A client who has recently undergone a kidney transplant is prescribed cyclosporine. Which action should the nurse prioritize to prevent potential toxicity?

Monitor the client's BUN and creatinine levels regularly.

Advise the client to consume grapefruit juice to enhance the medication's effectiveness.

Instruct the client to take cyclosporine with food to reduce gastrointestinal irritation.

Encourage increased fluid intake to dilute the medication in the bloodstream.

Answer and Explanation

The Correct Answer is A

Post–kidney transplant clients require lifelong immunosuppression to prevent organ rejection. Cyclosporine is commonly used to suppress T-cell activation and reduce the risk of graft rejection. However, it has a narrow therapeutic window and is known for significant nephrotoxicity. Careful monitoring of renal function is essential to detect early signs of toxicity and preserve graft function.

Rationale:
A. Monitoring BUN and creatinine levels regularly is the priority because cyclosporine is highly nephrotoxic and can cause dose-dependent kidney damage. Rising creatinine and BUN levels may indicate impaired renal perfusion or direct tubular toxicity. Early detection allows for dose adjustment or medication changes to prevent irreversible graft injury.

B. Advising the client to consume grapefruit juice is unsafe because grapefruit inhibits cytochrome P450 enzymes, specifically CYP3A4, which metabolizes cyclosporine. This leads to increased drug levels and a higher risk of toxicity, including nephrotoxicity and neurotoxicity. Therefore, grapefruit juice should be strictly avoided rather than encouraged.

C. Instructing the client to take cyclosporine with food to reduce gastrointestinal irritation is not the priority intervention for toxicity prevention. While taking the medication consistently with or without food may improve absorption consistency, food intake does not significantly reduce its toxic effects. The primary concern remains monitoring blood levels and renal function.

D. Encouraging increased fluid intake does not directly prevent cyclosporine toxicity. Although adequate hydration supports kidney perfusion, it does not counteract the drug’s nephrotoxic effects or prevent accumulation in the body. The most effective strategy is ongoing laboratory monitoring to detect early renal impairment.

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Free Nursing Study Resources

Correct Answer is ["A","C","D"]

Explanation

Paracentesis is a procedure used to remove excess fluid (ascites) from the peritoneal cavity, commonly performed in clients with conditions such as liver cirrhosis or malignancy. The procedure helps relieve abdominal pressure, improve breathing, and obtain fluid for diagnostic analysis. Nursing care focuses on ensuring client safety, preventing complications such as infection or bladder injury, and monitoring fluid balance before and after the procedure.

Rationale:
A. Assessing the abdominal site for skin integrity issues before puncture is important to reduce the risk of infection and complications. The nurse must ensure that the skin is intact, free from infection, and appropriately prepared for sterile needle insertion. This helps maintain aseptic technique and prevents peritoneal contamination.

B. Administering routinely scheduled diuretics before the procedure is not appropriate. Diuretics may already be used in managing ascites, but they are not specifically required or beneficial immediately before paracentesis. The procedure itself removes fluid directly, making pre-procedure diuretic administration unnecessary for the intervention.

C. Having the client void prior to the procedure is essential to reduce the risk of accidental bladder puncture during needle insertion. An empty bladder improves anatomical safety and allows better access to the peritoneal fluid collection. This is a standard pre-procedure safety measure in paracentesis care.

D. Weighing the client before and after the procedure is important to evaluate the amount of fluid removed and assess fluid balance. Changes in body weight help determine the effectiveness of the procedure and guide ongoing management of ascites. It also assists in monitoring for potential fluid shifts or hypovolemia.

E. Providing the client a heavy meal prior to the procedure is not appropriate because it may increase abdominal discomfort and pressure. Paracentesis is often performed on an empty or lightly fed stomach to improve comfort and reduce risk of complications. Heavy meals can also interfere with positioning and procedure tolerance.

A. Maintain proper cuff inflation pressure on the endotracheal tube to ensure airway patency. B. Position the client in a supine position to facilitate breathing. C. Administer high-flow nasal oxygen to increase oxygenation. D. Increase the tidal volume on the ventilator to enhance lung expansion.

Correct Answer is A

Explanation

Flail chest occurs when multiple consecutive ribs are fractured in more than one place, creating a free-floating segment of the chest wall that moves paradoxically during respiration. This injury significantly impairs ventilation and often requires mechanical ventilation for respiratory support and stabilization. Ensuring a secure airway and preventing aspiration are critical priorities in clients with endotracheal intubation. Proper management of the airway cuff is essential to maintain ventilation effectiveness and protect the lower respiratory tract.

Rationale:
A. Maintaining proper cuff inflation pressure on the endotracheal tube is the priority intervention because it ensures a sealed airway, prevents air leaks, and reduces the risk of aspiration of gastric or oropharyngeal contents. Adequate cuff pressure also supports effective mechanical ventilation by ensuring that delivered tidal volumes reach the lungs without loss.

B. Positioning the client in a supine position is not appropriate because it can impair lung expansion and increase the risk of aspiration. In clients with flail chest, semi-Fowler’s position is preferred to improve diaphragmatic excursion and promote better oxygenation while reducing pressure on the chest wall.

C. Administering high-flow nasal oxygen is not the priority because the client is already mechanically ventilated. Oxygen delivery alone does not address the structural instability of the chest wall or the need for airway protection. Mechanical ventilation provides more effective respiratory support in flail chest.

D. Increasing the tidal volume on the ventilator may be used in some cases of flail chest management, but it is not the immediate priority compared to airway protection. Excessively high tidal volumes can increase the risk of barotrauma or volutrauma. Ensuring airway integrity and preventing aspiration take precedence before adjusting ventilator settings.

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A client who has recently undergone a kidney transplant is prescribed cyclosporine. Which action should the nurse prioritize to prevent potential toxicity?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following are important nursing considerations during a paracentesis procedure? Select all that apply

Correct Answer is ["A","C","D"]

Explanation

A client with flail chest is receiving mechanical ventilation. Which of the following interventions is the priority to ensure adequate ventilation and prevent aspiration?

Correct Answer is A

Explanation

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