A nurse is caring for a client who is admitted to the emergency department for fatigue.
Which of the following findings indicate that the client may be experiencing transplant rejection? (Select all that apply).
Assessment of lower extremities
Sodium level
Lung sounds
Creatinine level
Assessment of Incision site
Bowel sounds
Blood pressure.
Correct Answer : D,E
A. Assessment of Lower Extremities
Edema is common in renal failure but not specific to transplant rejection.
B. Sodium Level
Sodium level changes can occur with various conditions but are not specific to transplant rejection.
C. Lung Sounds
Lung sounds are important for respiratory issues but not directly indicative of kidney transplant rejection.
D. Creatinine Level
Elevated creatinine indicates possible kidney dysfunction or rejection.
E. Assessment of Incision Site
Signs of infection or inflammation at the incision site could indicate transplant issues.
F. Bowel Sounds
Hypoactive bowel sounds are related to gastrointestinal issues, not directly to transplant rejection.
G. Blood Pressure
Elevated blood pressure can be a consequence of many conditions but is not specific for transplant rejection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. First-degree AV block shows a prolonged PR interval but not necessarily an irregular heart rate or a significant pulse deficit.
B. Atrial fibrillation is characterized by a rapid and irregular heart rate with a significant pulse deficit, which aligns with the client's symptoms.
C. Sinus tachycardia presents with a rapid but regular heart rate, not irregular palpitations.
D. Sinus bradycardia shows a slow heart rate and is not associated with an irregular heart rate or significant pulse deficit.
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}
Explanation
- Incisional Site Bleeding: This is important to check as it indicates possible complications like infection or hematoma formation at the pacemaker insertion site.
- Bradycardia: It is essential to ensure that the pacemaker is functioning correctly and managing bradycardia as intended. Continuous monitoring is needed to detect any issues related to pacemaker settings or lead placements.
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