Nokea
A patient who has had a recent organ transplant is taking sirolimus as part of the immunosuppressant therapy. Today, the patient realized that a dose was missed, and it is now time for the next dose. Which action is appropriate?
- A. Just take the dose that is now due, not both doses.
- B. Take the missed dose of sirolimus along with the next dose that is due.
- C. Take half of the missed dose along with the current dose that is due.
- D. Contact the transplant physician for instructions.
Correct Answer: D
Rationale: If a dose of sirolimus is missed, it should be taken as soon as the patient remembers, unless it is close to the time that the next dose is due. In this case, the patient must contact the transplant physician.
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A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified product (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct?
- A. Hold the dose until the prescriber makes rounds.
- B. Give the cyclosporine-modified drug.
- C. Double-check the order, and then give the cyclosporine-modified drug.
- D. Notify the pharmacy to obtain the Sandimmune form of the drug.
Correct Answer: D
Rationale: Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. The nurse must obtain the Sandimmune form of the drug from the pharmacy.
When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction?
- A. Reduced adverse effects of the cyclosporine
- B. Increased levels of cyclosporine and toxicity
- C. Reduced uric acid levels
- D. Reduced nephrotoxic effects of cyclosporine
Correct Answer: B
Rationale: Allopurinol may cause increased levels of cyclosporine, and toxicity may result.
A patient will be on a tacrolimus infusion after receiving a liver transplant. The order reads, 'Give 0.03 mg/kg/day as a continuous IV infusion.' The patient weighs 211 pounds, and the medication injection solution is available in a 5 mg/mL strength. Identify how many milliliters will the nurse draw up for this infusion. (Record answer using two decimal places.)
Correct Answer: 0.58 mL
Rationale: Convert pounds to kilograms: 211 ?· 2.2 = 95.91 kg. Calculate dose: 0.03 mg/kg/day ?? 95.91 kg = 2.8773 mg/day. Calculate volume: 2.8773 mg ?· 5 mg/mL = 0.57546 mL, rounded to 0.58 mL.
Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect?
- A. Nausea and vomiting
- B. Fever and tremors
- C. Agitation
- D. Hypertension
Correct Answer: D
Rationale: Moderate hypertension may occur in patients taking cyclosporine.
A patient has started azathioprine therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.)
- A. Tremors
- B. Leukopenia
- C. Diarrhea
- D. Thrombocytopenia
- E. Hepatotoxicity
- F. Fluid retention
Correct Answer: B,D,E
Rationale: Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity.