Which of the following assessment findings or results will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate for a client with chronic kidney disease?

A. bone marrow transplant: Bone marrow transplant does not reverse hyperacute rejection. This type of rejection occurs because of pre-existing antibodies, and once the process begins, the damage progresses too rapidly for immune-modulating procedures like marrow transplant to be effective.

B. immediate dialysis to prevent damage to the new kidney: Dialysis may be needed after the kidney is removed, but it does not stop the rejection process. Hyperacute rejection results in irreversible vascular injury to the graft, so dialysis cannot salvage the transplanted organ.

C. high-dose intravenous cyclosporin therapy: Cyclosporin is useful for preventing or managing acute rejection, not hyperacute rejection. In hyperacute rejection, the tissue damage occurs within minutes to hours, and immunosuppressive therapy cannot reverse the destruction once it has begun.

D. removal of the transplanted kidney: Hyperacute rejection is caused by preformed antibodies that immediately attack the graft, leading to rapid thrombosis and necrosis. The transplanted organ is nonviable, so prompt removal is necessary to prevent systemic complications such as sepsis or disseminated clotting.

A. hypokalemia, hypernatremia, and hypoalbuminemia: Hypokalemia and hypernatremia are not expected early findings after a major burn. Potassium initially rises due to massive cell destruction, and sodium commonly falls because of fluid shifts into the interstitial space, making this pattern inconsistent with the emergent phase.

B. hyperkalemia, hypernatremia, and hyperalbuminemia: Although hyperkalemia is expected, hypernatremia is unlikely because sodium shifts into the tissues with extensive edema. Albumin levels usually fall due to increased capillary permeability and plasma protein loss, so hyperalbuminemia would not be seen.

C. hyperkalemia, hyponatremia, and metabolic alkalosis: The potassium and sodium patterns fit early burn physiology, but metabolic alkalosis does not. Massive fluid loss, hypoperfusion, and lactic acid accumulation commonly produce metabolic acidosis rather than alkalosis during the emergent period.

D. hyperkalemia, hyponatremia, and metabolic acidosis: This combination reflects typical early burn responses. Potassium rises from cellular lysis, sodium falls due to third spacing, and acidosis develops from tissue hypoxia and anaerobic metabolism.