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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

1. DI develops in 40% to 70% of organ donors and results in production of large volumes of dilute urine. Typical findings include urine output greater than 300 mL/hr and urine specific gravity less than 1.01.
2. A low urine output is not a manifestation of diabetes insipidus.
3. A high urine specific gravity is not a manifestation of diabetes insipidus.
4. Low serum sodium is not a manifestation of diabetes insipidus.

Question 5

Why should the nurse realize the importance of advocating for organ donation?

Accepted Answer

1. This is not the case today.
2. This is not true.
3. Organ recipients are expected to live a longer life with better quality at a lower cost to the health care system.
4. The organ recipient needs expert health care but is not confined by frequent visits 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?

Accepted Answer

1. According to the UNOS, over the past 5 years, living donors accounted for approximately 6,000 transplants each year.
2. According to the UNOS, over the past 5 years, living donors accounted for approximately 6,000 transplants each year.
3. According to the UNOS, over the past 5 years, living donors accounted for approximately 6,000 transplants each year.
4. According to the UNOS, over the past 5 years, living donors accounted for approximately 6,000 transplants each year.

Question 7

What best describes the role of the critical care nurse in the organ donation process?

Accepted Answer

1. The organ procurement specialist is the best person to talk about benefits of organ donation with the family.
2. It is the nurse who must reinforce the explanations and ensure the family's understanding.
3. The organ procurement specialist would be the best person to answer questions about financial concerns of organ donation.
4. The nurse has a role with the family and should not permit the organ procurement nurse to 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?

Accepted Answer

1. A beta blocker would not be indicated for this patient situation.
2. A diuretic would not be indicated for this patient situation.
3. An infusion of 50% dextrose would not be indicated for this patient situation.
4. If hemodynamic stability cannot be achieved using fluids and vasoactive medications, therapy with vasopressin would be instituted. Vasopressin is a synthetic form of antidiuretic hormone (ADH). The expected outcome would be increased vascular volume and decreased urine output.

Question 9

The nurse is caring for a patient who is approaching death. When must the nurse notify the organ bank?

Accepted Answer

1. It is the law that institutions notify the organ bank when death is imminent.
2. Many times an organ donation card is not signed, but the bank must be notified.
3. Prior to informing the family, they should have been informed about the death.
4. In many cases, the potential donor has not signed a donor card or indicated intent to donate prior to death. Prior to informing the family, they should have been informed about the death.

Question 10

The nurse is determining the MELD score for a patient waiting for a liver transplant. This score contains which criteria?

Accepted Answer

1. MELD does not consider time on the transplant list.
2. The MELD score is calculated using the bilirubin, INR, and creatinine.
3. These are not criteria of the MELD score.
4. These are not criteria of the MELD score.

Question 11

A patient in a critical care area has passed away. Who is the best person to approach the family about organ donation?

Accepted Answer

1. The nurse is not the best person trained to approach families about organ donation.
2. Families are likely to donate if approached by an organ procurement specialist.
3. The doctor can discuss organ donation with the family but is not the best person trained to approach families about organ donation.
4. The clergy should not approach a family regarding donation.

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?

Accepted Answer

1. Apnea is a cardinal sign of brain death.
2. Decorticate posturing is an indication of increased intracranial pressure but not a cardinal sign of brain death.
3. Unresponsiveness is a cardinal sign of brain death.
4. Absence of brainstem reflexes is a cardinal sign of brain death.

Question 13

The nurse is teaching a patient about the antigen-antibody response. Which statement best describes an antigen?

Accepted Answer

1. Antigens are recognized by the body as foreign or non-self.
2. HLA antigens found on chromosome 6 helps the immune system determine what tissue is foreign and what is self.
3. A recipient may have antihuman antibodies (not antigens) that would react with a donated organ.
4. A complete match is rare and could only occur with identical twins.

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?

Accepted Answer

1. A pregnant patient would not be a candidate for donation until the unborn child has been delivered or has also died.
2. Brain death cannot be determined for a patient who was just admitted after overdosing with barbiturates until the drugs are reversed or wear off.
3. Any other malignancy, such as small primary lung carcinoma, would preclude donation.
4. The 55-year-old with intracranial pressure is near death (unconscious and on mechanical ventilation) due to pressure from a primary cranial tumor and would be the most appropriate candidate for organ donation.

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?

Accepted Answer

1. This central venous pressure is too low.
2. Hemodynamic stability is determined by a CVP of 6-8 mm Hg and a PCWP of 8-12 mm Hg.
3. This central venous pressure is too low and wedge pressure is too high.
4. This central venous pressure is too low.

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?

Accepted Answer

1. Immediate action is not warranted. These symptoms do not represent an allergy or an adverse drug reaction.
2. After communicating the reaction to the doctor, the nurse would expect to receive orders for medications that would help with these symptoms while continuing therapy to prevent organ failure. There is no need to hold the medication.
3. Although the patient is showing signs of infection, the medication should be continued and the patient monitored. Fever, chills, and joint pains are common side effects of this medication.
4. The physician would decide whether to change drug therapy.

Question 17

What should the nurse include when providing discharge instructions to a patient recovering from a kidney transplant?

Accepted Answer

1. Post-transplant patients should have a diet high in carbohydrates initially.
2. Daily rather than weekly measurement of weight measures fluid volume increases.
3. Activity such as walking would be encouraged to prevent postop complications.
4. The transplant center will need to know any changes in medications. Many medications interact with immunosuppressants. The nurse would advise the patient to contact the transplant center before starting any new medication.

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?

Accepted Answer

1. There is no need to reintubate the patient when death is imminent.
2. This does not need to be done because the maximum amount of time has passed.
3. This does not need to be done because the maximum amount of time has passed.
4. An hour is considered the maximum acceptable interval between withdrawal of support and recovery of organs for minimizing ischemic damage. In the process of consent for organ donation, the patient would be allowed to die without resuscitation. However, if the patient continues to breathe with a heart rhythm for 60 minutes, then organ donation is no longer an option and the patient receives palliative care while death occurs naturally.

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?

Accepted Answer

1. Transplant patients receive medications to prevent rejection and will need to be monitored.
2. This statement provides false reassurance to the patient.
3. This may or may not be true.
4. This does not address the concern of the patient most appropriately.

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?

Accepted Answer

1. The intent is to attain the highest level of oxygen concentration in the donor's blood. FiO₂ is to be less than 60%. 2. Excess fluid replacement can cause pulmonary edema. Avoiding excessive fluid is essential when recovering lungs for donation. 3. Donors receive vigorous pulmonary hygiene and should be suctioned frequently. 4. Oxygen saturation is maintained greater than 98%.

Quiz 16: Care of the Organ Donor and Transplant Recipient