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
Checking the client's blood pressure
Checking the client's peripheral pulses
Checking the most recent potassium level
Checking the client's intake-and-output record for the last 24 hours
Obtaining serum drug levels periodically to verify therapeutic range
Correct Answer : A,E
Cyclosporine (Sandimmune) is a calcineurin inhibitor used to prevent organ rejection after a kidney transplant. It works by suppressing the immune system to prevent the body from attacking the transplanted organ. Before administering the medication, the nurse should check the client's blood pressure because cyclosporine can cause hypertension¹. The nurse should also obtain serum drug levels periodically to verify that the medication is within the therapeutic range. This is important because cyclosporine has a narrow therapeutic index, meaning that there is a small difference between an effective dose and a toxic dose. Monitoring drug levels can help ensure that the client is receiving an effective dose while avoiding toxicity¹.
The other options are not the best choices for the following reasons:
B. Checking the client's peripheral pulses: While it is important to monitor the client's peripheral pulses as part of routine care, it is not a priority assessment before administering cyclosporine.
C. Checking the most recent potassium level: Cyclosporine can affect electrolyte levels, including potassium, but it is not a priority assessment before administering the medication.
D. Checking the client's intake-and-output record for the last 24 hours: Monitoring the client's fluid balance is important, but it is not a priority assessment before administering cyclosporine.
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Related Questions
Correct Answer is C
Explanation
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the stomach lining and increase the risk of ulcers. Proton pump inhibitors (PPIs) and misoprostol are medications that can help protect the stomach lining and reduce the risk of ulcers in people taking NSAIDs. PPIs work by reducing the amount of acid produced by the stomach, while misoprostol helps to replace prostaglandins, which are important for protecting the stomach lining. Giving aspirin with a PPI or misoprostol can help prevent ulcer formation in people with a history of peptic ulcer disease who need to take aspirin.³
The other options are incorrect because:
- A. Give enteric-coated or buffered aspirin to reduce gastric irritation: Enteric-coated aspirin is designed to resist dissolving and being absorbed in the stomach, so it passes into the small intestine, where it’s absorbed into the bloodstream. The goal is to prevent stomach ulcers and bleeding that can sometimes occur with aspirin use. However, research indicates that enteric-coated aspirin may not be as effective as regular aspirin at reducing blood clot risk. Also, the gastrointestinal benefit of enteric-coated aspirin is minimal to nonexistent. When it comes to rates of ulceration and bleeding, there’s no difference between enteric-coated and regular aspirin¹.
- B. Give aspirin with an antacid to neutralize gastric acid: While antacids can help reduce heartburn and upset stomach that aspirin may cause, they do not prevent the formation of ulcers. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding, including in the stomach and gastrointestinal tract (digestive tract)⁵.
- D. Give aspirin with food or milk to decrease gastric absorption: Taking aspirin with food or milk can help reduce stomach irritation caused by aspirin⁷. However, this does not prevent the formation of ulcers in people with a history of peptic ulcer disease.
Correct Answer is ["A","B","C","D","E"]
Explanation
A. Shake the oral solution vigorously before administration. This is to ensure that the drug is well mixed and evenly distributed in the solution¹². Cyclosporine is a lipophilic drug that forms a microemulsion in the oral solution, which enhances its absorption and bioavailability¹². Shaking the oral solution helps to maintain the stability and consistency of the microemulsion¹².
B. Dilute the oral solution in a glass container with milk or orange juice. This is to improve the taste and palatability of the drug, which may otherwise be bitter or unpleasant¹². Cyclosporine can be diluted with milk, chocolate milk, or orange juice, but not with grapefruit juice, which can increase its blood levels and toxicity¹². The diluted solution should be consumed immediately or refrigerated and used within 24 hours¹². A glass container should be used instead of a plastic one, which may absorb some of the drug and reduce its dose¹².
C. Administer the medication at the same time every day. This is to maintain a consistent blood level of the drug and avoid fluctuations that may affect its efficacy and safety¹². Cyclosporine has a narrow therapeutic window and requires careful monitoring and dosing adjustment to prevent organ rejection or toxicity¹². Administering the medication at regular intervals helps to achieve optimal blood concentrations and avoid peaks and troughs that may increase the risk of adverse effects or suboptimal response¹².
D. Monitor blood pressure and report hypertension to the provider. This is to detect and manage one of the most common and serious side effects of cyclosporine, which is hypertension¹². Cyclosporine can cause vasoconstriction and sodium retention, which can increase blood pressure and lead to cardiovascular complications such as stroke, heart failure, or kidney damage¹². The nurse should measure blood pressure regularly and report any elevation or signs of hypertensive crisis to the provider¹². The provider may prescribe antihypertensive drugs or adjust the dose of cyclosporine to control blood pressure¹².
E. Obtain serum drug levels periodically to verify therapeutic range. This is to ensure that the dose of cyclosporine is adequate and appropriate for the individual patient's needs and response¹². Cyclosporine has a high inter- and intra-patient variability in pharmacokinetics, which means that its absorption, distribution, metabolism, and excretion can differ significantly among different patients or even within the same patient over time¹². Factors such as age, weight, gender, genetics, diet, drug interactions, organ function, and disease state can affect cyclosporine blood levels and require dose adjustment¹². The nurse should obtain serum drug levels at specified times (usually 12 hours after the last dose) and report them to the provider, who may modify the dose based on the results¹².
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