Twenty hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for

A. Creatinine clearance: Creatinine clearance measures kidney function and glomerular filtration rate but does not reflect the effectiveness of calcium carbonate therapy. Calcium carbonate is prescribed to bind phosphate, not to improve renal filtration. Monitoring creatinine is important for overall kidney status but not for medication efficacy.

B. Blood pressure: Blood pressure assessment is important in chronic kidney disease management, but it does not indicate whether calcium carbonate is effectively controlling phosphate levels. Hypertension may be affected by fluid balance and other medications, not directly by calcium carbonate.

C. Neurologic status: Neurologic assessment can detect complications of electrolyte imbalances, such as severe hyperphosphatemia or hypocalcemia, but it is not a direct measure of calcium carbonate effectiveness. Changes in neurological function are late indicators rather than immediate markers.

D. Phosphate level: Calcium carbonate binds dietary phosphate to reduce serum phosphate levels in chronic kidney disease. Monitoring phosphate levels allows the nurse to determine if the medication is achieving its therapeutic goal. A decrease in phosphate indicates effective treatment.

A. Perform a halo test: Clear nasal drainage in a client with periorbital ecchymosis may indicate cerebrospinal fluid (CSF) leakage. The halo or ring test helps differentiate CSF from normal nasal secretions, which is critical for detecting a basilar skull fracture. Early identification guides further neurologic assessment and prevents complications.

B. Instruct the client to blow his nose and check the nares for inflammation: Blowing the nose can increase intracranial pressure and worsen CSF leakage. Assessing for inflammation does not confirm CSF presence and may be harmful in suspected skull fractures.

C. Obtain a specimen of the fluid for culture and sensitivity: Culturing the fluid is unnecessary initially and may delay urgent assessment. Identifying CSF leakage takes priority to prevent infection and guide immediate care.

D. Check the nasal drainage for glucose: Glucose testing can suggest CSF, but the halo test provides a more rapid and reliable bedside assessment. Confirming CSF leakage quickly is essential for early intervention.