Organ Donation NCLEX

The charge nurse of a transplant unit is reviewing the clinical course of several transplant patients being cared for in the unit. Which patient assessed by the charge nurse requires immediate action? a. Renal transplant recipient, 1 day post op with a 3/10 pain level b. Lung transplant recipient, 1 day post op with a productive cough c. Heart transplant recipient, 1 day post op with a cardiac output of 4 L/min d. Liver transplant recipient, 12 hours post op with a serum glucose of 58 mg/dL

ANS: D Hypoglycemia may indicate a poorly functioning liver and requires immediate action. Postoperative pain level of 3/10 in a renal transplant patient, a lung transplant patient with a productive cough, and a heart transplant recipient with a cardiac output of 4 L/min are normal or expected findings requiring no immediate action.

A patient 30 days postoperative after allogeneic hematpoietic stem cell transplant presents with adenovirus and Candida infection. The critical care nurse suspects which of the following? A) Acute graft-versus-host disease B) Chronic graft-versus-host disease C) Neutropenia D) Stem cell rejection

A

The charge nurse is reviewing the status of patients in the critical care unit. Which patient should the nurse notify the organ procurement organization to evaluate for possible organ donation? a. A 36-year-old patient with a Glasgow Coma Scale score of 3 with no activity on electroencephalogram b. A 68-year-old male admitted with unstable atrial fibrillation who has suffered a stroke c. A 40-year-old brain-injured female with a history of ovarian cancer and a Glasgow Coma Scale score of 7 d. A 53-year-old diabetic male with a history of unstable angina status post resuscitation

ANS: A A patient with a GCS score of 3 and no activity on EEG is facing impending death. The OPO should be notified. There are no indications of impending death in any of the other patient scenarios.

The nurse is caring for a patient who is being evaluated clinically for brain death by a physician. Which assessment findings by the nurse support brain death? a. Absence of a corneal reflex b. Unequal, reactive pupils c. Withdrawal from painful stimuli d. Core temperature of 100.8 F

ANS: A Absence of a corneal reflex indicates altered brainstem activity and is a component used in the clinical evaluation of brain death. Reactive pupils, withdrawal reaction to painful stimuli, and the ability to maintain core temperature indicate brainstem activity.

The nurse is working for a hospital that holds an agreement with a local organ procurement organization (OPO). The patient has a Glasgow Coma Scale (GCS) score of 3 and discussions have been held with the family about withdrawing life support. Which statement by the nurse best describes requirements that must be met to sustain Centers for Medicare and Medicaid Services (CMS) Conditions of Participation? a. I need to notify TransLife (OPO) of my patients impending death. b. I will contact the physician to obtain informed consent for organ donation. c. The charge nurse will notify TransLife (OPO) once the patient has been pronounced brain dead. d. I need the physician to evaluate my patients suitability for organ donation.

ANS: A Hospitals that receive Medicare or Medicaid reimbursement must notify the local OPO in cases of impending death. It is the responsibility of the organ procurement organization, not the physician, to obtain family consent for organ donation and to evaluate the patient for potential suitability as a donor. Notification of the organ procurement organization must occur prior to death, not after the patient has been pronounced dead.

The nurse is managing a donor patient six hours prior to the scheduled harvesting of the patients organs. Which assessment finding requires immediate action by the nurse? a. Morning serum blood glucose of 128 mg/dL b. pH 7.30; PaCO2 38 mm Hg; HCO3 16 mEq/L c. Pulmonary artery temperature of 97.8 F d. Central venous pressure of 8 mm Hg

ANS: B Donor management, focuses on maintaining hemodynamic stability and normal laboratory parameters. Care of the patient is under the direction of the OPO coordinator working collaboratively with the physician and critical care nurses. Standardized order sets are usually used, and they focus on preserving organ function and viability.Immediate action is required for an arterial blood gas value of pH 7.30; PaCO2 38 mmHg; HCO3 16 mEq/L which indicates metabolic acidosis. All other values are within normal limits.

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? a. Your admission lab results will determine if your kidney is being rejected. b. A procedure called a renal biopsy will be the best way to confirm rejection. c. Monitoring over the next few days will determine if your kidney is failing. d. An ultrasound of your kidney will determine if your kidney has failed.

ANS: B 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 if there is blood flow to the kidney but will not provide information at the cellular level.

The nurse is caring for a patient in the critical care unit who, after being declared brain dead, is being managed by the OPO transplant coordinator. Thirty minutes into the shift, assessment by the nurse includes a blood pressure 75/50 mm Hg, heart rate 85 beats/min, and respiratory rate 12 breaths/min via assist/control ventilation. The oxygen saturation (SpO2) is 99% and core temperature 93.8 F. Which physician order should the nurse implement first? a. Apply forced air warming device to keep temperature > 96.8 b. Obtain basic metabolic panel every 4 hours until surgery c. Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg d. Draw arterial blood gas every 4 hours until surgery

ANS: C Hemodynamic stability is a priority in donor management. Following brain death, loss of autoregulation results in intense vasodilation. To maintain perfusion to the vital organs, the priority action is to begin a phenylephrine (Neo-Synephrine) infusion to get systolic BP > 90 mm Hg. Maintaining normothermia is the next priority. Obtaining laboratory tests and arterial blood gasses is a part of donor management but not the priority in this scenario.

A family member approaches the nurse caring for their gravely ill son and states, We want to donate our sons organs. What is the best action by the nurse? a. Arrange a multidisciplinary meeting with physicians. b. Consult the hospitals ethics committee for a ruling. c. Notify the organ procurement organization (OPO). d. Obtain family consent to withdraw life support.

ANS: C It is the ultimate responsibility of the organ procurement organization to approach the family and obtain consent for organ donation. The best action by the nurse is to notify the OPO. Arranging a multidisciplinary meeting with physicians and consulting the hospitals ethics committee are not appropriate actions in this scenario. Informed consent to withdraw life support is provided by the physician.

Which clinical scenario best represents hyperacute rejection? a. A cardiac transplant patient with a 3-month history of shortness of breath b. A lung transplant patient with small pustules that follow a dermatome c. A liver transplant patient with several small lumps under the skin d. An implanted renal transplant that, upon reperfusion, becomes cyanotic

ANS: D 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.

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? a. To be a living donor, you must be related to the recipient. b. You must be over the age of 30 to be a living donor. c. Living donor donation is coordinated by UNOS. d. Let us orient you to the process required to become a donor.

ANS: D 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.

The nurse obtains initial vital signs on a patient 2 weeks posttransplant who presents for follow-up monitoring to the outpatient transplant clinic. Which assessment finding by the nurse requires immediate action? a. Blood pressure of 100/60 mm Hg b. Serum creatinine of 1.5 mg/dL c. Hemoglobin of 9.2 gm/dL d. Tenderness over graft site

ANS: D Tenderness over the graft site may be indicative of acute rejection in a renal transplant recipient 2 weeks posttransplant. Blood pressure, serum creatinine, and hemoglobin values are all within acceptable ranges and do not require immediate action.

A patient who has received a solid organ transplant is experiencing chronic rejection. What symptoms does the nurse most expect? A) Lack of T-cell activity or increase B) Evidence of deteriorating organ function C) Evidence of immune suppression D) Negative antigenantibody reactions

B

A patient who has received an allogenic stem cell transplant has developed graft-versus-host disease. What symptoms does the nurse most expect? A) Diminished lymphocytes B) Elevated liver function tests C) Absence of active T cells D) Very high fever

B

During evaluation for compatibility with the donor, a potential organ transplant recipient undergoes HLA matching. When explaining the importance of this test to the patient, what is the best rationale for the nurse to use? A) This is simply a routine part of compatibility testing for all organs. B) The higher the number of matching antigens, the lower the risk of rejection. C) This test is used to ensure that the donor does not have an active infection. D) HLA testing is part of the ongoing research into organ transplant success.

B

A patient has experienced brain death after a head injury and the family has consented to organ donation. In this situation, who does the nurse now recognize as managing the care of that donor? A) Attending physician B) Intensive care physician team C) Registered nurse from organ procurement organization D) Pathophysiologist from the medical examiners office

C

A patient who received a kidney transplant 2 months ago is having an episode of acute rejection. The patient expresses fear that his new kidney will not survive. What is the best rationale for the nurses response? A) Cytotoxic T cells damage the donor organ by secreting lysosomal enzymes. B) Acute rejection is the most common type of rejection. C) Acute rejection is the type most likely to respond to *immune suppression*. D) Acute rejection occurs when donor organ antigens trigger helper T cells.

C

The patient is being evaluated for compatibility for a solid organ transplant. What congruency between donor and recipient is the primary requirement? A) B and DR locus B) HLA matching C) ABO blood grouping D) White blood cell (WBC) match

C