When monitoring a client after a kidney transplant, which of the following findings would indicate a potential acute rejection of the transplant?

Fever and fluid retention

A steady increase in urine output

Decreased blood creatinine levels

Increased appetite and weight gain

Answer and Explanation

The Correct Answer is A

After a kidney transplant, the immune system may recognize the transplanted organ as foreign and initiate an inflammatory response known as acute rejection. This typically occurs within days to months post-transplant and can compromise graft function if not identified early. Clinical monitoring focuses on early signs of inflammation, reduced renal function, and systemic changes indicating immune activation. Prompt recognition is essential to preserve graft viability and prevent irreversible damage.

Rationale:
A. Fever and fluid retention are key indicators of potential acute rejection. Fever reflects an inflammatory or immune response against the transplanted kidney. Fluid retention occurs due to impaired renal function as the rejecting kidney loses its ability to regulate fluid balance effectively, often leading to edema and hypertension.

B. A steady increase in urine output is not typically associated with acute rejection and may instead indicate improving graft function or appropriate response to therapy. In acute rejection, urine output more commonly decreases due to declining renal function and reduced glomerular filtration.

C. Decreased blood creatinine levels suggest improved kidney function rather than rejection. In acute rejection, serum creatinine typically rises due to impaired filtration and declining graft performance. A downward trend in creatinine is a reassuring finding, not a warning sign.

D. Increased appetite and weight gain are not specific indicators of acute transplant rejection. While weight gain may occur due to fluid retention, increased appetite alone is not associated with immune-mediated graft dysfunction. More specific signs such as fever, rising creatinine, and reduced urine output are more clinically relevant.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is C

Explanation

Tumor lysis syndrome (TLS) is an oncologic emergency that occurs when rapid destruction of malignant cells releases intracellular contents such as potassium, phosphate, and uric acid into the bloodstream. This leads to metabolic disturbances including hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury due to uric acid crystal deposition in renal tubules. Prevention of renal failure through aggressive hydration is a key priority in management. Nursing care focuses on maintaining renal perfusion and promoting excretion of toxic metabolites.

Rationale:
A. Administering a bisphosphonate is not a primary intervention for tumor lysis syndrome. Bisphosphonates are mainly used to treat hypercalcemia associated with malignancy, not the metabolic disturbances seen in TLS. While calcium imbalances may occur, the primary concern in TLS is preventing renal failure through hydration and metabolic correction.

B. Obtaining blood cultures is not relevant to tumor lysis syndrome because TLS is not an infectious process. It is a metabolic complication caused by rapid tumor cell breakdown following chemotherapy or radiation therapy. Blood cultures are indicated for suspected infection, not for metabolic emergencies like TLS.

C. Encouraging fluid intake of 3 L daily is the priority intervention because it promotes renal perfusion and enhances excretion of uric acid, potassium, and phosphate. Adequate hydration helps prevent crystal precipitation in the renal tubules, reducing the risk of acute kidney injury. In some cases, intravenous fluids are also used to maintain high urine output as part of aggressive prophylaxis and treatment.

D. Placing the client in a semi-Fowler’s position does not address the underlying metabolic and renal complications of tumor lysis syndrome. While positioning may support breathing comfort in some conditions, it has no effect on electrolyte imbalance or uric acid clearance. The priority remains fluid management and renal protection.

A. WBC count of 4,800 mm3 B. WBC count of 500 mm3 C. Hemoglobin level of 11.5 g/dL D. Platelet count of 150,000 mm3

Correct Answer is C

Explanation

Bone marrow suppression leads to decreased production of blood components, including red blood cells, white blood cells, and platelets. The specific abnormality depends on the affected cell line. Epoetin alfa is used to stimulate red blood cell production in the bone marrow, particularly in clients with anemia related to chronic kidney disease, chemotherapy, or bone marrow suppression. Therefore, improvement is best reflected by an increase in hemoglobin levels.

Rationale:
A. A WBC count of 4,800 mm³ indicates a normal or near-normal white blood cell level, but it does not reflect the therapeutic effect of epoetin alfa. This medication does not stimulate leukocyte production. WBC changes are more relevant to growth factors like filgrastim, not erythropoiesis-stimulating agents.

B. A WBC count of 500 mm³ indicates severe neutropenia and significant bone marrow suppression. This reflects a high risk for infection and does not demonstrate improvement. It is unrelated to the action of epoetin alfa, which targets red blood cell production.

C. A hemoglobin level of 11.5 g/dL indicates improvement because epoetin alfa stimulates erythropoiesis, increasing red blood cell production. This rise in hemoglobin suggests improved oxygen-carrying capacity and reduced anemia. It reflects the intended therapeutic outcome of the medication.

D. A platelet count of 150,000 mm³ is within normal limits but does not reflect the action of epoetin alfa. Platelet production is regulated by different mechanisms and medications such as thrombopoietin agonists or oprelvekin. Therefore, it is not an appropriate indicator of response to epoetin alfa therapy.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

When monitoring a client after a kidney transplant, which of the following findings would indicate a potential acute rejection of the transplant?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is being treated for tumor lysis syndrome. Which nursing intervention should the nurse prioritize to minimize complications associated with this condition?

Correct Answer is C

Explanation

A nurse is reviewing the laboratory values of a client with bone marrow suppression and is receiving epoetin alfa. Which of the following values would indicate an improvement in the client's condition?

Correct Answer is C

Explanation

A client with severe cirrhosis presents with elevated ammonia levels. Which of the following dietary modifications should the nurse prioritize for the client to help manage ammonia levels?

A nurse is caring for a client with pneumonia who is on mechanical ventilation and exhibits a respiratory rate of 34 breaths per minute. The client's ABG results show a pH of 7.5, PaCO2 of 28 mm Hg, and HCO3 of 22 mEq/L. Which nursing action should be prioritized?

A client with cirrhosis presents with a serum sodium level of 127 mEq/L. Which of the following interventions should the nurse prioritize in the client's care plan after discussion with the provider?

A client with liver cirrhosis presents with confusion, lethargy, and asterixis. Which complication is the client most likely experiencing?

A nurse is caring for a client with cirrhosis who is scheduled to undergo a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure. What is the primary purpose of this procedure in clients with cirrhosis?

A client on mechanical ventilation with extensive burns covering 30% of total body surface area requires nutritional support. Which of the following is the most appropriate initial intervention to address the client's increased metabolic demands?

A client presents with a partial-thickness burn covering 20% of their total body surface area (TBSA) after an industrial accident. What is the most appropriate initial action by the nurse to manage fluid resuscitation for this client?

Which of the following statements about internal radiation therapy (brachytherapy) are accurate? Select All that Apply