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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

At the least,a mask should be worn by caregivers and visitors in the first 48 hours after transplantation,and hand washing should be performed before and after each interaction with the patient throughout hospitalization.Anyone with a respiratory infection should not be allowed to have contact with the patient.

Question 5

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

Accepted Answer

Cardiomyoplasty is a rarely used alternative to heart transplantation.It is a surgical procedure in which a fatigue-resistant skeletal muscle,the latissimus dorsi,is wrapped around the patient's heart and is stimulated electrically to contract in synchrony with cardiac systole.

Question 6

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

Accepted Answer

Diabetes mellitus with microvascular organ damage is one of the six absolute contraindications for heart transplant.Answers B,C,and D are all relative contraindications.

Question 7

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

Accepted Answer

As part of a patient evaluation for heart or lung transplant,the physical therapist completes an exercise tolerance test,exercise prescription,musculoskeletal assessment,and cough/mucociliary clearance.The other team members include a transplant coordinator,physicians and medical staff,dietician,social worker or pastoral care,and psychologist/psychiatrist.

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?

Accepted Answer

Fatalistic coping is a predictor of poorer quality of life in heart transplant candidates.Whereas evasive coping is a predictor or of more difficulty with activities of daily living,depression,and poor quality of life in lung transplant candidates.

Question 9

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

Accepted Answer

Heterotopic heart transplantation (HHT),referred to as the "piggyback" technique,is considered to be an alternative technique.This technique is performed without the removal of the native 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?

Accepted Answer

The delayed reaction of the denervated heart to the stimulus of activity necessitates an adequate warm-up and cool-down period in conjunction with each exercise session.This is to permit accommodation to the change in activity level.

Question 11

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

Accepted Answer

The biatrial technique used for orthotopic heart transplantation leaves the recipient sinoatrial (SA)node intact to avoid the need for venous anastomoses.The SA node remains functional.The donor heart's SA node is denervated and operates independently of the recipient's node.Thus,two separate P waves are revealed on ECG.

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)?

Accepted Answer

Patients with high exercise capacity whose lower lobes were primarily affected had a higher mortality with LVRS than with medical treatment.Patients with low exercise capacity whose upper lobes were primarily affected had lower mortality with LVRS.

Question 13

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

Accepted Answer

Heart rate is not a good choice due to denervation.Blood pressure is important to monitor,but using a patient's rate of perceived exertion or symptoms of fatigue are BEST to use initially for making decisions during treatment.

Question 14

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

Accepted Answer

The primary indication for heart or lung transplantation is a progressive terminal cardiopulmonary disease with limited life expectancy.End-stage disease is indicated by a marked decrease in cardiopulmonary function,requirement of multiple medications and/or oxygen to complete activities of daily living,and the inability to work or go to school full-time.

Question 15

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

Accepted Answer

Absolute criteria for heart donor include age <40 years,no history of cardiac disease,no positive test for hepatitis B,no evidence of cardiac trauma,and no prolonged resuscitative efforts applied prior to death.

Question 16

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

Accepted Answer

An age of 65 years or older is one of seven relative contraindications for lung transplant.Answers A,C,and D are all considered absolute contraindications.

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?

Accepted Answer

In heart transplant candidates,the research demonstrated that a peak oxygen consumption (VO₂mₐₓ)of <14 mL/kg/min indicates that they are at higher risk for death and need to be referred for transplantation.A candidate with >14 mL/kg/min could be safely deferred for transplantation.

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?

Accepted Answer

Sciurba,Cooper,and Trulock proposed three hypotheses to explain improvements in symptoms and pulmonary function.The hypotheses include the following:(1)surgery causes an increase in elastic recoil of the lung creating greater efficiency in respiratory muscle and chest wall mechanics;(2)beneficial effect on the mechanical function of musculoskeletal components by reducing the functional residual capacity allowing the muscles to work at a more optimal length;and (3)the decrease in hyperinflation and normal cardiac filling is possible.

Question 19

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

Accepted Answer

Examples of unstable hemodynamic abnormalities include hypotension,reduced lung volumes,decreased pulmonary perfusion,and increased (not decreased)pulmonary vascular resistance.

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?

Accepted Answer

As the transplanted lung is denervated,the patient may not be able to sense the need to cough and should be taught to cough on a regular schedule (directed coughing techniques).Other techniques are vital,but cough becomes the most important secondary to the denervated tissue.

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