Biologic Response Modifiers

Every question here, with the answer

1. A client is scheduled for a first infusion of rituximab. Which action should the nurse take before starting the infusion?

   1. Check the client's hearing.
   2. Give the ordered diphenhydramine and acetaminophen premedication.
   3. Hold all oral fluids for 12 hours.
   4. Give the infusion as a rapid IV push to shorten exposure.

   Answer: Give the ordered diphenhydramine and acetaminophen premedication.

   Monoclonal antibodies carry a high risk of sensitivity reactions, so clients must be premedicated with diphenhydramine and acetaminophen. Fluid restriction, IV push administration and hearing checks are not part of the section's guidance.

2. A nurse is preparing to give a client's first dose of a biologic therapy. Which actions are appropriate? Select all that apply.

   1. Leave the client alone once the infusion is running smoothly.
   2. Make sure emergency drugs such as epinephrine are available.
   3. Give all ordered premedications.
   4. Skip premedication if the client has no allergies.
   5. Monitor the client carefully throughout the infusion.

   Answer: Make sure emergency drugs such as epinephrine are available., Give all ordered premedications., Monitor the client carefully throughout the infusion.

   Hypersensitivity reactions may occur suddenly, especially with the first treatment, so premedication must be given, epinephrine should be available, and the client should be monitored throughout the infusion. Leaving the client unobserved or skipping premedication ignores this risk.

3. A client receiving pembrolizumab asks why the nurse keeps asking about new symptoms in other body systems. Which explanation is accurate?

   1. PD-1 inhibitors lower estrogen levels.
   2. PD-1 inhibitors are known to cause hearing loss.
   3. PD-1 inhibitors increase T lymphocyte activity, which can lead to autoimmune syndromes.
   4. PD-1 inhibitors suppress the bone marrow like alkylating agents.

   Answer: PD-1 inhibitors increase T lymphocyte activity, which can lead to autoimmune syndromes.

   PD-1 inhibitors unblock T lymphocytes so they kill cancer cells more easily, and because T-cell activity increases, autoimmune syndromes can develop. The other options describe effects of other drug classes or effects not in the section.

4. A client taking erlotinib for non-small cell lung cancer calls the clinic reporting sudden severe abdominal pain. Why is this report a concern?

   1. Erlotinib has been shown to cause gastrointestinal perforation.
   2. Abdominal pain is an expected, harmless effect of erlotinib.
   3. It means the drug should be taken with more food.
   4. Erlotinib commonly causes hemorrhagic cystitis.

   Answer: Erlotinib has been shown to cause gastrointestinal perforation.

   Erlotinib has been shown to cause renal dysfunction, arrhythmias, hepatotoxicity, and gastrointestinal perforation, so sudden severe abdominal pain needs urgent evaluation. The section does not describe it as harmless or as linked to food intake or cystitis.

5. A nurse reviews the adverse effects associated with rituximab. Which should the nurse monitor for? Select all that apply.

   1. Tumor lysis syndrome
   2. Cardiotoxicity
   3. Increased bone density
   4. Neutropenia and infection
   5. Reactivation of hepatitis B

   Answer: Tumor lysis syndrome, Cardiotoxicity, Neutropenia and infection, Reactivation of hepatitis B

   Rituximab is associated with cardiotoxicity, nephrotoxicity, leukoencephalopathy, bowel obstruction or perforation, tumor lysis syndrome, neutropenia, infection, and reactivation of hepatitis B. Increased bone density is not a listed effect.

6. When is a client receiving rituximab at greatest risk for a fatal infusion-related reaction?

   1. Only after the fifth dose
   2. During the initial treatment
   3. Only after the drug is stopped
   4. Only if it is given orally

   Answer: During the initial treatment

   Rituximab may cause fatal infusion-related reactions, most often with the initial treatment, which is why the first infusion needs close monitoring. The other options contradict the section; rituximab is given IV.