A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, "I am experiencing right flank pain and have a temperature of 101 ° F." How should the nurse respond?
a. "The anti-rejection drugs you are taking make you susceptible to infection."
b. "You should go to the hospital immediately to have your new liver checked out."
c. "You should take an additional dose of cyclosporine today."
d. "Take acetaminophen (Tylenol) every 4 hours until you feel better."
ANS: B
Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.
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