A patient who underwent kidney transplantation is being educated about the types of transplant rejection.

Which statement about hyperacute rejection is true?

Choice A rationale

While maintaining hydration is generally important for oncology patients to prevent complications like tumor lysis syndrome, it does not address the acute mechanical compression of the spinal cord. Spinal cord compression is a structural emergency where a tumor mass or vertebral collapse puts direct pressure on the neural elements. Fluid intake has no effect on reducing this pressure or preventing the permanent paralysis that can occur if the compression is not relieved by medical interventions.

Choice B rationale

Bisphosphonates are used to treat hypercalcemia of malignancy by inhibiting osteoclast activity, but they are not the primary treatment for spinal cord compression. Although some patients with bone metastases may have concurrent hypercalcemia, the immediate threat in spinal cord compression is neurological deficit due to edema and ischemia of the spinal cord. Therefore, bone stabilizing agents are secondary to interventions that directly reduce the inflammatory response and the physical size of the compressive mass.

Choice C rationale

Positioning a client in a semi-Fowler position may help with respiratory effort if the compression is high in the cervical or thoracic spine, but it is not a curative or primary intervention for the oncologic emergency itself. Proper alignment and stabilization of the spine are often more critical to prevent further mechanical injury to the cord. While comfort and ventilation are important, they do not provide the necessary medical treatment to reverse the neural compression.

Choice D rationale

High dose intravenous corticosteroids, such as dexamethasone, are the gold standard initial treatment for malignant spinal cord compression. They work by rapidly reducing vasogenic edema around the spinal cord and the tumor site, which relieves pressure and helps preserve neurological function. This intervention is often followed by radiation therapy or surgery. Prompt administration is essential because the duration of symptoms before treatment is a major predictor of the final functional and neurological outcome.

Choice A rationale

Succinylcholine is a depolarizing neuromuscular blocker, and enflurane is a volatile inhalation anesthetic. Both are well-known primary triggers for malignant hyperthermia in genetically susceptible individuals. These agents induce a massive, uncontrolled release of calcium from the sarcoplasmic reticulum in skeletal muscle cells. This leads to a hypermetabolic state characterized by muscle rigidity, hypercapnia, and dangerous pyrexia. Anesthesiologists must strictly avoid these medications and instead use safe alternatives like nitrous oxide or propofol for at-risk clients.

Choice B rationale

Communication is a critical safety intervention to prevent the accidental administration of triggering agents. Malignant hyperthermia is an autosomal dominant genetic disorder, meaning a family history significantly increases the client's risk. Notifying the entire intraoperative team, including surgeons, scrub nurses, and circulating nurses, ensures that the operating room is prepared with a "clean" anesthesia machine and that the malignant hyperthermia emergency cart, containing the necessary dantrolene, is immediately accessible if a crisis occurs during the procedure.

Choice C rationale

Placing an allergy or risk-alert band on the client serves as a visual safeguard that persists throughout the perioperative period. In the fast-paced environment of a surgical suite, this band provides a constant reminder to all healthcare providers that the client has a life-threatening contraindication to specific medications. This redundancy in communication helps prevent human errors, such as the administration of succinylcholine during emergency intubation or the use of halogenated gases during the maintenance phase of general anesthesia.

Choice D rationale

Documentation of a family history of malignant hyperthermia is a legal and clinical necessity for the preoperative record. This information alerts subsequent providers to the risk and ensures that a thorough assessment of the client's own history with anesthesia is conducted. Accurate documentation triggers the hospital's specific malignant hyperthermia protocol, which includes specialized monitoring of end-tidal carbon dioxide and core body temperature, as these are the earliest indicators of a hypermetabolic crisis during the administration of anesthesia.

Choice E rationale

Naloxone is an opioid antagonist used primarily to reverse the effects of respiratory depression caused by opioid overdose. It has no pharmacological role in the prevention or treatment of malignant hyperthermia. The gold-standard treatment for a malignant hyperthermia crisis is dantrolene sodium, a skeletal muscle relaxant that inhibits calcium release from the sarcoplasmic reticulum. Preparing to administer naloxone instead of focusing on dantrolene or cooling measures would be an inappropriate and ineffective response to this specific genetic risk. .