Chapter - 082 Clients Requiring Transplantation

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 82: Management of Clients Requiring Transplantation
MULTIPLE CHOICE
1. The nurse reminds a client awaiting a kidney transplant that to ensure long-term graft
survival the minimal number of human leokocyte antigen (HLA) matches is
a. d.
b. 5.
c. 6.
d. 7.
ANS: c
To ensure greater opportunity for graft suvival the recommended number of HLA matches is 6.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2435

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
2. The nurse on a team maintaining the donor prior to organ harvest makes an assessment that
would interfere with organ viability. The condition that must be corrected immediately is
a. respirations of 10/minute.
b. blood pressure of 100/40.
c. pulse of 120.
d. urine ouput of 60 ml/hour.
ANS: d
The “Rule of 100s” outlines that for organ viability the donor should be maintained at blood
pressure systolic 100, heart rate 100 beats/minute, urine output 100 ml/hour, and a PaO2 of 100
mm Hg.
DIF: Cognitive Level: Analysis REF: Text Reference: 2431

TOP: Nursing Process Step: Assessment
3. The nurse working with a group of potential donors informs them that at present the Uniform
Determination of Death Act (UDDA) uses in its definition of death that there must be
irreversible cessation of the entire brain
a. including the brain stem.
b. except in the situation of an ancephalic infant.
c. unless a vegetative state has exceeded 2 years.
d. excluding the situation of irreversible vegetative state.
ANS: a
Chapter 82: Management of Clients Requiring Transplantation 2
The UDDA includes the death of the brain stem in its definition, which allows people in
vegetative states and ancephalic infants not to be considered as donors.

MSC: NCLEX: Health Promotion and Maintenance
4. When a client develops deterioration of kidney function 4 months after the transplant, the
nurse suspects
a. urinary tract infection.
b. hyperacute rejection.
c. chronic rejection.
d. acute rejection.
ANS: c
Chronic rejection evolves gradually, usually after the first 3 months following transplantation.
Chronic rejection results in progressive loss of graft function.

5. 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. transplant organs into clients who have the best chance for a long-term successful
outcome.
b. find the best candidate who has appropriate immune function and the appropriate
level of insurance.
c. determine the histocompatibility of the donor and the recipient.
d. provide the greatest number of transplants as possible during any calendar year due
to the great need of this service.
ANS: a
A primary responsibility of the transplantation team is to transplant organs into clients who have
the best chance for a long-term successful outcome.

MSC: NCLEX: Psychosocial Integrity
6. 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
Elsevier items and derived items © 2005 by Elsevier Inc.

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

7. Basing the assessment on knowledge of cultural customs and beliefs, the nurse would
identify the client who would have the greater conflict with heart transplantation as being
from the faith of
a. Buddhist.
b. Friends (Quakers).
c. Russian Orthodox.
d. Black Muslim.
ANS: c
In the Russian Orthodox religion donation/transplantation of kidneys, eyes, and tissues is
permitted; heart donation/transplantation is not allowed.
DIF: Cognitive Level: Comprehension

REF: Text Reference: Evolve website table: Religious and Cultural Customs and Beliefs
Related to Death and Organ Donation/Transplantation
8. A nurse providing information to a potential organ recipient tells the client and family that
lifestyle must be arranged to be able to reach the transplant center within
a. 30 minutes.
b. 1 hour.
c. 2 hours.
d. 4 hours.
ANS: c
Usually a client who lives at a distance from the transplantation center requiring more than 2
hours’ travel time must relocate or arrange air transportation to arrive at the center within an
acceptable time.

9. The nurse explains an ethical issue relative to xenotransplantation is

a. informed consent.
b. organ rejection.
c. infection transmission.
d. incompatibility of immune response.
ANS: a

Informed consent is the ethical issue; the other options are medical issues.

MSC: NCLEX: Health Promotion and Maintenance
10. 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. lack of sufficient donor organs.
c. insufficient financial resources.
d. high risk for infection.
ANS: b
The shortage of organ donors is the most significant limitation to transplantation.

11. The nurse working with a client awaiting organ transplant would focus on dispelling the false
belief that
a. the risk of organ rejection is an ongoing possibility post transplant.
b. the medications used to prevent organ rejection have significant side effects.
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 life's
problems.

12. The nurse working in an emergency department assesses that the client near death that would
be the best candidate for organ donation is the client with
a. coronary heart disease.
b. cirrhosis.
c. subarachnoid hemorrhage.
d. cancer.
ANS: c
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: Cognitive Level: Comprehension REF: Text Reference: 2431


13. A nurse working as part of a transplantation team reminds the client that the viability time for
a donated pancreas is approximately
a. 4 hours.
b. 8 hours.
c. 12 hours.
d. 24 hours.
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.

14. The nurse teaches a post-transplant client that the most common reason for rehospitalization
following transplant is
a. malignancy.
b. infection.
c. acute rejection.
d. chronic rejection.
ANS: b
Infection is the most common indication for hospital readmission after transplantation.
DIF: Cognitive Level: Application REF: Text Reference: 2435

15. To identify manifestations of rejection following kidney transplant, the nurse would instruct a
client to self-monitor for
a. hypothermia.
b. fatigue.
c. weight gain.
d. recurrent nausea.
ANS: c
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).


16. The nurse is aware that the client who would benefit most from kidney-pancreas
transplantation is the client with
a. end-stage renal disease and type 1diabetes.
b. acute renal failure and pancreatitis.
c. polycystic kidney disease and type 2 diabetes.
d. glomerulonephritis and pancreatitis.
ANS: a
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.

17. The nurse informs a client who underwent a liver transplant that the diagnostic method used
to confirm organ rejection following liver transplant is
a. white blood cell count.
b. liver biopsy.
c. result of the International Normalized Ratio.
d. liver enzyme results.
ANS: b
Diagnosis of rejection is confirmed by liver biopsy. Elevated laboratory values may suggest
rejection.

18. 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.


19. The nurse clarifies that in 1996 Medicare extended insurance coverage for
a. all organ transplants.
b. postoperative immunosuppressants.
c. relocation expenses.
d. preoperative immunosuppressive protocol.
ANS: b
Medicare expanded coverage for postoperative immunosuppressants for 3 years after
transplantation.
DIF: Cognitive Level: Comprehension REF: Text Reference: 2426

20. The nurse explains that the law prohibiting the buying and selling of organs is the
a. Uniform Anatomical Gift Act.
b. National Transplant Act.
c. Organ Procurement and Transplant Network.
d. United Network of Organ Sharing.
ANS: b
The National Transplant Act forbids the buying or selling of organs.


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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 82: Management of Clients Requiring Transplantation

DIF: Cognitive Level: Knowledge REF: Text Reference: 2435

DIF: Cognitive Level: Analysis REF: Text Reference: 2431

DIF: Cognitive Level: Analysis REF: Text Reference: 2427

DIF: Cognitive Level: Analysis REF: Text Reference: 2434

DIF: Cognitive Level: Knowledge REF: Text Reference: 2427

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 2427

DIF: Cognitive Level: Comprehension

DIF: Cognitive Level: Knowledge REF: Text Reference: 2428

9. The nurse explains an ethical issue relative to xenotransplantation is

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 2428

DIF: Cognitive Level: Analysis REF: Text Reference: 2426

DIF: Cognitive Level: Analysis REF: Text Reference: 2429

DIF: Cognitive Level: Comprehension REF: Text Reference: 2431

Elsevier items and derived items © 2005 by Elsevier Inc.

TOP: Nursing Process Step: Assessment

DIF: Cognitive Level: Knowledge REF: Text Reference: 2432

DIF: Cognitive Level: Application REF: Text Reference: 2435

DIF: Cognitive Level: Application REF: Text Reference: 2437

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 2437

DIF: Cognitive Level: Knowledge REF: Text Reference: 2437

DIF: Cognitive Level: Application REF: Text Reference: 2439

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 2426

DIF: Cognitive Level: Analysis REF: Text Reference: 2430

Elsevier items and derived items © 2005 by Elsevier Inc.

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