J.P. requires aggressive immunosuppressive therapy. What drugs will be used? How do these
alter the rejection process?
What will be an ideal response?
• The standard immunosuppressive therapy used for organ rejection is intravenous (IV)
methylprednisolone (Solu-Medrol) and either oral azathioprine (Imuran) or mycophenolate
(CellCept) plus tacrolimus (Prograf).
• The exact action of azathioprine (Imuran) is unknown, but it appears primarily to suppress T-cell
and B-cell production. When given with steroids, it appears to have a steroid-conserving effect; a
lower dosage of steroid might be used.
• Mycophenolate (CellCept) is an antimetabolite, which suppresses T- and B-cell production.
• Tacrolimus (Prograf) prevents helper T cells from producing interleukin 2 (IL-2), interferon gamma,
and other cytokines, resulting in decreased proliferation of B cells and cytotoxic T cells.
• If the patient does not respond to the previously mentioned drugs, antithymocyte globulin
(Thymoglobulin) is given. Thymoglobulin inhibits T-cell activation.
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a. "So I can have shade over my sandbox." b. "Because God made them that way." c. "To hide behind when they are scared." d. "For the squirrels to play in."
The mother of a terminally ill child stays with the child day and night. Which statement indicates that the mother is in the chronic sorrow of depression stage?
A) "I will never accept that my child is dying.". B) "I know that there is nothing that can be done for my child.". C) "There must be another doctor somewhere than can help my child.". D) "I will go to church every week if this will keep my child from dying.".
A patient with depression repeatedly tells staff members, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis
a. Powerlessness b. Risk for suicide c. Stress overload d. Spiritual distress
Calcitriol is prescribed for a client with hypocalcemia. Which foods does the nurse, knowing that they may interfere with calcium absorption, instruct the client to limit in the diet?
A. Bran B. Milk C. Clams D. Spinach E. Orange juice