A nurse is caring for a client who is prescribed cyclosporine.
Which of the following findings should the nurse report to the provider immediately?

Choice A rationale

Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators like histamine from mast cells. This prophylactic action requires consistent, daily use to build up therapeutic levels and prevent the initiation of the asthmatic response, rather than acting as a rescue medication during an acute attack.

Choice B rationale

Using cromolyn as soon as one feels like wheezing is incorrect because cromolyn is not a bronchodilator and does not provide immediate relief for acute bronchospasm. Its mechanism of action involves stabilizing mast cells, which prevents the degranulation and release of inflammatory mediators, thus preventing symptoms from occurring.

Choice C rationale

Expecting to feel better in a week is an inappropriate timeframe for assessing cromolyn's efficacy. The full prophylactic benefits of cromolyn may take several weeks of consistent use to become apparent. Patients should be educated on the preventative nature and delayed onset of action.

Choice D rationale

While cromolyn can be used prophylactically before exercise, using it 2 hours before playing softball is not the recommended timing. For exercise-induced bronchospasm, cromolyn is typically administered 15 to 30 minutes prior to the activity to allow for adequate absorption and mast cell stabilization before exertion.

Choice A rationale

Constipation is a very common and expected adverse effect of codeine due to its opioid effects on gastrointestinal motility, specifically by decreasing propulsive contractions. While it requires management, it is generally not the highest priority unless it leads to severe complications like impaction, making other acute symptoms more immediately concerning. Normal bowel frequency varies but ranges from three times daily to three times weekly.

Choice B rationale

Dry mouth, or xerostomia, is a common anticholinergic-like effect of opioid medications like codeine. While uncomfortable, it is typically a mild, non-life-threatening side effect. It can be managed with hydration and oral hygiene measures and does not represent an acute physiological threat requiring immediate reporting as a priority.

Choice C rationale

Agitation, especially in the context of opioid use, can be a sign of central nervous system excitation or an idiosyncratic reaction. It can indicate a paradoxical effect of the medication or an emerging adverse event that could escalate to more serious neurological complications, such as seizures or respiratory compromise if not promptly addressed.

Choice D rationale

Urinary retention is a known adverse effect of opioids due to their effect on bladder detrusor muscle tone and sphincter function. While it is important to monitor and manage, potentially requiring catheterization, it is generally not as immediately life-threatening as signs of central nervous system instability or respiratory compromise, making agitation a higher priority in the acute setting.