hard · NCLEX-RN pharmacology
A 59-year-old female with metastatic renal cell carcinoma developed Grade 3 immune-mediated myocarditis during combination therapy with ipilimumab and nivolumab. Her troponin peaked at 1.20 ng/mL, and her left ventricular ejection fraction (LVEF) temporarily fell to 40% with associated electrocardiogram changes. After 6 weeks of high-dose methylprednisolone followed by a slow corticosteroid taper, the myocarditis has completely resolved. She is in the outpatient clinic for a follow-up visit. Which nursing evaluation criteria are appropriate? Select all that apply.
- Ensure that a schedule for long-term, serial electrocardiograms (ECGs) and echocardiograms is established.
- Confirm that both ipilimumab and nivolumab have been permanently discontinued.
- Advise the client that she can safely receive her scheduled live-attenuated yellow fever vaccine for an upcoming trip.
- Prepare to administer the next scheduled outpatient dose of nivolumab now that the LVEF has recovered to 55%.
- Verify that the daily prednisone dose is tapered to 10 mg or less before any further immunotherapy is scheduled.
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