A patient is taking cyclosporine (Sandimmune) and prednisone to prevent organ rejection after right renal transplantation. The patient is febrile and complains of right-sided flank pain
The nurse reviews the patient's chart and finds that the patient's BUN and serum creatinine are elevated. The cyclosporine trough is 150 ng/mL. What will the nurse do?
a. Be concerned that the left kidney is failing.
b. Expect the provider to order intravenous methylprednisolone.
c. Request an order for a urine culture.
d. Suspect nephrotoxicity secondary to an elevated cyclosporine level.
ANS: B
The patient is showing signs of acute organ rejection, which include pain at the graft site, fever, and elevated BUN and creatinine; therefore, intravenous methylprednisolone is indicated. Because the patient is having pain on the right side, along with fever and elevated renal function test results, there is no reason to suspect that the left kidney is failing or that an infection is present. The cyclosporine level is within normal limits.
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