You are on page 1of 16

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking

for Collaborative Care, 6h Edition


Test Bank
Chapter 19: Inflammation and the Immune Response
MULTIPLE CHOICE
1. How do immune system cells differentiate between normal, healthy body cells and
non-self cells within the body?
A. All normal, healthy body cells are considered part of the immune system.
B. Immune system cells recognize normal healthy body cells by the presence of the
nucleus, a structure that is lacking in non-self cells.
C. Non-self cells express surface proteins that are different from normal, healthy body
cells and recognized as foreign by immune system cells.
D. Non-self cells are easily identified by the immune system cells, because non-self
cells are much larger than normal, healthy body cells.
ANS: C
Normal, healthy body cells all express surface proteins that are unique to the person,
coded by the major histocompatibility genes. Non-self cells express different cell surface
proteins. Immune system cells can distinguish between their own surface proteins and all
others.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity
2. Which manifestations or processes of inflammation are caused specifically by blood
vessel dilation?
A. Increased production and migration of leukocytes
B. Phagocytosis and fever
C. Warmth and redness
D. Swelling and pain
ANS: C
Dilated blood vessels increase blood flow to an area, leading to increased warmth and
color in that area. Dilation alone does not result in swelling. Swelling results from
increased capillary permeability.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

3. Why is the inflammatory response alone insufficient to provide complete protection


against infection?
A. It only responds to tissue injury and not to invasion by microorganisms.
B. It is nonspecific and no long-lasting immunity is generated by inflammation alone.
C. When the inflammatory response is prolonged, it can cause serious tissue damage.
D. The body is not capable of synthesizing antibodies at the same time that
inflammatory processes are active.
ANS: B
The cells that provide the protection of inflammation, the neutrophils and the
macrophages, have no memory to aid them in mounting a faster or stronger response to
an invading microorganism upon repeated or subsequent exposure. Without
antibody-mediated immunity and cell-mediated immunity to augment the inflammatory
response, humans remain susceptible to reinfection by the same microorganism over and
over again.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity
4.
A.
B.
C.
D.

Which cell types provide protective responses during inflammation?


Macrophages and neutrophils
Erythrocytes and platelets
Eosinophils and basophils
Natural killer cells

ANS: A
Macrophages and neutrophils initiate and complete phagocytosis against invading
microorganisms, providing the body with protection against infection. Natural killer cells
are not particularly active during inflammation. Eosinophils and basophils are responsible
for vascular changes, not protection. Erythrocytes and platelets have no direct roles in
inflammation.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

5.
A.
B.
C.
D.

Which condition or health problem demonstrates inflammation without invasion?


Allergic rhinitis
Viral hepatitis
Osteoarthritis
Cellulitis

ANS: C
Osteoarthritis is a "wear and tear" disorder that mechanically causes tissue damage. All
the other disorders represent invasion by non-self proteins such as pollens, viruses, and
bacteria.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
6. How does the process of attraction during phagocytosis occur?
A. Antibodies attached to phagocytic cells identify non-self cells and apply ionic
pressure to mechanically connect the invaders to the immune system cells.
B. Activation of enzymes by phagolysosomes gives bacteria and viruses an overall
positive charge, enhancing the attraction of neutrophils and macrophages to these
invaders.
C. Capillary leak from histamine stimulates pooling of plasma in tissue spaces, filtering
leukocytes from the blood into sites of injury or invasion.
D. Cells in and around damaged tissues secrete chemotaxins that attract neutrophils and
macrophages to the sites of injury or invasion.
ANS: D
Cells in an area of tissue damage or a site of invasion secrete chemical magnets known as
chemotaxins or leukotaxins that draw other leukocytes to the area. A major cell
responsible for the secretion of the chemotaxins is the tissue macrophage, although
damaged tissues and blood vessels also secrete chemotaxins. These substances are a
signal for more leukocytes to come to the area of invasion to bind with the invaders and
to engage in phagocytosis.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

7. The client's white blood count with differential indicates a total count of 10,000 cells
/mm3. Which of the follow differential counts or percentages should the nurse report
to the physician?
A. Eosinophils 200/mm3
B. Monocytes 2000/mm3
C. Segmented neutrophils 6000/mm3
D. Lymphocytes 2100/mm3
ANS: B
The normal monocyte population in peripheral blood should be not greater than 5%. A
monocyte count of 2000 in 10,000 white blood cells represents 20% of the total and
indicates a significant increase.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and
Maintenance;
8.
A.
B.
C.
D.

What health problems are associated with a deficiency of complement proteins?


Increased severity of allergy and other hypersensitivity reactions
Decreased resistance to bacterial and viral infections.
Decreased ability to recognize self from non-self
Increased rate of cancer development

ANS: B
Complement attaches to viruses and bacteria, making it easier for the neutrophils and
macrophages to phagocytose these invaders. Without the assistance of complement, the
phagocytic cells are not as efficient in the process of phagocytosis and the person is more
susceptible to bacterial and viral infections.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
9. What is the function of a plasma cell?
A. It is a memory cell that remains dormant until activated by macrophages to secrete
colony-stimulating factor on re-exposure to the same invader.
B. This unsensitized B lymphocyte becomes sensitized on exposure to a new antigen.
C. It secretes specific antibodies in response to the presence of a specific antigen.
D. It secretes specific antigens in response to the presence of a specific antibody.
ANS: C
Plasma cells are active, sensitized B lymphocytes that are capable of secreting specific
antibodies directed against a specific antigen.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

10. Why is generation of the IgM class of antibodies advantageous upon first exposure to
a new antigen?
A. One molecule of IgM has 10 binding sites and is capable of binding 10 completely
different antigens.
B. Initial antibody production is limited and IgM is the most efficient antibody class for
binding and clearing antigens.
C. The assembly and activation of IgM molecules take less energy than the other
classes of antibodies, and this allows IgM to have a more rapid response.
D. IgM molecules have a longer life span (4 to 5 years) compared with all other classes
of antibody molecules, whose life spans range from only hours to days.
ANS: B
When B lymphocytes are first exposed to an antigen, it takes days before they become
plasma cells and first begin to make antibodies. They also make very few molecules of
antibody to start with, which is why people often get sick on first exposure to an
organism. Because IgM has 10 binding sites, even though there are only small numbers
of these molecules made at first, each one can bind up to 10 molecules of the antigen (the
same antigen, not 10 different ones), making the clearance of antigen more efficient than
with a bivalent antibody.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
11. The 28-year-old client has a deep puncture wound on his foot from stepping on a nail.
When the nurse prepares to give him a tetanus toxoid vaccination, he says he does not
need another tetanus shot because he had a tetanus shot just 1 year ago. What is the
nurses best response?
A. You need this vaccination because the strain of tetanus changes every year.
B. I will check with the doctor. You probably do not need another vaccination now.
C. Because antibody production slows down as you age, it is better to take this
vaccination as a booster to the one you had a year ago.
D. Tetanus is a more serious disease among younger people because it can be spread to
others by sexual transmission, so it is best to take this vaccination now.
ANS: B
When people have been boosting their tetanus antibodies on a regularly scheduled
basis, they should have sufficient circulating antibodies to mount a defense against
exposure to tetanus. If this clients medical records substantiate that he did indeed receive
a tetanus toxoid booster 1 year ago, he does not need another one now.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance

12. What role do macrophages have in the neutrophilia that occurs in response to an acute
bacterial infection?
A. Macrophages have no role in neutrophilia.
B. When invasion occurs, macrophages mature into neutrophils, increasing their
circulating numbers.
C. At the onset of invasion, macrophages secrete a colony-stimulating factor that
induces the bone marrow to increase the production and release of neutrophils.
D. Inflammatory damage to macrophages allows release of proteolytic enzymes that
enhance liver production of all white blood cell types, including mature, segmented
neutrophils.
ANS: C
The initial response to an acute bacterial invasion is generated by the fixed macrophages
in the tissues that have been invaded. These macrophages, in addition to phagocytosing
bacteria, produce two classes of substances, chemotaxins to bring other leukocytes to the
site of invasion, and colony-stimulating factors to stimulate the bone marrow to increase
neutrophil maturation rate and release.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity
13. Why is antibody-mediated immunity considered to be one type of adaptive
immunity?
A. The immune system adapts to the presence of specific invaders or antigens by
making specific antibodies against those invaders or antigens.
B. The antibody-making cells are more resistant to environmental attacks on the
immune system than are the cells involved in either innate immunity or
cell-mediated immunity.
C. The immune system is able to adapt to the severity of infection by matching the
number of neutrophils and other white blood cells generated with the number of
organisms causing the infection.
D. After childhood, the immune system adapts the rate of leukocyte production with the
rate of leukocyte destruction to maintain a steady-state or constant number of
white blood cells for maximum protection against infection.
ANS: A
Innate, or native, immunity is a natural feature of a person. This type of immunity cannot
be developed or transferred from one person to another and is not an adaptive response to
exposure or invasion by foreign proteins. Adaptive immunity is the immunity that a
persons body makes (or can receive) as an adaptive response to invasion by organisms or
foreign proteins.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

14. The client is undergoing a splenectomy as a result of splenic rupture and hemorrhage
after a motor vehicle crash. Which is the most important precaution to teach this
client regarding immunologic function and health alteration?
A. You will no longer develop a fever when you have an infection, so you must learn
to identify other symptoms of infection.
B. You will be at a decreased risk for developing allergies, so it will no longer be
necessary for you to avoid common allergens.
C. You will need to avoid people with viral infections because it is harder now for you
to develop antibodies.
D. You will need to have yearly checkups because your risk for cancer development is
greater now.
ANS: C
The spleen is the major site of B-lymphocyte maturation and antibody production. People
who undergo splenectomies for any reason have a decreased antibody-mediated immune
response and are particularly susceptible to viral infections.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
15. In reviewing a client's laboratory report of white blood cell count with differential, all
the following results are listed. Which laboratory finding indicates a left shift?
A. The total white blood cell count is 9000/mm3.
B. The lymphocytes outnumber the basophils.
C. The bands outnumber the segs.
D. The monocyte count is 1800/mm3.
ANS: C
Normally, the mature segmented neutrophils (segs) are the major population of
circulating leukocytes, constituting 55% to 70% of the total white blood count. Less than
3% to 5% of the circulating white blood cells should be the less mature band
neutrophils. A left shift occurs when the bone marrow releases more immature
neutrophils than mature neutrophils.
DIF: Cognitive Level: Application
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and
Maintenance;

16. The client is not able to activate complement during a repeated exposure to the same
antigen. Which immunoglobulin class is most likely to be insufficient in this client?
A. IgA
B. IgD
C. IgE
D. IgM
ANS: D
The two classes of antibody that stimulate the complement cascade are IgG and IgM.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Physiological Integrity
17. What is the role of IL-10 in the inflammatory response?
A. Limiting the duration of inflammation by suppressing inflammatory actions
B. Secreting chemotactic factors to ensure inflammatory responses are confined only to
areas of invasion or tissue damage.
C. Stimulating the liver to produce fibrinogen, allowing areas of inflammation to be
walled off, so that a local infection does not lead to sepsis
D. Triggering inflammatory responses to convert to more specific immune responses,
such as antibody production and activation
ANS: A
Although many interleukins are proinflammatory and either stimulate inflammatory
responses or enhance inflammatory responses, IL-10 is suppressive in nature and
attempts to limit or control inflammation.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Physiological Integrity
18. The client has lost the ability to synthesize T-suppressor lymphocytes. What type of
immune system problem should the nurse expect this client to demonstrate?
A. Increased severity of allergy and other hypersensitivity reactions
B. Decreased ability to recognize self from non-self
C. Decreased immunoglobulin production
D. Increased rate of cancer development
ANS: A
T-suppressor lymphocytes function to limit the actions of general and specific responses.
These cells prevent overresponses to the presence of "foreign proteins" within a person's
environment. People who are deficient in T-suppressor cell activity have more severe
hypersensitivity reactions, allergies, and autoimmune responses.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

19. The 75-year-old client tells the nurse that the she is afraid to visit her 5-year-old
granddaughter who has the chickenpox because she does not want to get shingles.
What is the nurses best response?
A. If you have already had the chickenpox, you are now immune to shingles.
B. If you have already had shingles, you have developed immunities and cannot get
them again.
C. You can only get shingles from the virus in your body left over from when you had
chickenpox.
D. There is no relationship between chickenpox and shingles.
ANS: C
Shingles is not transmitted from a person with chickenpox. Shingles (herpes zoster) is an
infection that manifests later in life from residual virus retained in the dorsal root ganglia
of sensory nerves after a client has had chickenpox. Usually, shingles occurs whenever
the client is immunocompromised.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial
Integrity;
20. What is the most important precaution to teach a client who has few natural killer
cells and the natural killer cells are not very active?
A. You will no longer develop a fever when you have an infection, so you must learn
to identify other symptoms of infection.
B. You will be at an increased risk for developing allergies, so it will be necessary for
you to avoid common allergens.
C. You will need to avoid people with viral infections because it is harder now for you
to develop antibodies.
D. You will need to have yearly checkups because your risk for cancer development is
greater now.
ANS: D
Natural killer cells provide protection against development of cancer by recognizing
unhealthy or cancer cells as non-self and taking action to destroy them.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance

21. The client is having prolonged, severe allergic reactions during the fall pollen season.
Which change in white blood cell differential should the nurse expect this client to
have?
A. Band neutrophils outnumber segmented neutrophils.
B. The macrophage count is low.
C. The eosinophil count is high.
D. The monocyte count is low.
ANS: C
During allergic episodes, the eosinophil count is elevated both in response to the presence
of allergens and to limit the tissue level responses of inflammatory cells by releasing
enzymes capable of degrading the vasoactive amines secreted by other leukocytes.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe, Effective Care Environment/Physiological Integrity;
22. The client who has recovered from chickenpox has what type of immunity to this
disease?
A. Natural acquired active immunity
B. Artificial acquired active immunity
C. Natural acquired passive immunity
D. Artificial acquired passive immunity
ANS: A
In response to the naturally acquired chickenpox virus (varicella zoster virus) present in
the client, the client's immune system will synthesize antichickenpox antibodies that will
provide this client with long-term protection against chickenpox. This type of immunity
is considered active because the client's body took an active part in making the
antibodies.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Health Promotion and Maintenance

23. The client who is recovering from hepatitis A infection asks the nurse whether he
should take the hepatitis A vaccine to avoid contracting this disease again. What is
the nurses best response?
A. Yes, because now you are more susceptible to this infection.
B. Yes, because hepatitis A is widespread and considered to be a sexual transmitted
disease.
C. No, your liver and immune system are too impaired at this time to respond
appropriately to a vaccination for hepatitis.
D. No, this infection has done the same thing a vaccination would and your immune
system now makes antibodies against hepatitis A.
ANS: D
A vaccination with hepatitis A vaccine is an artificial way of stimulating the immune
system to make antibodies against hepatitis A (artificially acquired active immunity).
This client's immune system has responded to an actual infection with hepatitis A by
making many antibodies to hepatitis A (naturally acquired active immunity) and he does
not need a vaccination for this virus.
DIF: Cognitive Level: Application
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance/Physiological
Integrity
24. The nursing student does not know if she has ever had chickenpox. When an antibody
titer to varicella zoster virus is performed, the titer is negative. What is the correct
interpretation of this finding?
A. The student nurse has chickenpox and can easily spread it to others.
B. The student nurse has never been infected with varicella zoster virus and is
susceptible to chickenpox.
C. The student nurse has had a subclinical case of chickenpox at least five years ago
and is now immune to the disease.
D. The student nurse has never been infected with varicella zoster virus and is
susceptible to the development of shingles
ANS: B
The student nurse does not have detectable levels of antibodies to the varicella zoster
virus. The most likely explanation for this is that she has never been infected with the
virus, although it is possible that she was infected at such a young age that she was
unable to generate sufficient antibodies. In either instance, she is at risk for infection
should she be heavily exposed to the virus.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance

25. Which type of inflammatory or immune protection can be successfully transferred


from one person to another?
A. Phagocytosis
B. Inflammation
C. Cell-mediated immunity
D. Antibody-mediated immunity
ANS: D
Antibodies are made by the B lymphocytes and are released into the blood and other
extracellular fluids, where they can then exert their effects on invading organisms and
damaged cells. Because they are not part of a cell but are free-floating in the blood,
they can be transferred into another person as a plasma infusion or collected from the
plasma as immunoglobulin and injected into another person to provide some degree of
immediate, passive immunity.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Health Promotion and Maintenance
26. Which specific cells are responsible for causing acute rejection episodes after a solid
organ transplant?
A. Activated monocytes and macrophages
B. Sensitized B lymphocytes
C. Cytotoxic/cytolytic T cells
D. Eosinophils
ANS: C
Cytotoxic/cytolytic T cells function in cell-mediated immunity by destroying cells that
contain a processed antigen, which also expresses at least one major histocompatibility
complex (MHC) identical to one expressed by the cytotoxic/cytolytic T cell. Thus, these
cells are most effective at eliminating cells and tissues from other people.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

27. The client recovering from bowel surgery has developed a systemic infection. The
most recent laboratory report indicates a "left shift" in the differential. What is the
nurses best action?
A. Prepare to administer antipyretics for severe fever.
B. Document the information as the only action.
C. Discontinue the intravenous antibiotics.
D. Notify the health care provider.
ANS: D
A left shift is an ominous clinical sign. It represents a failure of the inflammatory and
immune responses to keep pace with the proliferation of pathogenic microorganisms. It
also represents a failure of treatment. Prompt intervention is needed to prevent death by
sepsis.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Safe, Effective Care Environment/Physiological Integrity;
28. What is the priority nursing diagnosis for the client taking drug therapy for cancer
that suppresses neutrophil production but does not affect any other blood cell
production or activity?
A. Risk for Injury
B. Risk for Infection
C. Risk for Deficient
D. Risk for Bleeding
ANS: B
The general responses of neutrophils provide the best protection against bacterial and
fungal infections. Clients who have low numbers of mature, segmented neutrophils are at
extreme risk for developing infection, particularly from overgrowth of their own normal
flora.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and
Maintenance;

29. The 95-year-old nursing home client has a productive cough and night sweats. When
she is tested for tuberculosis with a PPD, the injection site does not have a skin
response of induration by 48 hours after the injection. What is the correct
interpretation of this finding?
A. The test is negative and airborne precautions are not necessary because the client
does not have tuberculosis.
B. The test is negative; however, airborne precautions are still necessary until other test
results for tuberculosis are also negative.
C. The test is negative and airborne precautions are still necessary because the client
probably has a bacterial pneumonia.
D. The test is negative and airborne precautions are not necessary because the client has
sufficient antibodies against the tuberculosis bacillus.
ANS: B
The PPD test for tuberculosis relies on a cell-mediated immune response in the skin to
react with the tuberculosis protein for a positive result. Adults who are very old may not
have enough of a cell-mediated immune response to demonstrate a positive reaction to a
PPD, a condition called anergy. Airborne precautions are needed when clinical
manifestations of tuberculosis are present and the results of more definitive testing are
unknown or such testing has not yet been performed.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe, Effective Care Environment/Physiological Integrity;

30. Two months after a kidney transplant, the client returns and is diagnosed as having an
acute rejection episode. The client says, I was doing so well with my new kidney
and the thought of having to go back to living on hemodialysis is so depressing.
What is the nurses best response?
A. You should have followed your drug regimen better.
B. You should be glad that at least hemodialysis is an option for you. Remember that
people whose liver transplants are rejected have no other options.
C. You should keep in mind that one acute rejection episode does not mean that you
will lose the new kidney. Usually, these episodes can be reversed with the right
treatment.
D. You should remember that finding a donor for a new kidney is the easiest transplant
option. Our center is high on the list for obtaining organs for transplant from the
national registry.
ANS: C
An episode of acute rejection does not automatically mean the client will lose the
transplant. Pharmacologic manipulation of host immune responses at this time can limit
damage to the organ and allow the graft to be maintained.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Psychosocial Integrity
31. Which statement made by the client getting ready for discharge after a solid organ
transplant indicates the need for clarification of the post-transplant drug regimen?
A. If I develop an infection, I should stop taking my prednisone.
B. If I have tenderness over the area of the transplant, I will call the transplant team
immediately.
C. I should avoid people who are ill or who have an infection because I am somewhat
immunosuppressed now.
D. I should mix my cyclosporine exactly the way I was taught because it won't work as
well if I change the routine.
ANS: A
Immunosuppressive agents should not be stopped without the consultation of the
transplant physician, even if an infection is present. Stopping immunosuppressive therapy
endangers the transplanted organ.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

32. Which precaution is most important to teach in preparation for self-care to a client
whose antirejection therapy includes sirolimus (Rapamune)?
A. Report any weight gain of 5 pounds or more in 1 month to your health care
provider.
B. Avoid drinking grapefruit juice when taking this drug.
C. Avoid crowds and people who might be ill.
D. Restrict your intake of table salt.
ANS: B
This drug is metabolized by an enzyme system that is enhanced by drinking grapefruit
juice or eating grapefruit. When the enzyme level or activity is increased, the sirolimus is
metabolized too quickly and the clients risk for rejection increases.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance