The nurse is administering sodium polystyrene sulfonate to a client in acute kidney injury (AKI). Which laboratory finding indicates that the medication has been effective?

• Glucose [Reference Range: 74 to 106 mg/dL (4.1 to 5.9 mmol/L)]
• Hemoglobin (Hgb) [Reference Range:12-16 g/dL (120-160 g/L)]
• Potassium (K+) [Reference Range: 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]
• Ammonia [Reference Range: Adult: 10 to 80 Mcg/dL (6 to 47 Mcmol/dL)]

Choice A rationale: Ingestion of Wort can reduce the client's intake of sodium: This information is not directly related to the situation of a renal transplant and graft rejection. It is not the most significant finding regarding the use of St. John's Wort in this context.

Choice B rationale: Adding the herb decreases the need for corticosteroids: There is no evidence or indication that St. John's Wort can decrease the need for corticosteroids, especially in the context of a renal transplant and graft rejection.

Choice C rationale: While St. John's Wort is sometimes used as an herbal remedy for depression, the most significant information, in this case, is its potential to interact with cyclosporine and affect the client's immunosuppressive medication. The focus should be on the drug interaction and the risk it poses to the client's graft health, rather than the reason for using the herb.

Choice D rationale: The most significant information about the finding that the client has been self-administering St. John's Wort is that it can decrease plasma concentrations of cyclosporine. Cyclosporine is an immunosuppressive medication commonly used after a renal transplant to prevent graft rejection. When St. John's Wort is taken concurrently with cyclosporine, it can induce certain liver enzymes responsible for drug metabolism, leading to a decreased concentration of cyclosporine in the bloodstream. This can potentially reduce the effectiveness of cyclosporine in preventing graft rejection, putting the client's transplanted kidney at risk.

Choice A rationale: Non-steroidal anti-inflammatory drugs (NSAIDs) are a different class of
medications commonly used to relieve pain, inflammation, and reduce fever. They are not used
for treating hypertension or acting as ACE inhibitors.
Choice B rationale: Angiotensin II receptor blockers (ARBs) are another class of
antihypertensive medications that work by blocking the action of angiotensin II, a hormone that
causes blood vessels to constrict. While ARBs are similar in function to ACE inhibitors in
managing blood pressure, captopril specifically belongs to the ACE inhibitor class.
Choice C rationale: Captopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE
inhibitors are a class of antihypertensive medications that work by inhibiting the enzyme ACE,
which converts angiotensin I to angiotensin II. By inhibiting this conversion, ACE inhibitors
help relax and dilate blood vessels, leading to decreased blood pressure. They are commonly
used to treat hypertension and other cardiovascular conditions.
Choice D rationale: Aldosterone antagonists are a different class of medications used to block the
action of aldosterone, a hormone that regulates sodium and water balance in the body. They are
used to manage conditions such as heart failure and hypertension but are not synonymous with ACE inhibitors like captopril.