Question 1

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.

Accepted Answer

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

Question 2

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.

Accepted Answer

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

Question 3

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.

Accepted Answer

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.

Question 4

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.

Accepted Answer

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

Question 5

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 (100/40) mm Hg
B) Pulse of 120 beats/min
C) Respirations of 16/min
D) Urine output of 60 ml/hr

Accepted Answer

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.

Question 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.

Accepted Answer

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

Question 7

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.

Accepted Answer

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.

Question 8

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.

Accepted Answer

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

Question 9

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.

Accepted Answer

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

Question 10

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.

Accepted Answer

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.

Question 11

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.

Accepted Answer

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.

Question 12

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.

Accepted Answer

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

Question 13

A nurse in the intensive care unit is caring for a post-transplantation client. This client's first set of vital signs were temperature 94.4° F, pulse 110 beats/min, respirations ventilated at 20 breaths/min, blood pressure 108/64 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 88/58 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.

Accepted Answer

Arterial blood pressure, systemic vascular resistance, and cardiac output usually decrease as the client's 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.

Question 14

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.

Accepted Answer

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.

Question 15

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.

Accepted Answer

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.

Question 16

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 client's primary health care provider.

Accepted Answer

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.

Question 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.

Accepted Answer

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.

Question 18

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.

Accepted Answer

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.

Question 19

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

Accepted Answer

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.

Question 20

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 can't talk about your friend's experience."
B) "How long ago did that occur?"
C) "Different transplant centers have different requirements."
D) "Each organ's viability time is different. Kidneys can last longer than hearts."

Accepted Answer

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.

Quiz 80: Management of Clients Requiring Transplantation

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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

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

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?