Question 1

The transplant team works to decrease the number of posttransplant infections due to iatrogenic causes.Which nursing intervention would support this goal?

Accepted Answer

Maintaining strict sterile technique with all invasive procedures would help to prevent iatrogenic infections. This includes procedures such as central line placement, dialysis catheter insertion, and surgical site care. By ensuring that all invasive procedures are performed with sterile technique, the risk of introducing pathogens into the patient's system is decreased.

Question 2

The nurse is preparing for oculocephalic reflex testing of a patient who may be brain dead.Which equipment should the nurse gather? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

The oculocephalic reflex, also known as the "doll's eye" reflex, involves testing eye movements in response to head movements. Cold water (B) can be used for the caloric reflex test, which is related but distinct, and a syringe (C) is needed to gently inject the cold water into the ear canal. The other options are not relevant for this specific test.

Question 3

Apnea testing is being done on a patient who may be brain dead.During the test the patient develops ventricular tachycardia.What nursing action is indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

A,B,E

Question 4

The nurse is caring for a patient who will be an organ donor.Which nursing intervention is indicated to protect endocrine function?

Accepted Answer

Administering a bolus of levothyroxine followed by a continuous levothyroxine intravenous infusion is indicated to protect endocrine function in an organ donor. This intervention helps maintain normal thyroid hormone levels, which is crucial for preserving organ function and optimizing the condition of organs for transplantation.

Question 5

A patient being prepared for a heart transplant is concerned that the transplanted organ will not be accepted in his body.What should the nurse consider when formulating a response to this concern?

Accepted Answer

The nurse should reassure the patient that heart transplants are very successful because of the use of immunosuppressant medication. This medication helps to prevent rejection of the transplanted organ.

Question 6

A patient,identified as an organ donor,is diagnosed as being brain dead.The organ procurement organization (OPO)rules that the patient is not a candidate for transplant.The nurse would attribute this decision to which patient history?

Accepted Answer

Being treated for hepatitis B can make a patient ineligible for organ donation due to the risk of transmitting the infection to the organ recipient. Other conditions listed do not automatically disqualify a patient from being an organ donor.

Question 7

A patient,identified as a potential organ donor,has been diagnosed as brain dead and is being maintained on ventilator support.The nurse is reviewing the patient's hemodynamic parameters and is concerned about which findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

A mean arterial pressure (MAP) of 50 mm Hg is considered low and indicates inadequate perfusion, which is concerning for a potential organ donor as it may affect the viability of organs. An ejection fraction (EF) of 30% is also concerning as it indicates poor cardiac function, which could compromise organ perfusion and viability. Central venous pressure (CVP) of 5 mm Hg, serum sodium of 145 mEq/L, and serum glucose of 140 mg/dL are within normal or acceptable ranges and are not typically concerning in the context of organ donation.

Question 8

After several months of testing,a patient is placed on the United Network for Organ Sharing (UNOS)waiting list for a kidney transplant.The patient says,"How long do you think it will take for me to get a kidney?" Which nursing response is indicated?

Accepted Answer

The waiting time for a kidney transplant depends on factors such as the patient's blood type, how long they've been waiting, and the availability of organs. It is impossible to predict when a kidney will become available for a patient on the waiting list. Option A may give false hope, option B is inappropriate and illegal, and option D is not a helpful response for the patient's question.

Question 9

A patient who received a kidney transplant 2 years ago has been diagnosed with skin cancer.He tells the nurse that he cannot believe that he has cancer since he has already gone through "so much" with the kidney disease.How should the nurse respond to this patient's statement?

Accepted Answer

Patients who receive long-term medications to prevent organ rejection after a transplant are at risk for developing cancer due to prolonged immunosuppression. It is important for the nurse to provide education and support to the patient regarding the increased risk of cancer and the importance of regular screenings and follow-up care. Option A is incorrect as malignancies can develop long after a transplant, especially with long-term immunosuppression. Option C is dismissive of the patient's concerns and not helpful in addressing the patient's anxiety. Option D is true but not helpful in addressing the patient's concerns or providing education.

Question 10

The nurse is caring for a patient recovering from a kidney transplant.The patient's blood pressure has been trending upwards and is now 158/98 mm Hg.Which information should the nurse provide to this patient?

Accepted Answer

Hypertension is a common problem after surgery, and the nurse should administer the antihypertensive medication ordered by the surgeon in case this occurred. A graft site leak or the need for fresh frozen plasma is not indicated based on the blood pressure readings provided. Slowing down the IV fluids may help in some cases, but it is not the best option in this situation.

Question 11

A patient declared brain dead after cardiac surgery has been accepted as a potential donor.The family has given consent for donation.The nurse providing care to this patient would expect directions from which provider?

Accepted Answer

The organ procurement organization (OPO) coordinator is responsible for managing the organ donation process and providing direction to the healthcare team, including the nurse caring for the potential donor. The surgeon and cardiologist may be involved in the donation process, but are not responsible for directing the nurse's actions. The hospitalist may be involved in the patient's care, but is not typically involved in the organ donation process.

Question 12

The older brother of a patient in renal failure has agreed to donate a kidney.Testing reveals that the brothers are a good match for this procedure.How would the nurse describe this treatment plan?

Accepted Answer

Allograft living donor transplantation involves the transfer of an organ or tissue from one person to another of the same species but with a different genetic makeup. In this case, the brother donating a kidney is an allograft living donor for his sibling in renal failure. Heterograft involves transfer of tissues or organs between different species, histograft refers to transfer within the same person, and isograft involves transfer between genetically identical individuals (e.g. twins).

Question 13

A patient tells the nurse that chronic kidney disease is "in his family" and his father died within a few months after having a kidney transplant in the late 1940s.What information should the nurse provide?

Accepted Answer

The patient's concern is about the success of the transplant and the nurse should address this by informing the patient that medications to prevent problems associated with organ transplantation are now widely available. Option A is not appropriate as it assumes the patient is considering kidney transplantation when there is no evidence of this. Option B is also not appropriate as heart and lung transplants are not relevant to the patient's concern about kidney disease. Option C is not appropriate as the patient's concern is not about technical failures, but rather about the overall success of kidney transplants.

Question 14

A patient is scheduled to receive a liver for transplantation from a person who has died.The nurse anticipates that the donor has which characteristic?

Accepted Answer

To donate a liver for transplantation, the donor must have experienced brain death, meaning that their brain has stopped functioning and they are legally deceased. Donors who have experienced cardiac death are not eligible for organ donation. Donors who have died of natural causes or in accidents may or may not be eligible depending on the specific circumstances.

Question 15

It has been determined that a patient who received hematopoietic stem cell transplantation is having poor functioning of the graft.The nurse would prepare the patient for which intervention?

Accepted Answer

A second stem cell infusion may be necessary to improve functioning of the graft. High-dose corticosteroids may cause further complications and surgery to remove the graft is a last resort option. Administration of platelets would not address the issue of poor functioning of the graft.

Question 16

A patient's recently transplanted kidney is not functioning optimally.A renal biopsy has been scheduled.What information should the nurse provide regarding this procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

An ultrasound is often used to guide the needle during a renal biopsy, and the biopsy provides critical information about the function of the transplanted kidney.

Question 17

A patient received allogeneic hematopoietic stem cell transplantation 2 days ago.Which information should the nurse provide?

Accepted Answer

Patients who receive hematopoietic stem cell transplantation are at risk for infection and other complications. The nurse should inform the patient that they may not feel well and emphasize the importance of infection prevention measures. Options A and B are incorrect because it is too early to tell if the patient's body has accepted the transplant or if they are making normal hematopoietic cells. Option C is incorrect because the described phenomenon is graft-versus-host disease, which is not a normal occurrence and can be life-threatening.

Question 18

A patient recovering from liver transplant surgery is being instructed on the long-term use of steroid medication.Which education should the nurse provide?

Accepted Answer

Option C provides the most accurate and relevant information concerning the long-term use of steroid medication after liver transplant surgery. The medication helps prevent organ rejection, but it has potential side effects that must be reported to the healthcare provider. The patient also needs to undergo regular testing for diabetes. Option A is incorrect because abdominal pain and nausea are not expected side effects of steroid medication. Option B is incorrect because all medications have potential side effects. Option D is incorrect because steroid medication is typically used long-term after liver transplant surgery to prevent organ rejection.

Question 19

During the posttransplantation period,a patient received tacrolimus (Prograf).The nurse would monitor this patient for the development of which adverse effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

Tacrolimus can cause hyperglycemia, so the nurse should monitor the patient's blood glucose levels closely. In addition, the patient is at risk for infection due to the immunosuppressive effects of tacrolimus, so the nurse should monitor for signs of infection and take appropriate precautions to prevent infection. Congestive heart failure, nausea and vomiting, and hair loss are not commonly associated with tacrolimus use.

Question 20

A patient awaiting a kidney transplant has O blood type.The nurse would explain that the patient's kidney can come from someone with which blood type?

Accepted Answer

A patient with O blood type can only receive a kidney from someone with O blood type.

Quiz 39: Solid Organ and Hematopoietic Stem Cell Transplantation

The transplant team works to decrease the number of posttransplant infections due to iatrogenic causes.Which nursing intervention would support this goal?

The nurse is preparing for oculocephalic reflex testing of a patient who may be brain dead.Which equipment should the nurse gather? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Apnea testing is being done on a patient who may be brain dead.During the test the patient develops ventricular tachycardia.What nursing action is indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.