The nurse is working with a client who is taking an immunosuppressant agent. Which statement made by the client would require further teaching?
1. "I know to call the physician if I start experiencing a lot of bruising.".
2. "I should drink plenty of water to keep me from getting dehydrated.".
3. "I should drink a lot of fruit juices, such as grapefruit juice.".
4. "If I experience any joint pain, I should take ibuprofen for the pain as needed every four hours.".
3. "I should drink a lot of fruit juices, such as grapefruit juice.".
Rationale:
Immunosuppressive agents inhibit T cell development and activation. They are given concurrently with glucocorticoids and in combination with other immunosuppressants, and inhibit immune system activity and organ rejection. Nursing responsibilities include monitoring BUN and creatinine for evidence of nephrotoxicity. The client should avoid grapefruit juice, which can raise cyclosporine levels by 50–200% and increase the risk of toxicity. Fluids should be increased to maintain good hydration and urinary output. Ibuprofen is acceptable for immunosuppressive medications, but should not be taken with cytotoxic agents.
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