Page 1917 - Saunders Comprehensive Review For NCLEX-RN

mg/dL (3.9–5.5 mmol/L).
Test-Taking Strategy: Focus on the subject, the adverse effects of cyclosporine.
Recall that cyclosporine can be nephrotoxic. The correct option is the only one that
indicates an increased level of a renal function test. Also, recalling the normal
laboratory reference levels will direct you to the correct option, the only abnormal
level.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Pharmacology: Renal and Urinary Medications: Organ rejection
prevention
Health Problem: Adult Health: Immune: Transplantation
Priority Concepts: Immunity; Safety
Reference: Lewis et al. (2017), pp. 211, 1026.

670. Answer: 3

Rationale: A compound present in grapefruit juice inhibits metabolism of
cyclosporine through the cytochrome P450 system. As a result, consumption of
grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly
increasing the risk of toxicity. Red meats, orange juice, and green, leafy vegetables
do not interact with the cytochrome P450 system.
Test-Taking Strategy: Focus on the subject, the item to exclude from the diet.
Recall that grapefruit juice is contraindicated with many medications. Use of general
pharmacology guidelines will direct you to the correct option.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology: Renal and Urinary Medications: Organ rejection
prevention
Health Problem: N/A
Priority Concepts: Client Education; Safety
Reference: Lewis et al. (2017), p. 209.

671. Answer: 4

Rationale: Tacrolimus is a potent immunosuppressant used to prevent organ
rejection in transplant clients. It is important that the medication be taken at 12-hour
intervals to maintain a stable blood level to prevent organ rejection. Adverse effects
include hyperglycemia and hypertension, so the client does not eat frequently to
avoid hypoglycemia or use precautions to avoid orthostatic hypotension. Tacrolimus
is metabolized through the cytochrome P450 system, so grapefruit juice is not
allowed.
Test-Taking Strategy: Focus on the subject, teaching a transplant client regarding
tacrolimus. Focus on the goal of avoiding organ rejection by maintaining a stable
level of tacrolimus in the blood by taking the medication at regular intervals every
day.

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