A nurse is caring for a client who is prescribed cyclosporine.
Which of the following findings should the nurse report to the provider immediately?
The client requests to have grapefruit juice.
Increased serum bilirubin level.
The client reports hair growth on their body.
Blood pressure 128/82 mm Hg.
The Correct Answer is B
Monitoring a patient on cyclosporine requires applying knowledge of immunosuppressant pharmacology and organ toxicity. The nurse must identify laboratory evidence of hepatic dysfunction or nephrotoxicity, which are critical adverse effects, to prevent permanent organ damage while distinguishing expected side effects from those requiring urgent medical intervention.
Choice A rationale: Grapefruit juice inhibits the cytochrome P450 3A4 enzyme, which metabolizes cyclosporine, leading to potentially toxic drug levels. While this requires patient education to avoid future consumption, it is a dietary request rather than an immediate clinical finding indicating current physiological damage.
Choice B rationale: Cyclosporine is hepatotoxic; an elevated bilirubin level (normal range 0.1 to 1.2 mg/dL) indicates impaired liver function or biliary obstruction. This finding must be reported immediately to prevent progressive hepatic failure and to allow for necessary dosage adjustments or discontinuation.
Choice C rationale: Hirsutism, or increased hair growth, is a common and expected side effect of cyclosporine therapy. While it may be distressing to the patient for cosmetic reasons, it does not pose an acute threat to physical health or indicate a life-threatening complication.
Choice D rationale: A blood pressure of 128/82 mm Hg is slightly elevated but generally considered within an acceptable range for many adults. Cyclosporine can cause hypertension, but this specific reading does not constitute an urgent hypertensive crisis requiring immediate notification of the provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Somatropin is a synthetic growth hormone used to treat growth hormone deficiency. The primary therapeutic effect of this medication is to promote linear growth in children. Therefore, monitoring the child's height monthly is a direct and quantifiable measure to evaluate the effectiveness of somatropin therapy and ensure that the child is achieving the expected growth velocity.
Choice B rationale
While thyroid function can influence growth, and growth hormone deficiency can sometimes coexist with or impact thyroid axis, evaluating the therapeutic effect of somatropin directly involves assessing growth. Monitoring thyroid function is important for overall endocrine health but is not the primary measure for the therapeutic effect of somatropin itself, assuming thyroid function is within normal limits (e.g., TSH 0.4-4.0 mIU/L, free T4 0.8-1.8 ng/dL).
Choice C rationale
Checking the child's sodium level regularly is not a direct measure of the therapeutic effect of somatropin. Growth hormone can influence fluid balance, but sodium levels (normal range 135-145 mEq/L) are primarily monitored for hydration status or potential adverse effects like fluid retention, not as an indicator of growth hormone's efficacy in promoting growth.
Choice D rationale
Measuring the child's abdominal girth is a measure of abdominal circumference, primarily used to assess abdominal distention, fluid accumulation, or changes in visceral fat. It is not a relevant parameter for evaluating the therapeutic effect of somatropin, which is specifically aimed at stimulating linear bone growth and overall somatic growth.
Correct Answer is D
Explanation
Choice A rationale
Aspartate aminotransferase (AST) is an enzyme primarily found in the liver, heart, and muscle. Elevated levels can indicate hepatocellular damage or cardiac muscle injury. While some medications can affect liver function, AST is not a primary monitoring parameter for methylprednisolone, which is a corticosteroid, unless specific hepatotoxicity is suspected or pre-existing liver conditions exist. Normal AST levels are typically 10-40 U/L.
Choice B rationale
Fibrin split products (FSPs) are indicators of fibrinolysis, the breakdown of fibrin clots. Elevated FSPs suggest active clotting and subsequent clot degradation, often seen in disseminated intravascular coagulation (DIC). Methylprednisolone, a corticosteroid, does not directly impact fibrinolysis or coagulation to warrant routine monitoring of FSPs as a primary concern. This test is not routinely indicated.
Choice C rationale
Blood urea nitrogen (BUN) measures the amount of nitrogen in the blood that comes from the waste product urea. Elevated BUN can indicate kidney dysfunction or dehydration. While corticosteroids can influence fluid balance, BUN is not a specific or primary laboratory value monitored for the direct effects of methylprednisolone therapy unless a pre-existing renal impairment is present. Normal BUN levels are typically 7-20 mg/dL.
Choice D rationale
Methylprednisolone, a glucocorticoid, significantly impacts carbohydrate metabolism by promoting gluconeogenesis and glycogenolysis, leading to increased blood glucose levels. This can induce hyperglycemia and even steroid-induced diabetes, particularly in predisposed individuals. Therefore, close monitoring of blood glucose is crucial to prevent and manage this common adverse effect. Normal fasting glucose is typically 70-99 mg/dL.
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