# A kidney transplant client on sirolimus is scheduled for an elective inguinal hernia repair. Which is the nurse's most appropriate action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391875&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A kidney transplant client on sirolimus is scheduled for an elective inguinal hernia repair. Which is the nurse's most appropriate action?

## Option

1. No medication change required
2. Stop all immunosuppression for 1 month
3. Double the sirolimus dose pre-op
4. Notify the provider — sirolimus impairs wound healing; many programs hold sirolimus before surgery and bridge with another agent, resuming after wound healing **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): Sirolimus (mTOR inhibitor) markedly impairs wound healing and increases dehiscence — most programs hold sirolimus before elective surgery and bridge with another agent (calcineurin inhibitor + MMF) until wound healing. Also causes hyperlipidemia, oral ulcers, proteinuria, interstitial lung disease. (1,3,4) Wrong.

## In-depth explanation

Memory Tip mTOR inhibitor (Sirolimus·Everolimus) = "Slows wound healing + Lipids up". Hold around surgery. Used as anti-rejection AND for some cancers.

## Clinical scenario

Scenario 55-year-old male 1 year post-kidney transplant on sirolimus; scheduled for elective hernia repair next month.

## Key concepts

- **mTOR inhibitor** — Sirolimus, everolimus; mammalian target of rapamycin inhibitor; impairs wound healing.
- **Sirolimus pre-operative hold** — Hold electively before surgery; bridge with CNI + MMF; resume after wound healing.
- **Sirolimus adverse effects** — Hyperlipidemia, proteinuria, oral ulcers, interstitial lung disease.

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