A nurse is caring for a patient who has undergone a kidney transplant and is receiving cyclosporine as part of their immunosuppressive therapy. Which of the following should the nurse include in the care plan? Select all that apply.

Choice A rationale Cyclosporine is a lipophilic polypeptide that requires consistent administration in relation to food to ensure stable plasma concentrations. Variations in fat content within meals can significantly alter the bioavailability and absorption rate of the drug. By maintaining a consistent intake pattern, either always with food or always without, the patient avoids dangerous fluctuations in therapeutic levels. This consistency is vital to prevent graft rejection caused by subtherapeutic levels or toxicity caused by supratherapeutic levels. Choice B rationale Pulmonary status and coughing are not primary monitoring parameters specifically linked to the unique side effect profile of cyclosporine therapy. While general immunosuppression increases the risk of opportunistic infections like pneumonia, cyclosporine does not typically cause direct pulmonary toxicity. The nurse should focus more on renal, hepatic, and neurological assessments. Monitoring for a cough might be more relevant for patients on ACE inhibitors or those with specific fungal risks, rather than a standard cyclosporine protocol. Choice C rationale Nephrotoxicity is the most serious and common adverse effect of cyclosporine therapy, occurring in up to 75 percent of patients. The drug causes dose-dependent constriction of the afferent arterioles in the kidney, leading to decreased renal blood flow and a reduced glomerular filtration rate. Normal serum creatinine levels range from 0.7 to 1.3 mg/dL. The nurse must monitor for elevations in creatinine and BUN to distinguish between drug-induced renal damage and potential organ transplant rejection. Choice D rationale Hirsutism and gingival hyperplasia are well-documented side effects of cyclosporine that affect patient appearance and oral health. Hirsutism involves the growth of excess body hair, while gingival hyperplasia is the overgrowth of gum tissue around the teeth. These conditions can lead to significant body image distress and dental complications. The nurse should encourage meticulous oral hygiene and frequent dental checkups to manage tissue overgrowth and prevent secondary infections or tooth loss associated with these side effects. Choice E rationale Administering cyclosporine without food is not a mandatory requirement, but consistency is the priority. Some protocols allow for administration on an empty stomach to achieve faster peak levels, but this often causes gastrointestinal upset. The most critical factor is that the method chosen by the patient remains identical every day. Switching between taking it with a large meal and taking it on an empty stomach causes unpredictable absorption, making it difficult to maintain the narrow therapeutic window.