Page 1895 - Saunders Comprehensive Review For NCLEX-RN

658. Answer: 4

Rationale: Acute rejection most often occurs within 1 week after transplantation
but can occur any time post-transplantation. Clinical manifestations include fever,
malaise, elevated white blood cell count, acute hypertension, graft tenderness, and
manifestations of deteriorating renal function. Treatment consists of increasing
immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal
dialysis cannot be used with a newly transplanted kidney due to the recent surgery.
Removal of the transplanted kidney is indicated with hyperacute rejection, which
occurs within 48 hours of the transplant surgery.
Test-Taking Strategy: Note the words A week after kidney transplantation. Focus on
the data in the question and the time frame and symptoms, which describe acute
rejection. Recall the treatment for acute rejection to direct you to the correct option.
Level of Cognitive Ability: Synthesizing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Immune: Transplantation
Priority Concepts: Elimination; Immunity
Reference: Ignatavicius, Workman, Rebar (2018), pp. 1423-1424.

659. Answer: 4

Rationale: Frank bleeding (arterial or venous) may occur during the first day after
surgery. Some hematuria is usual for several days after surgery. A urinary output of
200 mL more than intake is adequate. A client pain rating of 2 on a 0 to 10 scale
indicates adequate pain control. A rapid pulse with a low blood pressure is a
potential sign of excessive blood loss. The PHCP should be notified.
Test-Taking Strategy: Focus on the subject, the need to notify the PHCP, and
determine if an abnormality exists. Think about the expected findings following
this procedure and note that the vital signs are not within the normal range and
could indicate excessive blood loss.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Renal and Urinary: Obstructive problems
Priority Concepts: Collaboration; Clotting
Reference: Lewis et al. (2017), pp. 1274-1275.

660. Answer: 4

Rationale: Disequilibrium syndrome is characterized by headache, mental
confusion, decreasing level of consciousness, nausea, vomiting, twitching, and
possible seizure activity. Disequilibrium syndrome is caused by rapid removal of
solutes from the body during hemodialysis. At the same time, the blood–brain
barrier interferes with the efficient removal of wastes from brain tissue. As a result,

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