A nurse is assessing a client who is 2 weeks postoperative following a kidney transplant. Which of the following manifestations should the nurse identify as possible organ rejection?
Temperature 36.1°C (97.0° F)
Weight loss
Insomnia
Oliguria
The Correct Answer is D
Rationale:
A. A low temperature is not indicative of organ rejection; fever would be more concerning.
B. Weight loss is not a typical sign of acute organ rejection; weight gain due to fluid retention might be observed.
C. Insomnia is not specifically associated with organ rejection.
D. Oliguria (decreased urine output) is a significant sign of possible kidney transplant rejection, as it may indicate impaired kidney function.
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View Related questions
Correct Answer is C
Explanation
Rationale:
A. An increase in weight is typically a symptom of untreated or poorly managed hypothyroidism, not a therapeutic response.
B. A decrease in body temperature is associated with hypothyroidism, and an improvement in this condition should result in a normalization of temperature, not a decrease.
C. An increase in energy is a therapeutic response to liothyronine, as hypothyroidism often causes fatigue and low energy levels. Treatment with liothyronine should alleviate these symptoms and restore normal energy levels.
D. A decreased heart rate (bradycardia) is a symptom of hypothyroidism, and effective treatment should normalize the heart rate, not lower it further.
Correct Answer is D
Explanation
Rationale:
A. Fluid intake may need to be monitored, but restricting fluids is not typically advised unless specifically directed by the healthcare provider due to complications like diabetes insipidus.
B. Avoiding deep breathing exercises is not recommended, as these exercises are important for preventing respiratory complications postoperatively.
C. Lying flat for 48 hours after surgery is incorrect; the head of the bed is usually elevated to decrease intracranial pressure and promote healing.
D. Avoiding blowing the nose and bending at the waist is crucial after transsphenoidal hypophysectomy to prevent increased intracranial pressure and avoid disrupting the surgical site, which could lead to complications such as cerebrospinal fluid leakage.