A nurse is caring for a client who is taking cyclosporine (Sandimmune), a calcineurin inhibitor, to prevent kidney transplant rejection. Which assessment does the nurse perform as a priority before administering the medication? (Select all that apply.)¹

The laboratory value that should be monitored periodically when taking allopurinol is serum creatinine level. Allopurinol is a drug that lowers the level of uric acid in the blood and urine by inhibiting the enzyme xanthine oxidase, which is involved in the metabolism of purines¹². Allopurinol is used to treat gouty arthritis, a condition that causes painful inflammation of the joints due to the deposition of uric acid crystals¹².

The other options are incorrect because:

- Option A is wrong because serum uric acid level is not the laboratory value that should be monitored periodically when taking allopurinol. Serum uric acid level is the amount of uric acid in the blood, which is a waste product that is produced by the breakdown of purines. Serum uric acid level is usually high in patients with gouty arthritis, which causes inflammation and pain in the joints due to the deposition of uric acid crystals . Allopurinol lowers serum uric acid level by inhibiting xanthine oxidase, which is involved in the metabolism of purines . However, serum uric acid level is not a reliable indicator of allopurinol's effectiveness or toxicity, because it does not reflect the amount of uric acid in the tissues or urine, where it can cause damage or complications . Serum uric acid level may also fluctuate due to various factors such as diet, hydration, renal function, or drug interactions . Therefore, serum uric acid level is not the laboratory value that should be monitored periodically when taking allopurinol.

- Option B is wrong because serum potassium level is not the laboratory value that should be monitored periodically when taking allopurinol. Serum potassium level is the amount of potassium in the blood, which is an electrolyte that is essential for the function of nerves, muscles, and heart. Serum potassium level is normally regulated by the kidneys, which excrete excess potassium or retain potassium when needed . Serum potassium level can be affected by various factors such as diet, hydration, acid-base balance, renal function, or drug interactions . Allopurinol does not have a direct effect on serum potassium level, but it may interact with some drugs that can alter serum potassium level, such as diuretics, angiotensin-converting enzyme inhibitors, or potassium supplements . However, these drug interactions are not specific to allopurinol and can occur with any drug that affects renal function or electrolyte balance . Therefore, serum potassium level is not the laboratory value that should be monitored periodically when taking allopurinol.

- Option D is wrong because serum calcium level is not the laboratory value that should be monitored periodically when taking allopurinol. Serum calcium level is the amount of calcium in the blood, which is a mineral that is involved in various processes such as bone formation, muscle contraction, nerve transmission, and blood clotting. Serum calcium level is normally regulated by the parathyroid glands, which secrete parathyroid hormone (PTH) to increase calcium absorption from the gut and bone resorption from the skeleton . Serum calcium level can be affected by various factors such as diet, hydration, vitamin D status, renal function, or drug interactions . Allopurinol does not have a direct effect on serum calcium level, but it may interact with some drugs that can alter serum calcium level, such as thiazide diuretics, which can increase calcium reabsorption in the kidney and cause hypercalcemia . However, these drug interactions are not specific to allopurinol and can occur with any drug that affects renal function or calcium metabolism . Therefore, serum calcium level is not the laboratory value that should be monitored periodically when taking allopurinol.

D. "I will report any signs of infection to my provider." Prednisone is a synthetic glucocorticoid that is used to treat rheumatoid arthritis, a chronic inflammatory autoimmune disease that affects the joints and other tissues . Prednisone reduces inflammation, pain, swelling, and stiffness by inhibiting the synthesis of inflammatory mediators and suppressing the immune system .

One of the possible side effects of prednisone is infection, which can be serious or life-threatening due to the suppression of the immune system and increased susceptibility to opportunistic pathogens such as fungi, viruses, bacteria, and parasites . The client should monitor for signs of infection such as fever, sore throat, cough, wound drainage, or urinary symptoms, and report them to the provider as soon as possible . The provider may prescribe antibiotics or antifungals to treat the infection or adjust the dose of prednisone to prevent further complications .

The other options are incorrect because:

Option A is wrong because the client should not take prednisone every other day to prevent side effects. Prednisone should be taken as prescribed by the provider, usually once or twice daily with food or milk to prevent gastrointestinal irritation . Prednisone should not be taken every other day or on an irregular schedule, because this can cause fluctuations in blood levels and increase the risk of adverse effects or suboptimal response . Prednisone should also not be stopped abruptly, because this can cause withdrawal symptoms such as fatigue, weakness, nausea, vomiting, or hypotension due to adrenal insufficiency . Prednisone should be tapered gradually under the supervision of the provider to allow the adrenal glands to resume normal cortisol production .

Option B is wrong because the client should not stop taking prednisone if they develop indigestion. Indigestion is a common side effect of prednisone that can be caused by irritation or ulceration of the gastric mucosa due to increased acid secretion and decreased mucus production . The client should not stop taking prednisone without consulting with the provider, because this can cause withdrawal symptoms or worsen their condition . The client should take prednisone with food or milk to reduce gastric irritation and report any severe or persistent indigestion to the provider . The provider may prescribe antacids, histamine-2 blockers, or proton pump inhibitors to protect the stomach lining and prevent bleeding or perforation .

Option C is wrong because the client does not need to increase their intake of foods that are high in potassium. Potassium is an electrolyte that is essential for the function of nerves, muscles, and heart. Potassium levels are normally regulated by the kidneys, which excrete excess potassium or retain potassium when needed . Prednisone does not have a significant effect on potassium levels, unlike mineralocorticoids such as aldosterone, which promote sodium reabsorption and potassium excretion in the kidney . Prednisone may interact with some drugs that can alter potassium levels, such as diuretics, angiotensin-converting enzyme inhibitors, or potassium supplements . However, these drug interactions are not specific to prednisone and can occur with any drug that affects renal function or electrolyte balance . The client should have their potassium levels monitored periodically and follow a balanced diet that meets their nutritional needs . The client should not increase their intake of foods that are high in potassium without consulting with the provider, because this can cause hyperkalemia , which can lead to cardiac arrhythmias or cardiac arrest .