Question 1

A nurse is caring for a patient declared brain dead following a car crash in preparation for the harvesting of organs.The patient's urine output was 1050 mL in the last hour.What medication does the nurse prepare to administer?

Accepted Answer

The patient's history and urine output point to diabetes insipidus.The nurse should prepare to administer desmopressin acetate to control the urine output.Vasopressin,methylprednisolone,and esmolol would not be warranted.

Question 2

The nurse often assists with brain-death testing.Which patient might have confounding factors for this testing?

Accepted Answer

High spinal cord injury is a confounding factor as it can yield absent responses to brainstem testing with preserved brain/brainstem function.The other scenarios would not have confounding factors.

Question 3

The nurse obtains initial vital signs on a patient 2 weeks post-liver transplant who presents for follow-up monitoring to the outpatient transplant clinic.Which assessment finding by the nurse requires immediate action?

Accepted Answer

Tenderness over the graft site may be indicative of acute rejection in a liver transplant recipient 2 weeks posttransplant.Blood pressure,serum creatinine,and hemoglobin values are all within acceptable ranges and do not require immediate action.

Question 4

A family member of a gravely ill child approaches the child's nurse and states,"We want to donate our child's organs." What is the best action by the nurse?

Accepted Answer

It is the ultimate responsibility of the organ procurement organization to approach the family and obtain consent for organ donation.The best action by the nurse is to notify the OPO.Arranging a multidisciplinary meeting with physicians and consulting the hospital's ethics committee are inappropriate actions in this scenario.Informed consent to withdraw life support is provided by the provider.

Question 5

The nurse is caring for a patient who is being evaluated clinically for brain death.Which assessment finding supports brain death?

Accepted Answer

Absence of a corneal reflex indicates altered brainstem activity and is a component used in the clinical evaluation of brain death.Reactive pupils,withdrawal reaction to painful stimuli,and the ability to maintain core temperature indicate brainstem activity.

Question 6

The transplant clinic social worker is completing a social history on a patient with end-stage renal disease who is being evaluated for transplant.Which statement by the patient warrants further action?

Accepted Answer

IV drug use is a contraindication to transplantation.A patient who reports using any recreational drugs should be evaluated further for other types of drug use.Family support is critical during posttransplant care.Adherence to dialysis indicates probable success in adhering to future treatment plans.A patient history of active or recent malignancy is a contraindication to transplantation.

Question 7

A patient being cared for in the ICU before organ donation shows increased PVCs on the cardiac monitor What medication does the nurse prepare to administer first?

Accepted Answer

Esmolol is a beta blocker used to control tachycardia and decrease myocardial oxygen consumption from catecholamine release,and it protects heart muscle from ischemia.An increase in PVCs indicates increased cardiac irritability,perhaps from cellular ischemia.The other drugs would not be indicated.

Question 8

The nurse is managing a donor patient six hours before the scheduled harvesting of the patient's organs.Which assessment finding requires immediate action by the nurse?

Accepted Answer

Donor management focuses on maintaining hemodynamic stability and normal laboratory parameters.Standardized order sets are usually used,and they focus on preserving organ function and viability.Immediate action is required for an arterial blood gas value of pH 7.30; PaCO₂ 38 mmHg; HCO₃ 16 mEq/L.The finding indicates metabolic acidosis.All other values are within normal limits.

Question 9

The charge nurse of a transplant unit is reviewing the clinical course of several transplant patients being cared for in the unit.Which patient assessed by the charge nurse requires immediate action?

Accepted Answer

One complication of liver transplant is renal failure.The patient with the elevated serum creatinine requires immediate action.Postoperative pain level of 3/10 in a renal transplant patient,a lung transplant patient with a productive cough,and a heart transplant recipient with a cardiac output of 4 L/min are normal or expected findings,requiring no immediate action.

Question 10

The charge nurse is reviewing the status of patients in the critical care unit.Regarding which patient should the nurse notify the organ procurement organization to evaluate for possible organ donation?

Accepted Answer

A patient with a GCS score of 3 and no activity on EEG is facing impending death.The OPO should be notified.There are no indications of impending death in any of the other patient scenarios.

Question 11

The nurse is educating a renal transplant patient about his immunosuppressant medication therapy.Which statement by the patient best indicates an appropriate understanding?

Accepted Answer

Posttransplant recipients will be on immunosuppressant medications for life.They have many side effects,including nephrotoxicity,hypertension,hyperlipidemia,bone loss,new-onset diabetes mellitus,and infection.

Question 12

The transplant clinic nurse is educating a patient about the renal criteria that must be met in order to be placed on the transplant waiting list.Which statement by the patient best indicates an understanding of the criteria?

Accepted Answer

Candidates are placed on the UNOS national waiting list once they have end-stage renal disease.Patients may be on dialysis or have a glomerular filtration rate of less than 5 to 20 mL/minute.ABO compatibility is necessary for successful renal transplantation.A point system is used to rank candidates to determine who will receive a kidney when a donor becomes available.

Question 13

The transplant clinic coordinator is evaluating relatives of a patient with end-stage renal disease,whose blood type is A positive,for suitability as a living donor for kidney transplantation.Which family member best qualifies for evaluation?

Accepted Answer

To qualify as a living donor,an individual must be free from hypertension,diabetes,cancer,kidney disease,and heart disease and generally between 18 and 60 years of age.A 35-year-old female with a history of food allergies and a blood type of O negative (universal donor)best qualifies for evaluation.The brother and mother,although blood-type compatible,are outside acceptable age ranges for living donation.The minor son does not qualify based on blood type.

Question 14

The nurse is caring for a patient who has a Glasgow Coma Scale (GCS)score of 3.Discussions have been held with the family about withdrawing life support.Which statement by the nurse best describes requirements that must be met to sustain Centers for Medicare and Medicaid Services (CMS)Conditions of Participation?

Accepted Answer

Hospitals that receive Medicare or Medicaid reimbursement must notify the local OPO in cases of impending death.It is the responsibility of the organ procurement organization,not the provider,to obtain family consent for organ donation and to evaluate the patient for potential suitability as a donor.Notification of the organ procurement organization must occur before death,not after the patient has been pronounced dead.

Question 15

The nurse is caring for a renal transplant recipient in the postanesthesia care unit.Blood pressure is 125/70 mm Hg; heart rate is 115 beats/min; respiratory rate is 24 breaths/min; oxygen saturation (SpO₂)is 95% on 3 L/min of oxygen via nasal cannula; temperature is 97.8° F; and the central venous pressure (CVP/RAP)is 2 mm Hg.What is the best action by the nurse?

Accepted Answer

Fluid replacement therapy is a priority in a postoperative renal transplant patient; a CVP of 2 mm Hg and elevated heart rate indicate hypovolemia.An oxygen saturation of 95% on 3 L/min via cannula is an acceptable value.The patient is normothermic; application of active warming measures is not indicated.Although pain assessment is an important part of postoperative nursing care,it is not the priority in this scenario.

Question 16

The nurse is caring for a patient in the critical care unit who,after being declared brain dead,is being managed by the OPO transplant coordinator.Thirty minutes into the shift,assessment by the nurse includes a blood pressure 75/50 mm Hg,heart rate 85 beats/min,and respiratory rate 12 breaths/min via assist/control ventilation.The oxygen saturation (SpO₂)is 99% and core temperature 93.8° F.Which provider prescription should the nurse implement first?

Accepted Answer

Hemodynamic stability is a priority in donor management.Following brain death,loss of autoregulation results in intense vasodilation.To maintain perfusion to the vital organs,the priority action is to begin a phenylephrine (Neo-Synephrine)infusion to get systolic BP >90 mm Hg.Maintaining normothermia is the next priority.Obtaining laboratory tests and arterial blood gasses is a part of donor management but not the priority in this scenario.

Question 17

While following up on a postoperative renal transplant recipient,the nurse discovers that the patient tested positive for cytomegalovirus (CMV).What is the priority action by the nurse?

Accepted Answer

It is mandatory to report any donor-derived infections to the organ procurement organization (OPO).The priority action is to notify the transplant coordinator.Verifying results with the lab technician,if indicated,would be the responsibility of the transplant coordinator.Repeating viral studies and continuing to monitor for signs of rejection are appropriate actions but not the immediate priority.

Question 18

The nurse is caring for a patient following a bilateral lung transplant.When planning postoperative care of the patient,priority is placed on pulmonary hygiene.Which statement provides the best explanation for this priority?

Accepted Answer

Nerves of the autonomic nervous system are severed during lung transplant surgery.This results in denervation of the lung and loss of the cough reflex.Loss of this reflex places the patient at greater risk for infection because of the potential inability to clear secretions effectively.Although immunosuppressant medications reduce the body's ability to fight infections,this is a general explanation for all increased risk of infection in transplant recipients.Atelectasis decreases oxygenation.The primary reason for pulmonary hygiene is to expectorate secretions.Primary graft dysfunction is caused by ischemia,surgical trauma,or denervation and is similar to acute respiratory distress syndrome.

Question 19

The nurse is caring for a postoperative renal transplant recipient from a cadaver donor in the critical care unit.After seeing minimal urine output in the catheter for most of the day,the patient expresses concern to the nurse.What is the best response by the nurse?

Accepted Answer

There are many factors that can delay normal functioning of a transplanted renal graft (e.g.,prolonged cold times,altered perfusion states during surgery).A kidney from a cadaver may not function immediately,and hemodialysis may be needed until it functions adequately.This is not necessarily a sign that the kidneys have failed and need removal or that the patient is experiencing acute rejection.There is also no indication that a retransplant needs to occur.

Question 20

The nurse is caring for a mechanically ventilated patient following bilateral lung transplantation.When planning the care of this patient,what is the priority nursing intervention?

Accepted Answer

Denervation of the lung that occurs during lung transplantation causes changes in mucous production and ciliary movement.As a result,to promote the drainage of secretions and prevent mucous plugging,endotracheal and oral suctioning should be a priority of nursing care in the postoperative lung transplant patient.Head of bed elevation,side to side repositioning,and application of sequential compression stockings are appropriate nursing interventions,but they are not the priority intervention.

Quiz 11: Organ Donation