# A nurse is caring for a client who received a kidney transplant 6 months ago. Which assessment finding would be the highest priority for immediate nursing intervention?

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## 문제

A nurse is caring for a client who received a kidney transplant 6 months ago. Which assessment finding would be the highest priority for immediate nursing intervention?

## 보기

1. Serum creatinine level of 1.8 mg/dL (normal: 0.6-1.2 mg/dL)
2. Oral temperature of 101.2°F (38.4°C) with productive cough **✔ 정답**
3. Blood pressure reading of 150/90 mmHg
4. Complaint of mild fatigue and decreased appetite

**정답: 2**

## 해설

Fever and productive cough in an immunocompromised post-transplant client indicate a life-threatening infection requiring immediate intervention. Other findings (elevated creatinine, hypertension, mild fatigue) are less urgent and manageable with routine monitoring.

## 심화 해설

Understanding the Priority: Acute Graft Dysfunction

In a client who is 6 months post-kidney transplant, the assessment must focus on detecting signs of rejection or other complications that threaten the viability of the graft. The most concerning finding is the one that indicates an acute and rapid decline in kidney function, as this requires immediate intervention to potentially salvage the organ.

Analysis of the Correct Answer (Option 1)

A rise in serum creatinine from 1.2 mg/dL to 2.8 mg/dL over just one week represents a rapid and significant loss of graft function. This is the hallmark of acute graft dysfunction. The provided evidence strongly supports the critical nature of this finding. Research demonstrates that early post-transplant serum creatinine is a powerful, independent predictor of long-term graft survival [1]. A sharp increase like this signals an active pathological process, such as acute rejection, which requires prompt diagnosis and management. Furthermore, the literature highlights that while serum creatinine is a late and nonspecific marker of kidney injury, a rapid functional decline is a critical clinical alarm that demands immediate investigation and intervention to prevent irreversible damage [3]. This change is the most direct and urgent indicator of a threat to the transplanted organ.

Why the Other Options Are Less Urgent

- Option 2: Blood pressure reading of 150/90 mmHg with mild headache. Hypertension is a common post-transplant issue and a known risk factor for long-term graft loss [4]. It can also be a sign of transplant renal artery stenosis (TRAS), a potentially reversible cause of graft dysfunction [2]. However, in the context of a 6-month post-transplant client, a single elevated reading with a mild headache is a subacute concern. While it requires evaluation and management, it does not represent the same level of immediate threat to the graft's viability as a doubling of the serum creatinine. The hypertension is a sign of a potential underlying problem, whereas the creatinine rise is the direct evidence of the organ failing.

- Option 3: White blood cell count of 3,500/mm³ with no fever. A low white blood cell count (leukopenia) is a significant finding in an immunosuppressed transplant recipient, as it increases the risk for opportunistic infections. This is a safety concern that requires dose adjustment of immunosuppressive medications. However, in the absence of fever or other signs of active infection, this finding is less immediately life-threatening or graft-threatening than an acute, severe decline in kidney function. The priority is to address the direct evidence of organ failure first.

- Option 4: Mild peripheral edema in bilateral lower extremities. Mild, bilateral edema can be a relatively common finding post-transplant and may be related to medications, fluid balance, or venous insufficiency. While it warrants monitoring and further assessment, it is a nonspecific and often non-urgent finding. It does not provide the same acute, objective evidence of deteriorating graft function as a rapid and significant increase in serum creatinine.References (research sources)

- [1]Serum Creatinine Level at One Month Post-Transplant Predicts 3-Year and 5-Year Graft Survival and Renal Function: A Large Single-Center Retrospective Cohort Study.Research articleLee J, Son S, Ju M. (2026) · DOI: 10.3390/jcm15114238

- [2]Silent but Severe: Transplant Renal Artery Stenosis Causing Acute Graft Dysfunction in a Child With Cystinosis.Research articleBecerir T, Altıntaş ÜS, Girişgen İ, Kabukcuoğlu MB, Kılıç P, Arslan M. (2026) · DOI: 10.1111/petr.70372

- [3]Early Post-Transplant Protein Biomarkers for Risk Stratification of Renal Allograft Dysfunction: Diagnostic Value and Clinical Chemistry Perspectives.Research articleBot Rachisan AL, Aldea PL, Bulata B, Delean D, Elec F, Sparchez M. (2026) · DOI: 10.3390/diseases14010036

- [4]Predictors of Long-Term Kidney Transplant Survival: A Scoping Review.Research articleToni E, Ayatollahi H, Ziyaee S, Rahimi F. (2026) · DOI: 10.1002/hsr2.72606

## 임상 시나리오

Clinical Practice Guide
Fever in post-transplant patients is an absolute indication for Notify HCP!. Blood cultures, chest X-ray, and urinalysis should be performed immediately to identify the source of infection. Adjustment of immunosuppressant dosage may be necessary.

Caution: In SATA (Select All That Apply) questions, when asked "What is the highest priority?", you must select **only one**. The same applies to "What requires immediate intervention?". When asked "What are potential complications?", you will select multiple answers.

## 핵심 개념

- **Immunosuppression (면역억제)** — A state in which the immune system's activity is intentionally suppressed to prevent rejection after organ transplantation. This significantly increases the risk of infection and cancer.
- **Creatinine (크레아티닌)** — It is a waste product of muscle metabolism, excreted through the kidneys. Blood levels are used as a key indicator of kidney function. An increase signifies reduced kidney function.
- **Sepsis (패혈증)** — A condition where life-threatening organ dysfunction occurs due to a systemic inflammatory response to infection. It can progress rapidly in immunosuppressed patients.
- **Productive Cough (가래성 기침)** — Cough with mucus (phlegm). This is a common symptom of respiratory infections (such as bronchitis, pneumonia, etc.).
- **Hypertension (고혈압)** — Persistently elevated blood pressure. It is common in kidney transplant patients and can be caused by immunosuppressants such as steroids and calcineurin inhibitors, and it threatens the health of the transplanted kidney.

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