A nurse is caring for a male client who has a new prescription for cyclosporine following a kidney transplant. Which of the following findings should the nurse identify as an adverse effect of this therapy?

Rationale:
A. "I am aware that my diabetes is caused by an autoimmune disorder.": Type 1 diabetes mellitus results from the immune system attacking the insulin-producing beta cells in the pancreas. This autoimmune destruction leads to a complete deficiency of insulin, making lifelong replacement necessary.

B. "I know that my diabetes developed slowly over several years.": Type 1 diabetes often has a rapid onset, especially in younger individuals. Symptoms such as polyuria, polydipsia, weight loss, and fatigue can appear suddenly over days or weeks, rather than gradually over several years.

C. "If I lose weight, I may be able to stop taking insulin.": Weight loss does not eliminate the need for insulin in type 1 diabetes. Because the pancreas no longer produces insulin, insulin therapy remains necessary regardless of changes in body weight or physical condition.

D. "I have developed a resistance to insulin.": Insulin resistance is a feature of type 2 diabetes, where the body produces insulin but cannot use it effectively. In type 1 diabetes, the problem is a lack of insulin production due to the destruction of pancreatic beta cells.

Rationale:

Stop transfusion: The client is showing signs of a serious transfusion reaction such as fever, chills, back pain, and hypotension. Immediately stopping the transfusion prevents further infusion of incompatible blood, which could worsen hemolysis and lead to shock or kidney failure.

Flush blood transfusion tubing: Flushing the existing blood tubing with saline could push more incompatible blood cells into the circulation. This can intensify the reaction and increase the risk of complications. Instead, new IV tubing with normal saline should be used if further IV access is needed.

Notify blood bank: The blood bank must be informed to initiate an investigation, verify blood compatibility, and conduct testing to determine the cause of the reaction. This helps prevent further occurrences and ensures patient safety.

Notify primary physician: The physician needs to be informed promptly to provide additional orders, such as fluid resuscitation, lab tests, or medications to stabilize the client. Immediate collaboration is essential to manage the adverse event effectively.

Return blood and tubing to blood bank: Returning the blood product and used tubing allows the blood bank to analyze the unit for errors or contamination. This is necessary for confirming the transfusion reaction and documenting the incident.

Administer IV diphenhydramine: Diphenhydramine may be used to reduce symptoms such as itching or chills if an allergic component is suspected. It is often part of the initial response while further evaluation and treatment are underway.

Administer oxygen: The client’s oxygen saturation has dropped, and respirations are rapid and labored. Administering oxygen supports tissue oxygenation and addresses hypoxia during this acute reaction, which may compromise respiratory function.