer PRN acetaminophen
D. Increase IV fluids
Answer: C
Rationale: Bone pain is common with colony-stimulating factors; managed symptomatically, not by discontinuing therapy.
Which teaching is MOST important for a patient taking tacrolimus at home?
A. Report fever immediately
B. Avoid eating cheese
C. Increase fluid intake
D. Take only at bedtime
Answer: A
Rationale: Immune suppressants increase infection risk; fever can signal life-threatening infection.
Which immune modulator is given SQ or IV to boost neutrophil counts?
A. Tacrolimus
B. Filgrastim
C. Rituximab
D. Cyclosporine
Answer: B
Rationale: Filgrastim is a colony-stimulating factor that boosts neutrophils.
Q4. Tacrolimus requires which nursing intervention?
A. Administer only IM
B. Monitor therapeutic drug levels
C. Assess for thyroid suppression
D. Encourage potassium intake
Answer: B
Rationale: Tacrolimus has a narrow therapeutic index and requires level monitoring
A patient on rituximab develops shortness of breath and wheezing during infusion. First action?
A. Stop infusion
B. Document finding
C. Slow infusion rate
D. Give antiemetic
Answer: A
Rationale: This is likely an infusion reaction—stop infusion and notify provider.
Which drug class has the greatest risk for infusion reactions?
A. Colony-stimulating factors
B. Interferons
C. Monoclonal antibodies
D. Interleukins
Answer: C
Rationale: Infusion reactions are most common with monoclonal antibodies.
Q5. Which PPE is required when administering oral cyclosporine?
A. Surgical mask
B. Gown only
C. Gloves at minimum
D. Full PPE including N95
Answer: C
Rationale: These drugs can be hazardous; gloves are required to prevent caregiver exposure.
. A patient on interferons reports anorexia. Which intervention is best?
A. Offer small, frequent meals
B. Hold medication
C. Increase IV fluids
D. Encourage fasting
Answer: A
Rationale: Appetite loss is expected; nutritional support is key.
A nurse prepares to administer tacrolimus IV. Which precaution is correct?
A. Administer without gloves
B. Verify therapeutic range orders
C. Mix with penicillin
D. Give only PO
Answer: B
Rationale: IV tacrolimus requires therapeutic level monitoring for safety.