A 45-year-old woman has just received a kidney transplant. She is placed on several immunosuppressants to prophylactically prevent her body rejecting the donor organ. Which of the following immunosuppressants interferes with T-cell activation by modifying the activity of calcineurin?

Correct Answer: A

Rationale: Post-kidney transplant, immunosuppression prevents rejection by targeting T-cell activation. Cyclosporine binds calcineurin, inhibiting its phosphatase activity, which blocks IL-2 transcription, crucial for T-cell proliferation-making it the correct answer. Methotrexate inhibits purine synthesis, affecting rapidly dividing cells, not calcineurin. Prednisolone , a corticosteroid, suppresses inflammation broadly but doesn't target calcineurin. Sirolimus inhibits mTOR, a different pathway, affecting T-cell proliferation downstream, not calcineurin. Temsirolimus (E) is similar to sirolimus. Cyclosporine's specificity to calcineurin aligns with the question's focus, a cornerstone in transplant regimens. Its mechanism disrupts early T-cell signaling, critical for alloimmune responses, unlike the broader or alternative actions of other options. This precision ensures effective prophylaxis while distinguishing it from other immunosuppressants in the list.

Correct Answer: D

Rationale: Acute asthma and pneumonia in pregnancy require urgent care. IV crystalloids rehydrate, safe and necessary. High FiO2 (40%) supports oxygenation in asthma/pneumonia, appropriate. Nebulized salbutamol, a beta-agonist, relieves bronchospasm, standard and safe. IV hydrocortisone reduces inflammation, suitable. IV gentamicin, an aminoglycoside, treats pneumonia but is inappropriate due to cephalosporin cross-reactivity risk (angioedema history) and fetal ototoxicity concerns, making it unsafe here. Alternative antibiotics (e.g., macrolides) are preferred, prioritizing maternal and fetal safety.

Correct Answer: A

Rationale: Post-kidney transplant, immunosuppression prevents rejection by targeting T-cell activation. Cyclosporine binds calcineurin, inhibiting its phosphatase activity, which blocks IL-2 transcription, crucial for T-cell proliferation-making it the correct answer. Methotrexate inhibits purine synthesis, affecting rapidly dividing cells, not calcineurin. Prednisolone , a corticosteroid, suppresses inflammation broadly but doesn't target calcineurin. Sirolimus inhibits mTOR, a different pathway, affecting T-cell proliferation downstream, not calcineurin. Temsirolimus (E) is similar to sirolimus. Cyclosporine's specificity to calcineurin aligns with the question's focus, a cornerstone in transplant regimens. Its mechanism disrupts early T-cell signaling, critical for alloimmune responses, unlike the broader or alternative actions of other options. This precision ensures effective prophylaxis while distinguishing it from other immunosuppressants in the list.

Correct Answer: D

Rationale: A sudden increase in temperature in a client receiving Pentamidine IV for the treatment of Pneumocystis carinii is most likely an indication that the client has developed another infection. Pentamidine is an antiparasitic medication used to treat Pneumocystis carinii pneumonia in immunocompromised individuals such as those with HIV/AIDS. An increase in temperature could be a sign of a new or worsening infection, especially in patients who are already immunocompromised. It is important for the nurse to monitor the client closely for signs of infection and notify the healthcare provider if there are any concerning symptoms.

Correct Answer: D

Rationale: Nystatin is used to treat oral thrush in infants, a fungal infection often linked to Candida albicans, which can be transmitted between mother and child during breastfeeding. The key instruction for the caregiver is that the breastfeeding mother may also need treatment to prevent reinfection, as Candida can persist on the mother's nipples. This addresses the infection's source comprehensively. Giving medication before feeding may reduce efficacy as milk washes it away too quickly. Water beforehand isn't necessary and could dilute the dose. Using a cotton swab is a technique but not the priority instruction compared to preventing recurrence. Since the correct answer includes multiple options (3, 5), and choice D aligns with the critical need to treat the mother, it's the focus here for its systemic impact on treatment success.