A nurse is preparing to administer cyclosporine (Sandimmune), a calcineurin inhibitor, to a client who had a kidney transplant. Which of the following actions should the nurse take? (Select all that apply.)¹
Shake the oral solution vigorously before administration
Dilute the oral solution in a glass container with milk or orange juice
Administer the medication at the same time every day
Monitor blood pressure and report hypertension to the provider
Obtain serum drug levels periodically to verify therapeutic range
Correct Answer : A,B,C,D,E
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","E"]
Explanation
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.
Correct Answer is D
Explanation
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 .
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