Deck 12: Thoracic Organ Transplantation: Heart, Heart Lung, and Lung

Question 1

Which of the following alternatives to transplantation would be appropriate for a patient with heart failure who has not responded to optimal medical management,left ventricular ejection fraction <25%,and a peak oxygen consumption of <12 mL/kg/min?

A)Left ventricular assistive device (LVAD)
B)Biphasic positive airway pressure (BiPAP)
C)Cardiomyoplasty
D)Home intravenous pharmacologic management

Answer 1

A
In patients who are not candidates for heart transplantation and have <2 years of life expectancy,destination VAD therapy is covered by Medicare for patients with NYHA Class IV heart failure under the following conditions:(1)patient's symptoms have not responded to optimal medial management (diet,medications),(2)patient has left ventricular ejection fraction <25%,(3)patient has functional limitation with a peak oxygen consumption of <12 mL/kg/min,(4)patient needs continued intravenous inotropic therapy,and (5)patient has appropriate body size.

Question 2

Medications provided postoperative heart or lung transplantation that inhibit cytokine synthesis,interleukin-1,and T-cell activation and act as an anti-inflammatory agent BEST describes which of the following drug classes?

A)Calcineurin inhibitors
B)Corticosteroids
C)Antiproliferative agents
D)Antithymocyte globulin

Answer 2

B
Corticosteroids such as prednisone,prednisolone,and methylprednisolone act to inhibit cytokine synthesis,interleukin-1,gamma interferon,and T-cell activation,and are anti-inflammatory agents.

Question 3

Which of the following lung diseases is the MOST common lung pathology requiring lung transplantation?

A)Emphysema
B)Idiopathic pulmonary fibrosis
C)Chronic bronchitis
D)Asthma

Answer 3

A
The majority of lung transplants have been performed in patients who have emphysema.Idiopathic pulmonary fibrosis is the second most frequent indication for lung transplant.

Question 4

Which of the following infection control practices should involve the minimum required personal protective equipment when visiting a patient who is within 12 to 24 hours postoperative thoracic organ transplantation?

A)Only the health care providers need to wear a mask and gloves to avoid spreading germs from other patients.
B)Only hand washing should be employed when entering the room.
C)Hand washing when entering the patient room and use of a mask if one has respiratory symptoms.
D)All visitors (family and health care providers)should at least wear a mask and perform hand washing.

Question 5

Which of the following muscles is considered fatigue resistant and utilized in a cardiomyoplasty procedure?

A)Pectoralis minor
B)Lateral head of gastrocnemius
C)Latissimus dorsi
D)Rectus abdominus

Question 6

Which of the following is considered an absolute contraindication to heart transplant?

A)Diabetes mellitus with microvascular organ damage
B)Morbid obesity (body mass index >30 kg/m²)
C)Irreversible renal dysfunction
D)Fixed pulmonary hypertension (>15 mm Hg)

Question 7

As part of the transplant evaluation team,which of the following evaluative procedures is MOST likely completed by the physical therapist?

A)Social history (smoking,alcohol,and drugs)
B)Ideal body weight caloric intake
C)Psychosocial assessment
D)Exercise tolerance test and exercise prescription

Question 8

Which of the following coping styles has been demonstrated by research evidence to be a predictor of poorer quality of life in heart transplant candidates?

A)Fatalistic
B)Emotive
C)Evasive
D)Optimistic

Question 9

Which of the following cardiac transplantation techniques is referred to as the "piggyback" technique?

A)Total transplantation
B)Biatrial technique
C)Bicaval technique
D)Heterotopic heart

Question 10

Which of the following treatment actions should be employed by the physical therapist when monitoring the patient during an exercise session who is postoperative heterotopic heart transplant candidate?

A)Monitor heart rate more frequently before,during,and after exercise.
B)Encourage the patient to perform a longer warm-up and cool-down during the session.
C)Make sure the patient does not exercise greater than low intensity during the session.
D)Use a pulse oximeter to monitor the patient's response to activity during the session.

Question 11

Which of the following cardiac transplantation techniques demonstrates two separate P waves on the ECG?

A)Total transplantation
B)Biatrial technique
C)Bilateral ventricular assistive device technique
D)Heterotopic heart

Question 12

According to the National Emphysema Treatment Trial (NETT),patients with high exercise capacity whose lower lobes were primarily affected had which of the following effects with lung volume reduction surgery (LVRS)?

A)Lower mortality with lung volume reduction than with medical treatment
B)No difference in mortality than medical treatment,but better clinical outcomes
C)Similar mortality with lung volume reduction and medical treatment
D)Higher mortality with lung volume reduction than with medical treatment

Question 13

Which of the following monitoring tools is BEST to assess a heart transplant patient's initial response to increases in activity?

A)Monitor heart rate
B)Rating of perceived exertion
C)Pulse oximetry
D)Blood pressure

Question 14

Which of the following patient characteristics indicates end-stage cardiopulmonary disease?

A)Marked decrease in cardiopulmonary function.
B)Require multiple medications and/or oxygen to complete daily activities.
C)Unable to work full-time.
D)All of the above.

Question 15

Which of the following criteria is considered absolute for a heart donor?

A)No positive test for hepatitis B
B)History of chest trauma
C)Elevation of myocardial enzymes
D)Correctable valvular dysfunction

Question 16

Which of the following is considered a relative contraindication to lung transplant?

A)Continued abuse of alcohol,tobacco,or narcotics
B)Age 65 years or older
C)Significant chest wall or spinal deformity
D)Absence of consistent support system

Question 17

In heart transplant candidates,research evidence demonstrated which of the following peak oxygen consumption values (VO₂mₐₓ)to be a cutoff indicating high risk of death and a need to be referred for transplantation?

A)13 mL/kg/min
B)15 mL/kg/min
C)18 mL/kg/min
D)20 mL/kg/min

Question 18

Which of the following statements is an accurate hypothesis explaining how lung volume reduction surgery improves symptoms and pulmonary function in a patient with end-stage emphysema?

A)The surgery causes an increase in elastic recoil of the lung,creating greater efficiency.
B)The surgery leads to a reduction in functional residual capacity,improving functional length of respiratory muscles.
C)The surgery leads to a decrease in lung hyperinflation allowing for normal cardiac filling.
D)All of the above are plausible hypotheses.

Question 19

Which of the following changes is NOT considered to be an unstable hemodynamic abnormality in a cardiopulmonary transplant candidate?

A)Hypotension
B)Reduced lung volumes
C)Decreased pulmonary vascular resistance
D)Decreased pulmonary perfusion

Question 20

Which of the following therapy techniques is MOST important for a patient who is 1 day postoperative lung transplant candidate in which it is common the donor lung tissue is denervated?

A)Active cycle of breathing
B)Manual hyperinflation
C)Use of a flutter valve
D)Cough on a scheduled basis

Question 21

Which of the following statements is TRUE regarding the use of biphasic positive airway pressure (BiPAP)intervention in a lung transplant candidate?

A)It is indicated for patients with signs of respiratory failure.
B)It is a method to decrease the work of breathing.
C)It will improve exercise tolerance in a patient with severe respiratory failure.
D)All of the above.

Question 22

When the physical therapist is making decisions about treatment and activity tolerance,emphasis should be placed on the donor heart response.

Question 23

Which of the following solid-organ transplants has the highest acute rejection rate?

A)Heart
B)Lung
C)Kidney
D)Liver

Question 24

Which of the following actions would be cost effective and assist the physical therapist and patient with the management of necessary equipment (i.e.,chest drainage tubes,portable suction unit,oxygen)when mobilizing the patient?

A)Wait for the nurse to complete the necessary tasks and request the nurse's assistance with carrying some of the equipment while the therapist assists the patient with ambulation.
B)Schedule a physical therapy aide or nurse aide to assist with carrying some of the equipment while the therapist assists the patient with ambulation.
C)Provide a wheelchair in which the equipment may be placed and assist the patient with ambulation behind the wheelchair for support.
D)Allow the patient to ambulate independently with a walker while the therapist carries the equipment.

Question 25

Which of the following exercise routines would be MOST appropriate for a transplant patient who required higher doses of steroid medications to achieve adequate immunosuppression?

A)Lower extremity bed exercises with low weight for 15 to 20 repetitions as tolerated
B)Standing active ROM and semisquats for 8 to 10 repetitions as tolerated
C)Ambulation in hall at low intensity two to three times per day at a pace preferred by the patient
D)Lower extremity resistance exercise with emphasis on proximal muscle groups at moderate intensity for 15 repetitions

Question 26

High-intensity exercise is encouraged when possible for a patient postoperative a lung transplant in a pulmonary rehabilitation program.

Question 27

Research evidence does not support the benefits of preoperative rehabilitation for heart and lung transplant candidates to improve function and activity tolerance.

Question 28

Which of the following goals is appropriate at discharge of a lung transplant recipient?

A)The patient will be modified independent with basic activities of daily living.
B)The patient will demonstrate independence in secretion clearance.
C)The patient will demonstrate a 10% increase in the 6-minute walk distance.
D)All of the above goals are appropriate for a lung transplant recipient.

Question 29

The use of steroids by patients after transplantation will MOST likely cause which of the following postoperative complications?

A)Hypertension
B)Impaired mitochondrial function
C)Weakness of proximal muscles of extremities
D)Type II diabetes mellitus

Question 30

Which of the following comorbidities would MOST likely contribute to the risk of dehiscence of a median sternotomy incision postoperative of a heart or lung transplant?

A)Hypertension
B)Obesity
C)Diabetes mellitus
D)Hypothyroidism