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The Nurse's Role in Administration of Intravenous Immunoglobulin Therapy

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional: February 2009 - Volume 27 - Issue 2 - p 112–113
doi: 10.1097/01.NHH.0000346314.72004.86
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CE TEST QUESTIONS

GENERAL PURPOSE

To provide registered professional nurses with the latest information about the indications for the administration of immunoglobulin, the various immunoglobulin products available, potential adverse reactions, routes of administration, and related nursing implications.

LEARNING OBJECTIVES

After reading this article and taking this test, you should be able to:

  1. Describe the indications and the administration guidelines and precautions for intravenous immunoglobulin.
  2. Outline the adverse effects of intravenous immunoglobulin.

1. Which of the following is an example of a secondary immunodeficiency state?

a. ataxia-telangiectasia

b. chronic lymphocytic leukemia

c. immunoglobulin subclass deficiency

d. common variable immune deficiency

2. What percentage of intravenous immunoglobulin (IVIG) infusions is given in the home care setting?

a. 20%

b. 30%

c. 40%

d. 50%

3. The highest concentration of IVIG currently available is

a. 12%.

b. 16%.

c. 20%.

d. 24%.

4. IVIG products containing sucrose have been associated with

a. cardiotoxicity.

b. pulmonary insufficiency.

c. hepatotoxicity.

d. acute renal failure.

5. Reactions to IgA are extremely rare but notably include

a. anaphylaxis.

b. insomnia.

c. hypertension.

d. joint pain.

6. Compared with lyophilized products, liquid IVIG products have the advantage of

a. variable osmolality.

b. flexibility in concentration.

c. long-term room temperature storage.

d. little to no preparation time.

7. Refrigerated IVIG products that are not allowed to come to room temperature before administration have been known to cause

a. nausea.

b. dizziness.

c. headache.

d. diarrhea.

8. For primary and secondary immunodeficient patients, the usual dose of IVIG is

a. 0.1 to 0.3 grams/kg per month.

b. 0.3 to 0.6 grams/kg per month.

c. 0.6 to 0.8 grams/kg per month.

d. 0.8 to 1.1 grams/kg per month.

9. How long does an IVIG typical infusion take?

a. 15 to 30 minutes

b. 30 minutes to 1 hour

c. 1 to 2 hours

d. 2 to 4 hours

10. Most adverse reactions to IVIG

a. are severe.

b. continue even with a slower infusion rate.

c. are self-limiting and transient.

d. occur within the first 10 to 15 minutes.

11. Adverse reactions to IVIG are more likely

a. during the first administration.

b. in patients taking NSAIDs.

c. after long-term IVIG therapy.

d. in patients taking corticosteroids.

12. Which of the following is recommended when administering IVIG to patients who have diabetes mellitus?

a. volume repletion

b. rapid infusion

c. diuretic therapy

d. higher IVIG concentration

13. It is believed that some patients who receive IVIG are specifically at risk for thromboembolic events because IVIG can increase

a. inflammation.

b. viscosity.

c. blood pressure.

d. capillary reflow.

14. Patients with a history of migraines who receive higher dosages of IVIG administered over a shorter duration of infusion are at risk for developing

a. cardiac dysrhythmias.

b. pulmonary edema.

c. acute pancreatitis.

d. aseptic meningitis.

15. Generally, the maximum volume for subcutaneous administration of immunoglobulin per site is

a. 10 to 20 mL.

b. 20 to 30 mL.

c. 30 to 40 mL.

d. 40 to 50 mL.

16. The most common as well as the most patient-preferred site for subcutaneous administration of immunoglobulin is the

a. abdomen.

b. upper arm.

c. thigh.

d. buttock.

17. All of these statements about subcutaneous immunoglobulin (SCIG) are correctexcept

a. its use is limited to children.

b. it is well tolerated and clinically efficacious.

c. this route is preferred by patients who treat themselves at home on their own schedule.

d. there is limited experience with using SCIG for indications other than primary immune deficiency.

18. Use of IVIG is not FDA-approved for which condition?

a. Kawasaki disease

b. B-cell chronic lymphocytic leukemia

c. bone marrow transplantation

d. stiff man syndrome

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© 2009 Lippincott Williams & Wilkins, Inc.