A nurse is caring for a client who is admitted to the emergency department for fatigue.
Which of the following findings indicate that the client may be experiencing transplant rejection? (Select all that apply).
Assessment of lower extremities
Sodium level
Lung sounds
Creatinine level
Assessment of Incision site
Bowel sounds
Blood pressure.
Correct Answer : D,E
A. Assessment of Lower Extremities
Edema is common in renal failure but not specific to transplant rejection.
B. Sodium Level
Sodium level changes can occur with various conditions but are not specific to transplant rejection.
C. Lung Sounds
Lung sounds are important for respiratory issues but not directly indicative of kidney transplant rejection.
D. Creatinine Level
Elevated creatinine indicates possible kidney dysfunction or rejection.
E. Assessment of Incision Site
Signs of infection or inflammation at the incision site could indicate transplant issues.
F. Bowel Sounds
Hypoactive bowel sounds are related to gastrointestinal issues, not directly to transplant rejection.
G. Blood Pressure
Elevated blood pressure can be a consequence of many conditions but is not specific for transplant rejection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A,B"}}
Explanation
1. Provider Consult
Angina: Not typically associated with immediate provider consultation.
MI: Requires immediate consultation for treatment decisions, such as medication or interventions.
2. Client's Initial Report of Manifestations
Angina: Can present with discomfort or pressure that is transient and relieved by rest or nitroglycerin.
MI: Can present similarly but is often more severe and sustained; discomfort may be a precursor to a myocardial infarction.
3. Treadmill Stress Test
Angina: Often used to provoke symptoms under controlled conditions for diagnosis.
MI: Not used during an acute phase; rather, diagnostics are performed through EKG and cardiac enzyme tests.
4. Result of Nitroglycerin Therapy
Angina: Relief from nitroglycerin indicates angina.
MI: Nitroglycerin might not provide relief; other treatments and diagnostics are needed.
5. 12 Lead EKG Report
Angina: ST depression and T-wave inversion can occur with angina.
MI: These EKG changes can indicate ischemia, which could be part of an acute MI if accompanied by other severe symptoms or in the presence of persistent symptoms.
Correct Answer is C
Explanation
A. Tachypnea is not a primary sign of increased intracranial pressure but might be seen in other conditions.
B. Bilateral weakness of extremities can indicate severe brain injury but is not the most specific sign of increased intracranial pressure.
C. Decreased level of consciousness is a direct sign of increased intracranial pressure affecting brain function.
D. Hypotension is not a typical manifestation of increased intracranial pressure; increased ICP more commonly leads to hypertension.
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