NORCET-11 Mains: A client underwent transplant surgery. Which finding indicates rejection of a transplanted kidney?

NORCET-11 Mains

Medical & Surgical Nursing

Medium

Appeared in: NORCET-11 Mains

Explanation

Kidney rejection involves an immune attack on the transplanted organ, leading to impaired function.
The primary function of the kidney is to filter waste products from the blood, a process measured by the Glomerular Filtration Rate (GFR).
Creatinine clearance is a key laboratory measure used to estimate the GFR.
During rejection, damage to the kidney's filtering units causes the GFR to fall.
Therefore, a reduced creatinine clearance is a direct and reliable indicator that the transplanted kidney is being rejected.

Option A: Kidney rejection typically leads to fluid retention and activation of the renin-angiotensin system, which causes an increase in blood pressure (hypertension), not a decrease.
Option B: Rejection is an inflammatory process mediated by the immune system. Such a response is more likely to cause a fever (increased body temperature), not a decrease.
Option D: As the transplanted kidney fails due to rejection, its ability to produce urine is compromised. This results in a decreased urine output (oliguria or anuria), not an increase.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of clinical signs indicating kidney transplant rejection as background academic context rather than a clinical decision trigger.
Nurses must meticulously monitor clients post-kidney transplant for signs of rejection. This includes tracking hourly urine output, daily weights, blood pressure trends, and, most importantly, laboratory results like serum creatinine.
A sudden spike in serum creatinine or a significant drop in urine output should be reported to the physician immediately, as it may indicate acute rejection requiring prompt intervention to save the graft.
Patient education is a key nursing responsibility. The client must be taught to self-monitor for signs like fever, reduced urination, and swelling, and understand the critical importance of adhering to their lifelong immunosuppressive medication regimen.

How to Approach the Question

First, identify the core concept of the question, which is organ transplant rejection.
Recall the primary function of the organ in question. For the kidney, the main function is filtering blood to produce urine and clear waste products.
Consider how rejection (i.e., the organ failing) would affect this function. If the kidney's filtering ability is impaired, waste products will build up in the blood, and urine production will decrease.
Evaluate each option based on this physiological understanding.
Option A (Decreased BP): Incorrect. Kidney failure leads to fluid retention, causing high BP.
Option B (Decreased temp): Incorrect. Rejection is an inflammatory response, which causes fever.

Concept Tested & Keywords

Concept Tested: Recognition of clinical signs indicating kidney transplant rejection.
Stem keywords: transplant surgery, transplanted kidney, rejection
Lead-in keywords: finding indicates

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