Deck 21: Solid Organ Transplantation

Question 1

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?

A) Thirty-degree elevation of head of bed
B) Endotracheal suctioning as needed
C) Frequent side to side repositioning
D) Sequential compression stockings

Answer 1

Endotracheal suctioning as needed

Question 2

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?

A) Renal transplant recipient, 1 day post op with a 3/10 pain level
B) Lung transplant recipient, 1 day post op with a productive cough
C) Heart transplant recipient, 1 day post op with a cardiac output of 4 L/min
D) Liver transplant recipient, 12 hours post op with a serum glucose of 58 mg/dL

Answer 2

Liver transplant recipient, 12 hours post op with a serum glucose of 58 mg/dL

Question 3

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?

A) "I qualify if my glomerular filtration rate is less than 20 mL per minute."
B) "I will not qualify until I have to go on regular hemodialysis treatments."
C) "My blood type does not have to be a match with the donor blood type."
D) "The national waiting list is based on the ability to pay for medications."

Answer 3

"I qualify if my glomerular filtration rate is less than 20 mL per minute."

Question 4

The nurse is providing preoperative care to a patient who will receive a transplant.The patient has high panel reactive antibodies ( PRA ).As part of induction therapy for this patient,the nurse understands which medication to be of priority for administration in the operating room?

A) Alemtuzumab ( Campath )
B) Tacrolimus ( Prograf )
C) Sirolimus ( Rapamune )
D) Cyclosporine ( Neoral )

Question 5

A family member approaches the nurse caring for their gravely ill son and states,"We want to donate our son's organs." What is the best action by the nurse?

A) Arrange a multidisciplinary meeting with physicians.
B) Consult the hospital's ethics committee for a ruling.
C) Notify the organ procurement organization (OPO).
D) Obtain family consent to withdraw life support.

Question 6

The nurse is providing discharge instructions to a renal transplant recipient.The patient has a follow-up appointment the next day for routine post-transplant laboratory bloodwork,including trough levels of anti-rejection medications.Which instruction describes what the patient should do regarding the anti-rejection medications the next day?

A) "Take your morning dose of medications at midnight with sips of water."
B) "Take your morning dose of medications after labs have been drawn."
C) "Skip your morning dose of medications and then resume your evening doses."
D) "Hold all doses of your medications the day you have labs drawn."

Question 7

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?

A) "I only smoke marijuana on an occasional basis."
B) "I have two sisters who live within two hours of me."
C) "I have attended all of my scheduled dialysis sessions."
D) "My mother's side of the family has a history of cancer."

Question 8

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?

A) Immunosuppressant medications reduce the body's ability to fight infections.
B) During the early postoperative period, atelectasis decreases oxygenation.
C) Pulmonary hygiene reduces the risk of early primary graft dysfunction.
D) Loss of cough reflex results in decreased ability to remove secretions effectively.

Question 9

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

A) "I will be gradually weaned off my medications during my lifetime."
B) "After 6 months, I will be down to taking one medication for life."
C) "My doctors may try to stop my steroids soon after my transplant."
D) "I will only need to take my mediations every other day for life."

Question 10

The transplant clinic nurse is conducting patient education on the importance of follow-up health screening activities important in detecting complications associated with long-term immunosuppressant therapy.Which statement is most important for the nurse to include in the discussion?

A) "Application of sunscreen may cause a reaction."
B) "Avoid sun exposure during peak hours of the day."
C) "Melanoma is the most common type of cancer."
D) "Skin examinations should occur every 5 years."

Question 11

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?

A) A 65-year-old brother with a history of hypertension; blood type A positive
B) A 35-year-old female with a history of food allergies; blood type O negative
C) A 14-year-old son, otherwise healthy with no history; blood type B negative
D) A 70-year-old mother, with a history of sinus infections; blood type A positive

Question 12

The nurse is caring for a postoperative renal transplant recipient 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?

A) "Your kidney has unfortunately failed and will be removed."
B) "It can take a few days for your kidney to start working"
C) "You are experiencing an acute rejection episode."
D) "You will have to undergo daily hemodialysis treatments."

Question 13

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 (SpO?)is 99% and core temperature 93.8° F.Which physician order should the nurse implement first?

A) Apply forced air warming device to keep temperature > 96.8°
B) Obtain basic metabolic panel every 4 hours until surgery
C) Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg
D) Draw arterial blood gas every 4 hours until surgery

Question 14

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

A) A 36-year-old patient with a Glasgow Coma Scale score of 3 with no activity on electroencephalogram
B) A 68-year-old male admitted with unstable atrial fibrillation who has suffered a stroke
C) A 40-year-old brain-injured female with a history of ovarian cancer and a Glasgow Coma Scale score of 7
D) A 53-year-old diabetic male with a history of unstable angina status post resuscitation

Question 15

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

A) Blood pressure of 100/60 mm Hg
B) Serum creatinine of 1.5 mg/dL
C) Hemoglobin of 9.2 gm/dL
D) Tenderness over graft site

Question 16

The nurse is working for a hospital that holds an agreement with a local organ procurement organization (OPO).The patient has a Glasgow Coma Scale (GCS)score of 3 and 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?

A) "I need to notify TransLife (OPO) of my patient's impending death."
B) "I will contact the physician to obtain informed consent for organ donation."
C) "The charge nurse will notify TransLife (OPO) once the patient has been pronounced brain dead."
D) "I need the physician to evaluate my patient's suitability for organ donation."

Question 17

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

A) Morning serum blood glucose of 128 mg/dL
B) pH 7.30; PaCO₂ 38 mm Hg; HCO₃ 16 mEq/L
C) Pulmonary artery temperature of 97.8° F
D) Central venous pressure of 8 mm Hg

Question 18

The nurse is caring for a patient who is being evaluated clinically for brain death by a physician.Which assessment findings by the nurse support brain death?

A) Absence of a corneal reflex
B) Unequal, reactive pupils
C) Withdrawal from painful stimuli
D) Core temperature of 100.8° F

Question 19

The nurse is caring for a renal transplant recipient in the post-anesthesia care unit.Blood pressure is 125/70 mm Hg; heart rate is 115 beats/min; respiratory rate is 24 breaths/min; oxygen saturation (SpO?)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?

A) Administer fluid replacement therapy; monitor intake and output closely.
B) Increase supplemental oxygen to 100% non-rebreather mask; notify physician.
C) Apply thermal warming blanket; administer all fluids through warming device.
D) Assess the patient for pain; administer pain medications as ordered.

Question 20

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

A) Notify the OPO transplant coordinator.
B) Verify results with the lab technician.
C) Repeat all pre-procedure viral studies.
D) Continue to monitor for signs of rejection.

Question 21

The nurse is providing postoperative education to a transplant patient's family.When asked about detecting rejection,which answer by the nurse is most appropriate?

A) "Endomyocardial biopsies will be performed weekly for the first six weeks after surgery."
B) "Increased shortness of breath most likely indicates immediate, acute rejection of the heart."
C) "Biopsies of the heart are done every 6 months after the day of the transplant surgery."
D) "As time passes, the more biopsies that are performed, the more reliable the results become."

Question 22

A patient presents to the outpatient transplant clinic stating,"I would like to donate one of my kidneys." What is the best response by the nurse?

A) "To be a living donor, you must be related to the recipient."
B) "You must be over the age of 30 to be a living donor."
C) "Living donor donation is coordinated by UNOS."
D) "Let us orient you to the process required to become a donor."

Question 23

The nurse is caring for a renal transplant patient admitted with an acute rejection episode.The patient asks the nurse how the doctors will know if the kidney has been rejected.What is the best response by the nurse?

A) "Your admission lab results will determine if your kidney is being rejected."
B) "A procedure called a renal biopsy will be the best way to confirm rejection."
C) "Monitoring over the next few days will determine if your kidney is failing."
D) "An ultrasound of your kidney will determine if your kidney has failed."

Question 24

The postanesthesia care unit receives handoff communication from the CRNA indicating that the renal transplant recipient received induction therapy in the operating room with antithymocyte globulin (ATG).What is the best understanding of the administration of this drug by the nurse?

A) The drug is administered for recipients of CMV-positive donor organs.
B) Administration of the drug decreases initial postoperative rejection rates.
C) Antiproliferative agents are recommended for routine induction therapy.
D) Antithymocyte globulin (ATG) is given as a single dose in the OR.

Question 25

The nurse is caring for a renal transplant recipient in the postanesthesia care unit.Handoff communication from the OR included a reported output of 500 mL following anastomosis of the renal vessels and reperfusion.One hour after the transplant recipient was admitted to the PACU,the RN notes no urine output.Which physician order should the nurse implement first?

A) Administer 20 mg furosemide intravenous (IV) every 4 hours as needed for urine output < 30 mL/hr.
B) Administer a 500-mL bolus of 0.9% normal saline intravenously over 2 hours.
C) Irrigate the indwelling urinary catheter gently with 30 mL 0.9% normal saline.
D) Provide maintenance IV fluids of D₅
NS to infuse at 100 mL/hr.

Question 26

The nurse assesses morning lab results for a postoperative day 1 liver transplant recipient.Lab results noted by the nurse include aspartate transaminase (AST)365 U/L; alanine aminotransferase (ALT)400 U/L; and serum glucose of 85 mg/dL.What is the best action by the nurse?

A) Notify the physician of liver enzyme results.
B) Treat hypoglycemia with 50 mL 5% dextrose.
C) Repeat the liver enzyme results in 4 hours.
D) Prepare to administer IV insulin infusion.

Question 27

Which statement best represents appropriate donor-to-recipient criteria for liver transplantation?

A) Blood type and HLA tissue type
B) HLA tissue type and body type
C) Body type and body size
D) Blood type and donor history

Question 28

Which statement best describes the lung allocation score (LAS)used to prioritize lung transplant recipients?

A) The LAS is based on lab values, diagnostic tests, and medical diagnosis.
B) Lungs from children and adolescents are offered to adults first.
C) The LAS is limited to candidates under the age of 65 years.
D) The score was developed to estimate 5-year survival rates.

Question 29

The family of a critically ill patient has asked to discuss organ donation with the patient's nurse.When preparing to answer the family's questions,the nurse understands which concern(s)most often influence a family's decision to donate? (Select all that apply.)

A) Donor disfigurement influences on funeral care
B) Fear of inferior medical care provided to donor
C) Age and location of all possible organ recipients
D) Concern that donated organs will not be used
E) Fear that the potential donor may not be deceased
F) Concern over financial costs associated with donation

Question 30

The nurse is preparing to admit a patient with heart failure who has been listed on the UNOS transplant list as status 1A.What is the best understanding of this classification by the nurse?

A) The patient can be managed at home with a left ventricular assist device.
B) Hospitalization is required with mechanical support and vasoactive infusions.
C) The patient has advanced heart failure and is being managed with medication.
D) An advanced heart failure patient not successfully managed on medications.

Question 31

The nurse is preparing to administer a renal transplant recipient's first dose of mycophenolate mofetil (CellCept).Prior to administering the medication,the nurse appropriately reviews drug formulary information.What is the best understanding of this medication by the nurse?

A) It is a calcineurin inhibitor used for induction therapy.
B) It is an antimetabolite used for maintenance therapy.
C) It is a polyclonal antibody used for maintenance therapy.
D) It is an mTOR inhibitor used for maintenance therapy.

Question 32

The transplant clinic nurse is educating a group of transplant recipients on health promotion and maintenance.What is the priority statement by the nurse?

A) "Adhere to all future scheduled appointments with the clinic."
B) "Obtain annual vaccinations for pneumonia from your physician."
C) "Report all routine lab results to your primary care physician."
D) "Notify the transplant clinic of all future hospital admissions."

Question 33

The transplant clinic nurse is conducting a pretransplant education session for patients being evaluated for liver transplantation.Which statement by the nurse provides the best explanation of the numeric system used to classify the severity of a patient's liver disease?

A) "A score is calculated based upon kidney function, clotting time, and bilirubin levels."
B) "A score is calculated that ranges between 6 and 40, with the lower score being more serious."
C) "There are currently no exceptions to the MELD score calculation for severity of disease."
D) "The calculated score represents the patient's risk of death within 1 year of diagnosis."

Question 34

A renal transplant recipient presents to the outpatient transplant clinic with blood glucose values for the past 3 days exceeding 250 mg/dL.The patient takes prednisone 5 mg daily and tacrolimus (Prograf)2 mg twice daily.Hemoglobin A1C level drawn the day of the clinic appointment was 8.5%.What is the best interpretation of this finding by the nurse?

A) The patient is at increased risk for infection.
B) The patient has developed posttransplant diabetes.
C) Temporary elevations in blood sugars are normal.
D) Discontinuation of steroids will normalize values.

Question 35

Which clinical scenario best represents hyperacute rejection?

A) A cardiac transplant patient with a 3-month history of shortness of breath
B) A lung transplant patient with small pustules that follow a dermatome
C) A liver transplant patient with several small lumps under the skin
D) An implanted renal transplant that, upon reperfusion, becomes cyanotic