The nurse is caring for a patient after a recent kidney transplant. What statement will the nurse include when teaching the patient about preventing organ rejection?

Take your immunosuppressive medications only when you notice symptoms of rejection.

It's important to avoid exercise for the first year after the transplant.

You should follow the prescribed medication regimen exactly as directed, even if you feel well.

You should take herbal supplements to boost your immune system.

Answer and Explanation

The Correct Answer is C

Choice A reason: Taking immunosuppressive medications only when symptoms of rejection are noticed is incorrect. Immunosuppressive medications must be taken consistently as prescribed to prevent rejection, even when the patient feels well.

Choice B reason: Avoiding exercise for the first year after the transplant is not necessary. Patients are usually encouraged to engage in light to moderate exercise to promote overall health and recovery. The type and level of exercise should be discussed with the healthcare provider.

Choice C reason: Following the prescribed medication regimen exactly as directed is crucial for preventing organ rejection. Consistent use of immunosuppressive medications helps maintain the balance needed to prevent the immune system from attacking the transplanted organ.

Choice D reason: Taking herbal supplements to boost the immune system is incorrect. Patients with organ transplants need to suppress their immune system to prevent rejection. Herbal supplements can interact with immunosuppressive medications and are generally not recommended without consulting a healthcare provider.

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Correct Answer is B

Explanation

Choice A reason: An arterial pH less than 7.3 indicates acidosis, which is common in diabetic ketoacidosis but not typical in hyperglycemic hyperosmolar syndrome. Patients with hyperglycemic hyperosmolar syndrome typically have a near-normal pH.

Choice B reason: Altered mental status is a significant clinical manifestation in hyperglycemic hyperosmolar syndrome due to severe hyperglycemia and the hyperosmolar state, which can lead to dehydration and impaired brain function.

Choice C reason: The presence of ketones in urine is more commonly associated with diabetic ketoacidosis rather than hyperglycemic hyperosmolar syndrome. The absence of significant ketonemia differentiates hyperglycemic hyperosmolar syndrome from diabetic ketoacidosis.

Choice D reason: Serum bicarbonate less than 15 mEq/L is indicative of metabolic acidosis, typically seen in diabetic ketoacidosis rather than hyperglycemic hyperosmolar syndrome, where bicarbonate levels are usually normal or slightly decreased.

A. Administer phosphate binders with meals. B. Encourage the patient to increase potassium-rich foods. C. Monitor calcium levels for signs of hypocalcaemia. D. Increase fluid intake to 3 litters per day.

Correct Answer is A

Explanation

Choice A reason: Administering phosphate binders with meals is an essential intervention for managing renal osteodystrophy in patients with chronic kidney disease (CKD). Renal osteodystrophy results from an imbalance of calcium and phosphate in the body due to impaired kidney function. Phosphate binders help reduce the absorption of phosphate from the diet, thereby lowering serum phosphate levels and preventing complications such as secondary hyperparathyroidism and bone disorders. This intervention helps maintain the proper balance of minerals, improving bone health and reducing the risk of fractures and other skeletal complications in CKD patients.

Choice B reason: Encouraging the patient to increase potassium-rich foods is not appropriate for managing renal osteodystrophy. Patients with CKD often need to limit their potassium intake because impaired kidney function can lead to hyperkalaemia (elevated potassium levels), which is potentially life-threatening. Instead of promoting potassium-rich foods, the focus should be on controlling phosphate and maintaining calcium levels.

Choice C reason: Monitoring calcium levels for signs of hypocalcaemia is important in CKD management, but it is not the primary intervention for renal osteodystrophy. While hypocalcaemia can occur in CKD due to disrupted vitamin D metabolism, addressing phosphate levels through the use of phosphate binders is a more targeted approach to managing renal osteodystrophy and preventing secondary hyperparathyroidism.

Choice D reason: Increasing fluid intake to 3 litters per day is generally not recommended for CKD patients, especially those with reduced urine output or fluid retention issues. Excessive fluid intake can lead to fluid overload, hypertension, and heart failure in CKD patients. The intervention should focus on phosphate control rather than fluid intake adjustments.

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