Deck 39: Solid Organ and Hematopoietic Stem Cell Transplantation

Question 1

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

A)Maintaining strict sterile technique with all invasive procedures
B)Teaching the patient to restrict the number of visitors after returning home
C)Identifying potential source of infection from patient history
D)Assisting with careful screening of donors

Answer 1

Maintaining strict sterile technique with all invasive procedures

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.

A)Reflex hammer
B)Cold water
C)Syringe
D)Hydrogen peroxide
E)A tongue blade

Answer 2

Cold water
Syringe

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.

A)Reconnect the patient to the ventilator.
B)Draw an immediate arterial blood gas.
C)No action is necessary unless ventricular fibrillation ensues.
D)Allow the patient to die a natural death.
E)Treat the dysrhythmia.

Answer 3

Reconnect the patient to the ventilator.
Draw an immediate arterial blood gas.
Treat the dysrhythmia.

Question 4

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

A)Provide bolus of levothyroxine followed by continuous levothyroxine intravenous infusion.
B)Administer salt-poor intravenous fluid.
C)Administer blood transfusion.
D)Provide intravenous dopamine.

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?

A)Heart transplants are very successful because of immunosuppressant medication.
B)Today it is more common to do heart-lung transplants.
C)Hearts were the first organs to be transplanted so the technique has been perfected.
D)There are no guarantees since transplants are more successful between twins.

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?

A)Experimented with intravenous heroin 20 years prior
B)Being treated for hepatitis B
C)Treated for prostate cancer one year ago
D)Treated for shock

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.

A)Mean arterial pressure 50 mm Hg
B)Central venous pressure 5 mm Hg
C)Serum sodium 145 mEq/L
D)Serum glucose 140 mg/dL
E)Ejection fraction 30%

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?

A)"Most people get a kidney within the first 6 months of being on the list."
B)"It depends on how much you are willing to pay for a kidney."
C)"It is impossible to predict when your kidney will be available."
D)"Some people die waiting for a kidney."

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?

A)"It is unusual for malignancies to develop this long after transplant."
B)"Patients on long-term medications to prevent organ rejection are at risk for developing cancer."
C)"At least this cancer will not affect the transplanted kidney."
D)"Everyone can develop cancer at any time."

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?

A)"You may have a graft site leak,so do not eat or drink anything until I talk to the surgeon."
B)"I am going to slow down your IV fluids to see if that brings your blood pressure down."
C)"It is probably going to be necessary to give you some fresh frozen plasma."
D)"Hypertension is a common problem after surgery,so I will be giving you the antihypertensive medication your surgeon ordered in case this occurred."

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?

A)Organ procurement organization (OPO)coordinator
B)Surgeon
C)Cardiologist
D)Hospitalist

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?

A)Heterograft living donor
B)Histograft living donor
C)Allograft living donor
D)Isograft living donor

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?

A)"Your chances of a successful transplant depend on finding a healthy family member who is a match and will agree to provide an organ."
B)"The most successful transplants have always been the heart and lungs."
C)"Many of the earlier failures of kidney transplants had to do with suturing technique."
D)"Medications to prevent problems associated with organ transplantation are now widely available."

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?

A)Died of natural causes
B)Experienced cardiac death
C)Died in an automobile accident
D)Experienced brain death

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?

A)Administration of high-dose corticosteroids
B)A second stem cell infusion
C)Administration of platelets
D)Surgery to remove 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.

A)"This biopsy will tell us if cancer has developed in the transplanted kidney."
B)"This procedure requires a surgical incision to retrieve a section of kidney tissue."
C)"An ultrasound will be performed during this test."
D)"You will not be able to have visitors until the radioactive substance used in the test is cleared from your system."
E)"The renal biopsy test provides us with the best information about how your new kidney is functioning."

Question 17

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

A)"Your body is accepting the transplanted cells,so you should be feeling a lot better."
B)"Your body is making normal hematopoietic cells."
C)"You feel so bad because the transplanted cells are attacking your tissues,but that is normal and will pass."
D)"You may not feel well today,and we need to protect you from exposure to any infections."

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?

A)"Abdominal pain and nausea are side effects and are expected."
B)"There are no major side effects associated with this medication."
C)"This medication helps prevent organ rejection,but you must report any vision changes and bone pain and be tested for diabetes regularly."
D)"This medication works for a few months and will be discontinued."

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.

A)Congestive heart failure
B)Nausea and vomiting
C)Hyperglycemia
D)Hair loss
E)Infection

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?

A)Only O
B)B or O
C)A or O
D)A,B,or O