Which statement made by the client taking an immunosuppressive agent to manage rheumatoid arthritis would require further teaching by the nurse?
1. "I should drink a lot of fluids like grapefruit juice.".
2. "I know I'll have to cope with having my blood drawn regularly.".
3. "This medication may cause damage to my kidneys.".
4. "If I experience any joint pain, I can take ibuprofen as needed every 4 hours.".
"I should drink a lot of fluids like grapefruit juice.".
Rationale: Fluids should be increased to maintain good hydration and urinary output, but the client should avoid grapefruit juice, which can raise cyclosporine levels by 50% to 200% and increase the risk of toxicity. Immunosuppressive agents inhibit T cell development and activation. Nursing responsibilities would include monitoring BUN and creatinine for evidence of nephrotoxicity that would require frequent blood draws. Ibuprofen is acceptable for immunosuppressive medications, but should not be taken with cytotoxic agents.
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