Chapter 80: Management of Clients Requiring Transplantation Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 80: Management of Clients Requiring Transplantation

MULTIPLE CHOICE

1. The nurse on a team maintaining an organ donor before organ harvest makes the following assessment findings. Which finding must be addressed first?

a.

Blood pressure of mm Hg

b.

Pulse of 120 beats/min

c.

Respirations of 16/min

d.

Urine output of 60 ml/hr

ANS: D

The Rule of 100s outlines that for organ viability the donor should be maintained at blood pressure systolic 100 mm Hg, heart rate 100 beats/minute, urine output 100 ml/hour, and a PaO2 of 100 mm Hg. The other findings do not require action.

DIF: Analysis/Analyzing REF: p. 2143 OBJ: Assessment

MSC: Safe, Effective Care Environment Establishing Priorities

2. The nurse working with the family of a potential organ donor informs them that the Uniform Determination of Death Act (UDDA) includes in its definition of death irreversible cessation of activity in the entire brain

a.

except in the situation of an ancephalic infant.

b.

in a person in an irreversible vegetative state.

c.

including the brain stem.

d.

unless a vegetative state has exceeded 2 years.

ANS: C

The UDDA includes the death of the brain stem in its definition. This excludes people in vegetative states and ancephalic infants as potential donors.

DIF: Comprehension REF: p. 2138 OBJ: Intervention

MSC: Safe, Effective Care Environment Legal Rights and Responsibilities

3. A client who had a kidney transplant develops decreased urine output, increased serum creatinine level, and a slight elevation in temperature. The nurse anticipates providing which intervention?

a.

Antibiotics

b.

Extra IV fluids

c.

High-dose steroids

d.

Plasmapheresis

ANS: C

This client is most likely experiencing acute rejection, which usually occurs during the first 3 months post-transplant. Clinical manifestations of rejection include decreased kidney function (decreased urine output and increased creatinine level). The slight elevation in temperature is most likely caused by the immune system activity. Acute rejection is treated with high-dose steroids. Antibiotics would be indicated for an infection. It is possible for this client to have an infection, but the urine output and lab data are more indicative of rejection. This client is probably not dehydrated because the increase in creatinine level points to a more direct kidney problem (and is a specific manifestation of kidney graft rejection) and one goal of treatment in the renal transplant client is to avoid overhydration. Plasmapheresis is used in the setting of hyperacute rejection.

DIF: Analysis/Analyzing REF: pp. 2146-2147, 2148

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

4. The nurse working with clients who need organ transplant includes in the teaching plan that the primary responsibility of the transplantation team is to

a.

determine the histocompatibility of the donor and the recipient.

b.

find the best candidate with good immune function and appropriate insurance.

c.

provide the greatest number of transplants possible because of the ongoing great need.

d.

transplant organs into clients with the best chance of long-term success.

ANS: D

A primary responsibility of the transplantation team is to transplant organs into clients who have the best chance for a long-term successful outcome. Good histocompatability helps ensure long-term graft survival but is not the only determinant. Finding clients with appropriate insurance is not the major determining factor for transplant success. Providing a large number of transplants to help meet demand is also not a consideration as the primary responsibility of the team.

DIF: Comprehension/Understanding REF: p. 2139 OBJ: Intervention

MSC: Physiologic Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

5. The nurse counseling a potential organ transplant candidate and his family explains that the evaluation process generally takes about

a.

1 to 2 days.

b.

3 to 5 days.

c.

7 to 10 days.

d.

1 to 2 weeks.

ANS: B

The evaluation can be performed on either an inpatient or an outpatient basis and usually takes 3 to 5 days.

DIF: Knowledge/Remembering REF: p. 2139 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

6. Basing the assessment on knowledge of cultural customs and beliefs, the nurse would identify the client who would have the greatest conflict with heart transplantation as being from the faith of

a.

Black Muslim.

b.

Buddhism.

c.

Friends (Quakers).

d.

Russian Orthodox.

ANS: D

In the Russian Orthodox religion, donation/transplantation of kidneys, eyes, and tissues is permitted; heart donation/transplantation is not allowed.

DIF: Comprehension/Understanding

REF: Table: Religious and Cultural Customs and Beliefs Related to Death and Organ Donation/Transplantation, Evolve site OBJ: Assessment

MSC: Psychosocial Integrity Religious and Spiritual Influences on Health

7. The most important topic related to health promotion the nurse should teach a client before being discharged after an organ transplant is

a.

housing options close to the transplant center for the next 1-2 months.

b.

how to access funding to pay for lifelong immunosuppressant therapy.

c.

primary prevention measures against common infectious diseases.

d.

transplant team contact information for the clients primary health care provider.

ANS: C

All choices are appropriate discharge education material. However, of special importance is information on manifestations of rejection and of clinical illness, including infectious illnesses. Due to immune suppression, the client remains at higher risk for catching common ailments and needs education on preventative measures.

DIF: Application/Applying REF: p. 2150 OBJ: Intervention

MSC: Health Promotion and Maintenance Self Care

8. A nurse in the intensive care unit is caring for a post-transplantation client. This clients first set of vital signs were temperature 94.4 F, pulse 110 beats/min, respirations ventilated at 20 breaths/min, blood pressure mm Hg. After 2 hours, the vital signs are temperature 98.4 F, pulse 108 beats/min, respirations ventilated at 20 breaths/min, blood pressure mm Hg. Which action by the nurse is most appropriate at this time?

a.

Anticipate an order for arterial blood gasses (ABGs).

b.

Call the physician to report that the client is still tachycardic.

c.

Chart the findings and continue to monitor the client.

d.

Prepare to administer vasoconstricting agents.

ANS: D

Arterial blood pressure, systemic vascular resistance, and cardiac output usually decrease as the clients temperature rises from the hypothermic state seen initially. Additional support measures are often used during this time of instability, such as vasoactive agents. There is no indication for ABGs and the client is probably tachycardic because of the low blood pressure and physiologic stress of the operation. With any intervention, charting and continued observation are required, but it is not the priority action in this situation.

DIF: Analysis/Analyzing REF: p. 2145 OBJ: Intervention

MSC: Safe, Effective Care Environment Establishing Priorities

9. The nurse warns a client who has been found to be an acceptable candidate for a kidney transplant, that now the greatest impediment to renal transplantation is

a.

high potential for rejection.

b.

high risk for infection.

c.

insufficient financial resources.

d.

lack of sufficient donor organs.

ANS: D

The shortage of organ donors is the most significant limitation to transplantation. Waiting is often the most stressful time for a client and the family.

DIF: Application/Applying REF: p. 2141 OBJ: Intervention

MSC: Psychosocial Integrity Coping Mechanisms

10. The nurse working with a client awaiting organ transplant would focus on dispelling the false belief that

a.

medications used to prevent organ rejection have significant side effects.

b.

the risk of organ rejection is an ongoing possibility post transplant.

c.

transplantation will resolve the manifestations of end-stage organ disease.

d.

transplantation will resolve most of the problems now faced by the family.

ANS: D

Many clients and their families unrealistically expect that transplantation will cure all lifes problems. The other three choices are actual situations that can occur.

DIF: Application/Applying REF: p. 2141 OBJ: Intervention

MSC: Psychosocial Integrity Coping Mechanisms

11. The nurse working in an emergency department assesses that the client near death who would be the best candidate for organ donation is the client with

a.

cancer.

b.

cirrhosis.

c.

coronary heart disease.

d.

subarachnoid hemorrhage.

ANS: D

The most common causes of injury leading to brain death and possible organ donation include head trauma, cerebrovascular accidents (CVAs), subarachnoid hemorrhage, and primary brain tumors.

DIF: Application/Applying REF: p. 2143 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. A nurse working as part of a transplantation team is conducting a group education session. A client waiting for a heart transplant asks why he cannot stay in his rural home to wait. He knows someone who had a kidney transplant and stayed in the same local area waiting for his transplant. The best response by the nurse would be

a.

Because of confidentiality rules, I cant talk about your friends experience.

b.

How long ago did that occur?

c.

Different transplant centers have different requirements.

d.

Each organs viability time is different. Kidneys can last longer than hearts.

ANS: D

Viability times for donated organs vary. Standard periods after organ recovery are as follows: for kidney, 48 to 72 hours; for heart, 4 to 5 hours; for lung, 4 to 6 hours; for liver, 24 to 30 hours; and for pancreas, 24 hours.

DIF: Application/Applying REF: p. 2143 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Potential for Complications from Surgical Procedures and Health Alteration

13. The nurse teaching a post-transplant client realizes that goals have been met when the client verbalizes understanding that the most common reason for rehospitalization in the post-transplant client is

a.

acute rejection.

b.

chronic rejection.

c.

infection.

d.

malignancy.

ANS: C

Infection is the most common indication for hospital readmission after transplantation.

DIF: Application/Applying REF: p. 2147 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Potential for Complications from Surgical Procedures and Health Alteration

14. To identify manifestations of rejection following kidney transplant, the nurse would instruct a client going home to monitor for

a.

fatigue.

b.

hypothermia.

c.

recurrent nausea.

d.

weight gain.

ANS: D

Clinical manifestations of potential complications in the renal transplantation client include fever, graft tenderness, weight gain, and abnormal organ-specific laboratory test results (blood urea nitrogen [BUN] and creatinine). As kidney function declines, urine output drops and weight increases. Hypothermia and nausea are not related to chronic rejection of a kidney, and fatigue is nonspecific.

DIF: Application/Applying REF: p. 2148 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Potential for Complications from Surgical Procedures and Health Alteration

15. The nurse conducting community education on transplant options would teach that the client who would benefit most from kidney-pancreas transplantation is the client with

a.

acute renal failure and pancreatitis.

b.

end-stage renal disease and type 1diabetes.

c.

glomerulonephritis and pancreatitis.

d.

polycystic kidney disease and type 2 diabetes.

ANS: B

Pancreas transplantation is indicated for the client with type 1 diabetes mellitus to restore normal glucose metabolism. Pancreas-kidney transplantation is performed in the diabetic client with end-stage renal disease.

DIF: Application/Applying REF: p. 2148 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

16. A client who had a liver transplant 4 days ago has developed a fever and decreased biliary tube drainage. The nurse anticipates an order for the client to have a

a.

liver biopsy.

b.

set of blood cultures.

c.

ultrasound.

d.

white blood cell count.

ANS: A

This client is most likely experiencing rejection. The diagnosis of rejection is made with a liver biopsy. Blood cultures and the white blood cell count would be more helpful in the diagnosis of infection.

DIF: Analysis/Analyzing REF: p. 2149 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Potential for Complications from Surgical Procedures and Health Alteration

17. The nurse working with a post-transplant client tells the client that he should refrain from returning to his distant original home for up to

a.

1 week.

b.

8 weeks.

c.

3 months.

d.

6 months.

ANS: B

Most clients reside close to the transplantation center for 2 to 8 weeks before going home. This proximity allows for frequent medical visits, ongoing education, and familiarization of the client with the postoperative regimen.

DIF: Knowledge/Remembering REF: p. 2150 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Potential for Complications from Surgical Procedures and Health Alteration

18. A client is confused about Medicare coverage post-transplant. The nurse clarifies that in 1996 Medicare extended insurance coverage for

a.

all organ transplants.

b.

postoperative immunosuppressants.

c.

preoperative immunosuppressive protocol.

d.

relocation expenses.

ANS: B

Medicare expanded coverage for postoperative immunosuppressants for 3 years after transplantation.

DIF: Comprehension/Understanding REF: p. 2138 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

19. The nurse explains that the law prohibiting the buying and selling of organs is the

a.

National Transplant Act.

b.

Organ Procurement and Transplant Network.

c.

Uniform Anatomical Gift Act.

d.

United Network of Organ Sharing.

ANS: A

The National Transplant Act forbids the buying or selling of organs.

DIF: Knowledge/Remembering REF: p. 2138 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

MULTIPLE RESPONSE

1. Important health promotion measures for the client who has received an organ transplant include regularly-scheduled (select all that apply)

a.

dental examinations.

b.

mammograms.

c.

Papanicolaou (Pap smears).

d.

substance abuse screening.

e.

vaccinations.

ANS: A, B, C, E

Because of the lifelong immunosuppression, clients are at higher risk for cancer and infectious diseases such as influenza. Good general health is maintained with routine dental care. Substance abuse evaluation is part of the pre-transplant workup.

DIF: Comprehension/Understanding REF: p. 2151 OBJ: Assessment

MSC: Health Promotion and Maintenance Health Screening

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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