Difficulty: Medium
Average Score: 81%
Simulated
A client diagnosed with brain death as a result of a severe head injury had received vigorous treatment to control cerebral edema. Which intervention should the nurse plan to implement as a priority to maintain viability of the kidneys before organ donation?
Correct answer
B
Rationale
The kidneys require a minimum perfusion pressure of 80mmHg to produce urine and maintain renal function, and because of the aggressive treatment for cerebral edema, the client is likely to have a fluid volume deficiency. Therefore, the nurse restores the intravascular blood volume to maintain the blood pressure and renal perfusion pressure. The nurse screens the donor for infections because diseases such as hepatitis B and human immunodeficiency virus contraindicate organ donation; however, this option is unrelated to viability of the kidneys. Ventilation and oxygenation are important factors in tissue viability; however, the organ must be perfused adequately, first, to deliver any blood. The nurse administers vasopressors with caution to help maintain the donor's blood pressure; however, vasopressors potentially contribute to tissue destruction.