Deck 16: Care of the Organ Donor and Transplant Recipient

Question 1

A patient is demonstrating signs of organ rejection 3 months following a kidney transplant. The nurse recognizes this reaction as being what type of rejection?
1) Acute rejection
2) Accelerated rejection
3) Hyperacute rejection
4) Chronic rejection

Answer 1

1
Explanation: 1. Acute rejection occurs during the first year following organ transplant.
2. Accelerated rejection occurs within the first week after transplant.
3. Hyperacute rejection occurs immediately and is rare.
4. Chronic rejection occurs months to years after organ transplantation.

Question 2

A patient has become a candidate to donate organs in Town A. Based on the UNOS priority system, which potential recipient would be the best candidate to receive a kidney transplant?
1) A patient on dialysis who lives in Town A and has been on the transplant list for 3 years
2) A patient with acute renal failure, the same blood type, and all matching antigens who lives in Town A
3) A patient on dialysis with compatible blood type and six matching antigens who lives in Town B (60 miles away)
4) A patient on dialysis who lives in Town B (60 miles away) and has been on the transplant list for 4 years

Answer 2

3
Explanation: 1. Being on a transplant list does not make the patient the best candidate without a match.
2. The patient has acute renal failure and is not a candidate for transplanting at this time.
3. A zero antigen-mismatched organ is when the donor and recipient have compatible blood types and all six of the HLA antigens match. When this occurs, the organ is offered to the matching potential recipient first.
4. Being on the transplant list does not make the patient the best candidate without a match.

Question 3

The nurse reviews the tissue requirements for organ recipients and donors. Which statement correctly describes which recipients can receive an organ from which donor?
1) Recipients with blood type O are universal recipients.
2) Recipients with blood type A can receive donations from donors with blood types A, AB, and O.
3) Recipients with blood type B can receive donations from donors with blood types A, B, and O.
4) Recipients with blood type AB can receive an organ from any donor blood type.

Answer 3

4
Explanation: 1. Recipients with blood type O are universal donors and not recipients.
2. A recipient with blood type A cannot receive a blood type AB donation.
3. A recipient with blood type B cannot receive a blood type A donation.
4. Recipients with blood type AB are universal recipients and can receive an organ from any donor blood type.

Question 4

A patient candidate for organ donation has developed diabetes insipidus. What should the nurse expect to assess in this patient?
1) Large urine output and low urine specific gravity
2) Low urine output and high serum sodium
3) High urine specific gravity and high serum glucose
4) Large urine output and low serum sodium

Question 5

Why should the nurse realize the importance of advocating for organ donation?
1) The supply of donor organs meets the demand of potential recipients.
2) Organ recipients are not expected to have a long life span because of complications associated with the transplant.
3) The organ recipient usually enjoys a better quality of life at less cost to the health care system.
4) The organ recipient is often confined by frequent health care visits in order to maintain health.

Question 6

A patient is placed on an organ transplant list for a living or deceased kidney donor. Over the past 5 years, how many annual transplants were conducted each year by living donors?
1) 2,500
2) 3,000
3) 5,000
4) 6,000

Question 7

What best describes the role of the critical care nurse in the organ donation process?
1) Talk about the benefits of organ donation to the family.
2) Reinforce the explanation of brain death after the doctor has talked to the family.
3) Answer questions about financial concerns related to organ donation.
4) Let the organ procurement nurse take over the care of the patient and family.

Question 8

A patient's urine output is greater than 200 mL/hour and hemodynamic stability cannot be achieved by using fluids and vasoactive medications. The nurse anticipates that which medication may be prescribed?
1) Beta blocker, such as Lopressor
2) Diuretic, such as furosemide
3) Concentrated sugar, such as 50% dextrose
4) Hormone, such as vasopressin

Question 9

The nurse is caring for a patient who is approaching death. When must the nurse notify the organ bank?
1) Death is imminent in all cases.
2) Death is imminent and an organ donation card or the back of the driver's license indicates that the person wanted to donate his organs.
3) Death is imminent and the family consents to organ donation.
4) The nurse assesses that the family can be approached about organ donation.

Question 10

The nurse is determining the MELD score for a patient waiting for a liver transplant. This score contains which criteria?
1) Time on the transplant list, INR, and bilirubin
2) Serum creatinine level, INR, and bilirubin
3) Quality of antigen match, AST, and ALT
4) Severity of illness, AST, ALT, and bilirubin

Question 11

A patient in a critical care area has passed away. Who is the best person to approach the family about organ donation?
1) The nurse
2) The organ procurement specialist
3) The doctor
4) A member of the clergy

Question 12

Which finding by the nurse assessing a potential organ donor would indicate that the patient did not meet the criteria for donation based on brain death?
1) Apnea
2) Decorticate posturing
3) Unresponsiveness
4) Absence of brainstem reflexes

Question 13

The nurse is teaching a patient about the antigen-antibody response. Which statement best describes an antigen?
1) Antigens are recognized by the body as foreign or non-self.
2) The presence of HLA antigens means that the recipient cannot receive an organ.
3) A recipient may have antihuman antigens that would react with a donated organ.
4) An organ can only be transplanted if the potential donor and recipient antigens completely match.

Question 14

The critical care nurse is reviewing patients who would be good candidates for organ donation. Which patient would be appropriate for this process?
1) A 25-year-old who is 28 weeks pregnant and has a severe traumatic head injury
2) A 30-year-old who was healthy before overdosing with barbiturates
3) A 45-year-old with a small primary lung carcinoma
4) A 55-year-old with intracranial pressure from a primary intracranial tumor

Question 15

A patient is a candidate for organ donation. A pulmonary artery catheter has been inserted to help maintain hemodynamic stability. Which finding demonstrates that the patient has adequate hemodynamic stability?
1) CVP 5 and PCWP 12
2) CVP 6 and PCWP 10
3) CVP 4 and PCWP 14
4) CVP 3 and PCWP 8

Question 16

A patient recovering from a kidney transplant is taking daclizumab (Zenapex) and has developed a fever and chills with joint pain. What action should the nurse take?
1) Call the doctor immediately and expect orders for Benadryl to treat the drug allergy.
2) Communicate the reaction to the doctor, and expect to hold the medication for 24 hours and then resume it.
3) Continue to give the medication as scheduled and communicate the reaction to the doctor.
4) Call the pharmacy for a suggestion regarding another medication that the patient could take.

Question 17

What should the nurse include when providing discharge instructions to a patient recovering from a kidney transplant?
1) "Your diet should be high in protein and low in carbohydrates."
2) "Weigh yourself once a week and notify your physician of any weight gain."
3) "You should avoid exercise such as walking for the first week postop."
4) "Contact the transplant center if your cardiologist changes your heart medications."

Question 18

A patient wants to donate organs after cardiac death. One hour after the withdrawal of life support the patient continues to breathe shallowly and has a slow heartbeat. What is the nurse's most appropriate response?
1) Call the patient's doctor to reintubate the patient.
2) Update the organ retrieval team that death is imminent.
3) Maintain hemodynamic stability to perfuse the donor's organs.
4) Allow death to occur naturally without organ donation.

Question 19

A patient who developed signs of rejection to a liver transplant within the first week of receiving the organ is asking about the possibility of organ failure. What is the nurse's most appropriate response to this patient?
1) "You are receiving medications to prevent the rejection. We will continue to do everything to treat the rejection and keep you informed of what is happening."
2) "As long as you continue to take your medications to prevent the rejection, everything should be OK with your new liver. I will call the chaplain to visit with you."
3) "Although you are receiving medications to prevent the rejection, most people in your situation end up losing their new liver."
4) "Please don't worry about rejection right now. You have a new liver, and we will give you the medications that you need to treat the rejection."

Question 20

Which intervention is important when the nurse is caring for a patient who is a potential lung donor in order to ensure that the lungs remain suitable for transplant?
1) Maintaining the FiO₂ at 98% to 99%
2) Avoiding excess fluid replacement
3) Avoiding frequent suctioning of the donor's endotracheal tube
4) Maintaining the donor's oxygen saturation at 80%

Question 21

A patient recovering from a liver transplant is at risk for malnutrition. What should the nurse include when planning care for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Consult with a dietician to plan for adequate energy from carbohydrates or fats.
2) Provide nutritional supplements enterally.
3) Prepare for placement of a central line for parenteral nutrition.
4) Encourage the consumption of high-protein foods.
5) Restrict fruits and vegetables.

Question 22

The spouse of a patient awaiting surgery to donate organs asks how the patient can be classified as "dead" when the chest rises and falls with respirations. What should the nurse respond to this family member?
1) "It's a response to the testing."
2) "Breathing is a reflex and may continue."
3) "The ventilator is breathing for the patient."
4) "At times breathing continues after brain death."

Question 23

A patient with end-stage renal disease wants to be considered for a kidney transplant. What should the nurse explain about the United Network for Organ Sharing waiting list process? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Waiting time begins when the glomerular filtration rate (GFR) is less than 30 mL/min.
2) The patient's location in proximity to the available kidney is a consideration in determining who will receive the kidney.
3) The number of matches between the candidate's and donor's human leukocyte antigens (HLA) is a significant consideration in who will receive an organ.
4) Family members must be available to care for the patient after transplant or the patient will not be placed on the list.
5) Body size

Question 24

A patient 3 months post-transplant is experiencing a sore mouth and throat and is having trouble eating. Upon assessment, the nurse sees white patches on the mucous membranes. This patient has probably developed what opportunistic infection?
1) Cytomegalovirus (CMV)
2) Epstein-Barr virus
3) Candidiasis
4) Staphylococcal pneumonia

Question 25

The nurse notes that a patient being evaluated for a kidney transplant has antihuman antibodies in the blood. What should the nurse realize is the potential source of these antibodies? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Pregnancy
2) History of a dog bite
3) Previous organ transplant
4) Previous blood transfusion
5) Exposure to bird droppings

Question 26

A patient recovering from a kidney transplant is prescribed tacrolimus (Prograf). What action should the nurse take when providing this medication to the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Provide the medication orally.
2) Provide the medication in the morning before breakfast.
3) Monitor blood pressure.
4) Assess capillary blood glucose level daily.
5) Administer through a central line with a filter over 6 hours for the first dose.

Question 27

A patient is being evaluated for rejection after a heart transplant. What should this assessment include?
1) Repeated heart biopsies to assess for myocyte damage or necrosis
2) Signs of chest pain or pain, numbness, or tingling in the left arm
3) 2D echo to assess heart function and left ventricular ejection fraction
4) Signs of heart failure, such as sudden weight gain, shortness of breath, and rales on auscultation of the lungs

Question 28

The nurse should suspect that a patient recovering from a liver transplant is experiencing acute rejection if what is found during assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Malaise and fatigue
2) Swollen and tender graft site
3) Colorless bile
4) Tea-colored urine
5) Constipation

Question 29

Which assessment finding should cause the nurse to suspect acute rejection of a transplanted kidney?
1) Protein in the urine
2) High blood pressure
3) Decreased urine output
4) Ketonuria

Question 30

A patient is being discharged to home after receiving a liver transplant. What should the nurse instruct the patient and family to do to reduce the risk of developing an infection? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Wash hands before eating and after using the bathroom.
2) Wear a mask when in a crowd for the first few months post transplant.
3) Remove plants and flowers in vases from the home.
4) Wash, peel, and cook all fruits and vegetables.
5) Obtain vaccinations with live vaccines.

Question 31

A patient in the intensive care unit is having brainstem reflexes assessed to validate brain death. What assessment finding would validate the diagnosis of brain death? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Pupils do not respond to light or accommodation
2) Absent corneal reflex
3) No cough reflex to bronchial suctioning
4) Grimacing to noxious stimuli
5) Involuntary gag reflex upon stimulation of the posterior pharynx

Question 32

The mother of a patient wants to be evaluated as a living kidney donor. Which diagnostic test would the mother need to be considered as a living donor? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Tissue typing
2) Antibody screening
3) Screening for transmissible diseases
4) Renal function tests
5) Chest x-ray

Question 33

The nurse suspects that an organ transplant patient is developing a cytomegalovirus (CMV) infection. What did the nurse most likely assess in this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Fever
2) Diarrhea
3) Joint pain
4) Abdominal pain
5) Malodorous urine

Question 34

Which intervention is most important to include in the multidisciplinary plan to prevent infection in a patient during the early post-transplant period?
1) Continuing the administration of antibiotics 10 to 14 days postop
2) Encouraging the patient to ambulate and use an incentive spirometer
3) Keeping the patient on contact precautions for at least 1 week
4) Providing vaccination against the flu virus

Question 35

The nurse cares for an organ donor patient who has been diagnosed as brain dead. What should the nurse do to ensure stability of the patient's body temperature? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Set the room temperature to 90°Fahrenheit.
2) Administer warm intravenous fluids.
3) Apply warming blankets to the patient.
4) Hyperventilate the patient to decrease arterial carbon dioxide level.
5) Suction frequently.

Question 36

A patient who received a liver transplant is beginning maintenance immunosuppressant therapy. For which medication should the nurse prepare teaching for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Prednisone
2) Basiliximab
3) Azathioprine
4) Cyclosporine
5) Thymoglobulin

Question 37

A patient has started taking corticosteroids for immune suppression following transplantation. What should the nurse teach the patient about this medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Take this medication 1 hour before or 2 hours after eating.
2) Increased thirst and urination may occur but should be reported immediately.
3) Your face may have a full or round appearance after taking this medication.
4) You may have a deceased appetite and lose weight while on this medication.
5) Mood swings are common when taking this medication.