A client is hospitalized with signs of transplant rejection following a recent transplant. Assessment of the client would be expected to reveal?

Appeared in: DHS 2018 shift 1st

Explanation

Kidney transplant rejection impairs the organ's ability to regulate fluid and blood pressure.
The failing kidney retains sodium and water, leading to an expanded fluid volume.
Dysregulation of the renin-angiotensin system by the failing graft also contributes to vasoconstriction and increased blood pressure.
Therefore, a rising blood pressure (hypertension) is a key and expected finding in a client experiencing transplant rejection.

Option A: Transplant rejection causes fluid retention due to decreased kidney function, which leads to weight gain, not weight loss.
Option B: A serum creatinine of 1.25 mg/dL is a near-normal value. The key indicator of rejection is a significant rise in creatinine from the patient's baseline, not a single value within the normal range.
Option C: A urinary output of 50 mL/hr is considered normal and adequate (normal is greater than 30 mL/hr).

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of kidney transplant rejection to guide bedside assessment, documentation, and the next nursing action.
Nurses play a critical role in the early detection of transplant rejection by meticulously monitoring vital signs, daily weights, fluid balance, and lab results.
Patient education is vital. Patients must be taught to self-monitor for signs like weight gain, decreased urination, and new-onset hypertension and to report them immediately.
Prompt identification and reporting of these signs can lead to timely intervention, potentially saving the graft from irreversible damage.

How to Approach the Question

First, identify the core concept of the question, which is 'transplant rejection'. Specifically, it's asking for an expected clinical sign.
Recall the pathophysiology of a failing kidney. A rejected kidney loses its ability to filter blood, produce urine, and regulate blood pressure.
Consider the consequences of this failure: fluid retention, waste product accumulation, and hormonal imbalance.
Evaluate each option based on this pathophysiology:
Does rejection cause weight loss or gain? (Gain, due to fluid). This eliminates option A.
Is a single normal lab value a sign of failure? (No, a change from baseline is key). This makes option B unlikely.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 pp. 314-316, 315-317

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.