Question 1

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.

Accepted Answer

1. The goal of nutritional support postoperatively is to provide adequate protein and energy from carbohydrates or fats equivalent to or slightly less than energy expenditure.
2. Nutritional requirements are provided enterally.
3. Parenteral nutrition is associated with increased risk of infection in the liver transplant recipient.
4. Protein intake should be adequate and not more than body needs.
5. Fruits and vegetables do not need to be restricted. They should be washed, peeled, and cooked to reduce the risk of infection.

Question 2

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?

Accepted Answer

1. The patient's respirations are caused by the ventilator and not testing.
2. Breathing is not a reflex.
3. The nurse may need to explain that a brain-dead person will not have the urge to breathe. Family members can be confused by ventilator autotriggering and may think that these represent actual patient movement.
4. Breathing does not occur spontaneously with brain death.

Question 3

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.

Accepted Answer

1. Patients interested in kidney transplant should be referred to a transplant center once the estimated glomerular filtration rate (GFR) is less than 30 mL/min and before renal function has irreversibly deteriorated, ideally before the need for maintenance dialysis.
2. Kidneys are allocated first locally, then regionally, and finally, nationally.
3. Points are assigned to a candidate based on the number of mismatches between the candidate's antigens and the donor's antigens at the HLA-DR locus.
4. This is not part of UNOS criteria to be placed on a waiting list for a kidney transplant.
5. This is not part of UNOS criteria to be placed on a waiting list for a kidney transplant.

Question 4

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?

Accepted Answer

1. Cytomegalovirus (CMV) is an immunomodulating virus that makes the patient more susceptible to opportunistic infections.
2. Epstein-Barr virus is an immunomodulating virus that makes the patient more susceptible to opportunistic infections.
3. This patient has probably developed candidiasis, which is also commonly known as thrush.
4. Staphylococcal pneumonia is not a common opportunistic infection in post-organ transplant patients.

Question 5

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.

Accepted Answer

1. A recipient may have antihuman antibodies in his or her blood, which may have developed during pregnancy, that would react with the tissue of a potential donor. The potential recipient cannot receive a transplant from that donor because the antibodies would immediately attack and damage the organ.
2. Antihuman antibodies do not develop after being bitten by a dog.
3. A recipient may have antihuman antibodies in his or her blood, which may have developed from a previous organ transplant, that would react with the tissue of a potential donor. The potential recipient cannot receive a transplant from that donor because the antibodies would immediately attack and damage the organ.
4. A recipient may have antihuman antibodies in his or her blood, which may have developed from a previous blood transfusion, that would react with the tissue of a potential donor. The potential recipient cannot receive a transplant from that donor because the antibodies would immediately attack and damage the organ.
5. Antihuman antibodies do not develop from exposure to bird droppings.

Question 6

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.

Accepted Answer

1. Oral therapy is preferred because of the risk of anaphylactic reactions with the intravenous form of the medication.
2. This medication should be taken on an empty stomach in the morning because food intake can limit its absorption by up to 40%.
3. This medication can affect blood pressure.
4. This medication can cause insulin-dependent diabetes mellitus. The patient's blood glucose level needs to be assessed frequently.
5. The oral form of this medication is preferred because of the risk of anaphylactic reactions with intravenous administration.

Question 7

A patient is being evaluated for rejection after a heart transplant. What should this assessment include?

Accepted Answer

1. Rejection is diagnosed via endomyocardial biopsies that are performed at regular intervals post-transplant. The post-heart transplant patient in early rejection often shows no signs. Therefore, biopsies are important to diagnose early rejection.
2. This is not an assessment for transplant rejection.
3. This is not an assessment for transplant rejection.
4. Late signs of heart rejection include signs of heart failure.

Question 8

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.

Accepted Answer

1. Malaise and fatigue are manifestations of acute liver transplant rejection.
2. A swollen and tender graft site is a manifestation of acute liver transplant rejection.
3. A change in color of bile from golden to colorless is a manifestation of acute liver transplant rejection.
4. Tea-colored urine is a manifestation of acute liver transplant rejection.
5. Constipation is not a manifestation of acute liver transplant rejection.

Question 9

Which assessment finding should cause the nurse to suspect acute rejection of a transplanted kidney?

Accepted Answer

1. Protein in the urine is not an early sign of acute rejection of a transplanted kidney.
2. High blood pressure is not an early sign of acute rejection of a transplanted kidney.
3. Decreased urine output is an early sign of acute rejection of a transplanted kidney.
4. Ketonuria is not an early sign of acute rejection of a transplanted kidney.

Question 10

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.

Accepted Answer

1. Family and patient teaching at the time of discharge from the hospital should focus on self-care practices that prevent infection. Some strategies that may help prevent infection include washing hands before putting anything in or near the mouth and after toileting.
2. Family and patient teaching at the time of discharge from the hospital should focus on self-care practices that prevent infection. Some strategies that may help prevent infection include wearing a mask when in a crowd for the first few months post transplant.
3. Family and patient teaching at the time of discharge from the hospital should focus on self-care practices that prevent infection. Some strategies that may help prevent infection include removing plants and flowers in vases.
4. Family and patient teaching at the time of discharge from the hospital should focus on self-care practices that prevent infection. Some strategies that may help prevent infection include washing, peeling, and cooking all fruits and vegetables.
5. Family and patient teaching at the time of discharge from the hospital should focus on self-care practices that prevent infection. Some strategies that may help prevent infection include avoiding vaccinations with live vaccines.

Question 11

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.

Accepted Answer

1. Pupils that are unreactive to light or accommodation indicate brain death.
2. A lack of corneal reflexes indicates brain death.
3. Absence of cough reflex indicates brain death.
4. Grimacing to noxious stimuli indicates intact brain pathways.
5. An involuntary gag reflex indicates intact brain pathways.

Question 12

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.

Accepted Answer

1. This test is done on the donor's blood for HLA typing.
2. This is a blood test that determines if the recipient has antibodies that could react to any of the donor's antigens.
3. These are blood tests that determine if the donor has any transmissible diseases (like HIV/AIDS, cancer, hepatitis) that could potentially be spread to the recipient or affect successful transplantation.
4. These include serum creatinine, urea, electrolytes, urinary sediment, albuminuria, 24-hour proteinuria, creatinine clearance, and glycosuria.
5. This test is not done as part of determining if a person is eligible to be a living donor.

Question 13

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.

Accepted Answer

1. In most cases, CMV infection results in mild to moderately severe disease manifesting as episodic fevers.
2. In most cases, CMV infection results in mild to moderately severe disease manifesting with diarrhea.
3. In most cases, CMV infection results in mild to moderately severe disease manifesting as joint pain.
4. In most cases, CMV infection results in mild to moderately severe disease manifesting as abdominal pain.
5. Malodorous urine is associated with a urinary tract infection, which is not associated with a CMV infection.

Question 14

Which intervention is most important to include in the multidisciplinary plan to prevent infection in a patient during the early post-transplant period?

Accepted Answer

1. Prophylactic antibiotics are only used during periods of increased risk, such as during dental procedures, or when an actual infection is present.
2. Early ambulation and use of an incentive spirometer are important measures to prevent pneumonia.
3. Contact precautions are not necessary.
4. Live vaccines, such as the nasal flu vaccine, are not recommended.

Question 15

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.

Accepted Answer

1. Following brain death, dysfunction of the hypothalamus often occurs. The donor becomes poikilothermic, which means that his body temperature fluctuates with the temperature of the environment. The nurse might adjust the room temperature to about 90°Fahrenheit.
2. The administration of warm intravenous fluids will help keep the patient's body temperature near normal.
3. The use of warming blankets will help maintain a body temperature of about 98°Fahrenheit.
4. Hyperventilation helps correct any electrolyte imbalances but does not maintain body temperature.
5. Frequent suctioning helps maintain adequate oxygenation but does not maintain body temperature.

Question 16

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.

Accepted Answer

1. Current maintenance therapy regimes after organ transplantation include corticosteroids.
2. Basiliximab (Simulect) is used for induction or antirejection immunosuppression.
3. Current maintenance therapy regimes after organ transplantation include antimetabolite or antiproliferative agents, like azathioprine.
4. Current maintenance therapy regimes after organ transplantation include calcineurin inhibitors, such as cyclosporine.
5. Rabbit ATG (thymoglobulin) is used during the induction phase of organ transplantation.

Question 17

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.

Accepted Answer

1. Corticosteroids should be taken with food to prevent gastric irritation and ulcerations.
2. Increased thirst and urination are signs of diabetes.
3. A cushingoid appearance, or full face and trunk, are common side effects of corticosteroids.
4. Patients on steroids often gain weight due to increased sodium and water retention as well as increased appetite.
5. Mood swings are common side effects of corticosteroids.

Quiz 16: Care of the Organ Donor and Transplant Recipient