Question 1

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?

Accepted Answer

A patient taking steroids and calcineurin inhibitors is at risk for the development of posttransplant diabetes as a complication of long-term medication therapy.Although the lab values in isolation do not indicate infection,blood sugars must be normalized to promote healing.Hemoglobin A1C levels indicate the level of blood sugar control over the past 2 to 3 months.Findings should not be considered temporary.Although steroids can elevate blood sugar values,discontinuation of steroid therapy may not be feasible in all transplant recipients.

Question 2

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?

Accepted Answer

The Model for End-Stage Liver Disease (MELD)score uses the patient's serum creatinine,international normalized ratio (INR)for prothrombin time,and serum bilirubin to predict survival.The MELD score measures the severity of liver disease.
Higher calculated MELD scores indicate a more critically ill patient.MELD exception points may be generated by the presence of hepatocellular carcinoma (HCC),worsening hypoxemia,ascites,or other consequences of liver disease.

Question 3

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

Accepted Answer

The LAS generates a score that estimates the probability of survival posttransplant and the benefits of transplant for potential lung recipients.Lungs from children and adults are offered to pediatric and adolescent candidates first.The LAS is used for all patients who are listed on the organ donor registry.The LAS was developed to estimate the change of first-year survival after transplantation.

Question 4

The nurse is preparing to administer a renal transplant recipient's first dose of mycophenolate mofetil (CellCept).What is the best understanding of this medication by the nurse?

Accepted Answer

Mycophenolate mofetil (CellCept)is an antiproliferative agent that inhibits T lymphocytes.CellCept is used for maintenance immunosuppression therapy.

Question 5

The nurse is caring for a renal transplant recipient in the postanesthesia care unit (PACU).One hour after the transplant recipient was admitted to the PACU,the RN notes the patient's blood pressure has dropped to 82/60 mm Hg and the pulse is 138 beats/min.Which physician order should the nurse implement first?

Accepted Answer

Surgical complications following renal transplantation include arterial or venous bleeding due to failure of the surgical anastomoses.A fluid bolus can replace preload temporarily until the provider determines the cause of this change in status.Extra pain medications may or may not be needed.Irrigating the catheter is not related to this scenario.Hypotonic fluids are generally not used in the immediate postoperative period.

Question 6

A nurse is preparing to admit a post-heart transplant patient for a second myocardial biopsy in 3 weeks.What conclusion does the nurse draw from this admission information?

Accepted Answer

After heart transplant,patients undergo myocardial biopsy every week for 4-6 weeks.After that period of time,biopsies are scheduled based on patient condition.The patient is not necessarily rejecting the heart,there is no indication the heart is not functioning well,and the patient is not being evaluated for a new transplant.

Question 7

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

Accepted Answer

To protect against viruses that would be detrimental to a transplant recipient,it is most important for transplant patients to consult with their clinic providers to obtain the appropriate vaccinations.Adherence to future scheduled appointments,reporting lab results,and notifying the clinic of all future hospitalizations are part of long-term care,but appropriate vaccinations are essential to the health of the patient.

Question 8

Which clinical scenario best represents hyperacute rejection?

Accepted Answer

A hyperacute rejection occurs within hours or days of the transplanted organ.An implanted renal transplant that becomes cyanotic upon reperfusion represents a hyperacute rejection.A cardiac transplant patient with a 3-month history of shortness of breath represents an acute rejection.Small pustules that follow a dermatome most likely represent herpes zoster.Several small lumps under the skin may indicate squamous cell carcinoma.

Question 9

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

Accepted Answer

Blood type and body size are the two criteria necessary for matching a donor liver to a recipient.HLA tissue typing is not used because it has not been known to affect outcomes.Donors are carefully screened for infectious diseases and carcinomas during the process,but blood type and body type are the essential matching criteria.

Question 10

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?

Accepted Answer

Common fears and concerns that can influence a family's decision to donate include fear of disfigurement of the donor,fear of inferior medical care being provided to the donor in order to hasten the process,fear that the donor may not really be deceased,and concern that the family of the donor will assume the financial burden associated with the donation.The number of individuals awaiting transplant,along with the current UNOS registry system,ensures that all procured organs will be transplanted.The age and location of recipients are not disclosed by the OPO.

Question 11

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?

Accepted Answer

An altruistic living donor is an individual who makes a decision to donate an organ or part of an organ to a stranger.The nurse can help the patient navigate the donation process.Living donors may be related or unrelated to the potential recipient.In general,living donors are usually between the ages of 18 and 60 years.All transplant centers coordinate the living donation process.

Question 12

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?

Accepted Answer

Administration of antiproliferative agents such as antithymocyte globulin (ATG)has been shown to decrease rejection rates in the initial postoperative period.Antiviral agents are administered if CMV donor status is positive.Antiproliferative agents are recommended as first choice for induction therapy in recipients at high immunological risk.ATG is given in the operating room as well as for several days postoperative.

Question 13

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

Accepted Answer

The traditional method of rejection surveillance in a heart transplant recipient is through endometrial biopsies performed weekly during the first 6 weeks posttransplant.Shortness of breath can be a symptom of rejection,but only in combination with other symptoms.Rejection is confirmed through biopsy.The need for biopsies decreases over time unless the patient suffers signs and symptoms suggestive of rejection.

Question 14

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?

Accepted Answer

Renal biopsy confirms the presence of rejection.Admission lab results will provide information related to the current functional level of the kidney but will not confirm rejection.Monitoring the patient will not confirm the presence of rejection.An ultrasound of the kidney will determine whether there is blood flow to the kidney but will not provide information at the cellular level.

Question 15

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?

Accepted Answer

Rejection is suspected with a rise in aspartate aminotransferase (AST),alanine aminotransferase (ALT),and bilirubin and warrants a liver biopsy.These values are very high,which warrants notifying the provider.Glucose of 85 mg/dL is considered within normal limits by most laboratories and would not require treatment with glucose or insulin to normalize.Repeating the enzyme results in 4 hours would be appropriate,but it is not the immediate priority.

Quiz 11: Organ Donation

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?

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

The nurse is preparing to administer a renal transplant recipient's first dose of mycophenolate mofetil (CellCept) .What is the best understanding of this medication by the nurse?