Which pretreatment results are most important for the nurse to verify?
1Tuberculosis screening and hepatitis B serologic test results✓ Correct answer
2Serum amylase and a 24-hour urine calcium measurement
3Skin-prick allergy testing and a stool occult blood test
4Visual acuity testing and a serum digoxin concentration
Explanation
Infliximab suppresses tumor necrosis factor alpha and can reactivate latent tuberculosis or hepatitis B. The nurse should verify tuberculosis evaluation and hepatitis B testing before treatment and report positive or indeterminate findings for management. The other test pairs do not address the major infection-reactivation risks associated with infliximab.
Clinical reasoning TNF-alpha is important for containing granulomatous infection. Blocking it can allow latent tuberculosis to become active, and immunosuppression can permit hepatitis B reactivation.
Decision rule Before a TNF-alpha inhibitor, verify infection screening, assess current infection, and review vaccine status; monitor for infection during and after therapy.
Scenario A 35-year-old client with refractory Crohn disease is scheduled to begin infliximab 5 mg/kg IV.
TNF-alpha inhibitor — A biologic medication that blocks tumor necrosis factor alpha to reduce inflammatory disease activity.
Latent tuberculosis — Tuberculosis infection without active disease that can reactivate during immunosuppressive therapy.
Infliximab infusion reaction — Acute (during/within 24h) or delayed (1-14 days); slow infusion with premedication if reactive.