Assessment Examination

Question 1

The drop in blood pressure while receiving a vasopressor indicates

Answer 1

a potential hypotensive condition. The most likely reason for this condition immediately following transport of a patient is a displaced IV line.

Question 2

Significant hemodynamic findings of a CVP below 4 mm Hg and a PAWP below 10 mm Hg indicate marked

Answer 2

volume depletion, resulting in a hypovolemic diagnosis. The best initial intervention to correct hypovolemia is to initiate a fluid bolus.

Question 3

If a medical/social history cannot be obtained. _________ However, the donation ___________

Answer 3

• A potential donor must be categorized as high-risk according to the CDC when
• process can proceed with full disclosure.

Question 4

Patient core temperature must be greater than or equal_____ to declare brain death.

Answer 4

to 32° C

Question 5

ARDS / Fi02 100% Pa02 60 torr HR 110 BP 70/40 CVP 1

The low CVP and B/P indicate ________,
How to ensure adequate organ perfusion and overall correction.

Answer 5

The low CVP and blood pressure indicate hypovolemia, which requires correction to ensure adequate organ perfusion. The addition of PEEP may further compromise blood pressure, and diuretic agents will worsen the hypovolemic condition.

Question 6

A change in patient status from DCD to brain death requires a

Answer 6

regeneration of the match run list prior to any other step in the allocation process. The host OPO is required to obtain release of the organs from the medical examiner rather than to report the death.

Question 7

A procurement coordinator is set to proceed to the OR for a brain dead donor within the next 30 minutes, and recovery teams are en route to the hospital. The coordinator receives notification from the OR charge nurse that an elective surgery has been scheduled in the donor OR and no other rooms are available. The elective case is scheduled for 4 hours. Which of the following is the BEST course of action?

Answer 7

A donor champion is personnel tasked with helping to overcome barriers to organ donation in real time. The donor champion is aware of the intricacies of hospital dynamics and is ideal for negotiating a solution in this situation.

Question 8

According to UAGA and OPTN policy for the hierarchy for consent, ultimate responsibility for determining who may give consent belongs to

Answer 8

the OPO coordinator.

Question 9

It is the responsibility of the host OPO to obtain accurate medical/social history from

Answer 9

ALL parties that have significant knowledge about a potential donor.

Question 10

The most likely results of chronic and uncontrolled high blood pressure are

Answer 10

a dilated cardiomyopathy, decreased cardiac output, and decreased renal perfusion.

left-ventricular hypertrophy and renal insufficiency.

Question 11

The majority of states now have donor designation laws that recognize first-person consent, and the family has not voiced concerns about donation. In this situation,

Answer 11

the procurement coordinator should provide the family with further information about the process of donation.

Question 12

BEST indicator of the effectiveness of OPO in-service education?

Answer 12

rate of conversion

The ultimate goal of OPO in-service education is to optimize donor conversion while working collaboratively with a hospital.

Question 13

Compassion in the transplant and recovery process should extend to all staff involved despite the

Answer 13

urgent need for transplantable organs.

Question 14

A 24-year-old female potential DCD donor was transferred from the general medical floor to the ICU 2 days ago. The donor’s blood cultures are negative, and a chest radiograph reveals right upper lobe infiltrates. CBC results on admission were as follows:

WBC 32000

Answer 14

Based on the clinical findings and radiographic results, obtaining a sputum culture is the most crucial intervention to

**confirm
or
**rule-out

a contraindication for lung donation due to infection.

Question 15

A brain dead patient is being transferred to the OR for multi-organ and tissue procurement. The attending physician had previously written a do not resuscitate (DNR) order at the request of the family. The patient has a cardiac arrest while en route to the OR. A procurement coordinator should

Answer 15

Coding a donor does not constitute resuscitation because the brain death declaration has invalidated the DNR order. To ensure that all organs consented for donation by the family are properly preserved, donor stability should be maintained throughout all stages of the process.

Question 16

In the absence of donor designation by the patient, the legal next of kin should always be offered the option of organ donation. Outcomes of the approach should be ________ and _________ regardless of consent.

Answer 16

documented and communicated to hospital staff

Question 17

The severe drop of central venous pressure, Hgb/Hct, and urine output indicate ________. The initial intervention for the procurement coordinator is to order diagnostic tests to

Answer 17

hypovolemia.

confirm or rule-out internal bleeding as a cause of the fluid loss indicated by the vital sign values.

Question 18

A host OPO must provide which of the following essential information when making an initial offer of a kidney for transplant?

A. Serology results
B. patient diagnosis
C. admission urinalysis
D. BUN/creatinine on admission

Answer 18

According to OPTN policy, patient diagnosis is the only required documentation of the listed options.

Question 19

A 35-year-old male donor is admitted with massive head injuries and abdominal bruising following a motor vehicle crash.

Severe drop in B/P CVP Sa02 H/H and UO

A procurement coordinator should treat the patient for

Answer 19

internal bleeding.

The severe drop of central venous pressure, coupled with the other abnormal values, is indicative of blood loss.

Question 20

Which of the following is mandatory to generate a match run?

A. donor blood type
B. hemodilution status
C. a medical/social history
D. a confidential donor form

Answer 20

Blood type is the only option that is mandatory for generating a match run, while the other options are required to send electronic notification of an organ offer.

Question 21

The presentation of typical severe blood loss in the early stages of recovery, most likely due to surgical trauma, which requires stabilization to ensure appropriate perfusion of organs for transplantation.

Instruct Anesthesia

Answer 21

to administer PRBCs.

Question 22

Prior to conducting additional education, which of the following are BEST for the coordinator to research about each community to address improvements in program effectiveness?

1. ethnicity
2. cultural diversities
3. median income
4. licensed drivers

Answer 22

1 and 2

Race, ethnicity, cultural practices, age, and gender are important factors when analyzing consent rates for program improvement plans. Cultural competency implemented in a strategic manner is supportive in a quality improvement process.

Question 23

This patient’s ABG results reveal respiratory acidosis.

the CPTC take on it

Answer 23

To treat this condition, the mechanical ventilatory rate should be increased to 12/min to reduce the PCO2 level to a normal level of approximately 40 torr.

Question 24

For neonates from an age of 7 days to 2 months, task force guidelines on pediatric brain death recommend two EEG and clinical examinations that are how many hours apart?

Answer 24

This age range of neonates should be subject to two EEG and clinical examinations that occur 48 hours apart. Following 2 months of age to 1 year of age, neonates may receive two examinations that are 12 to 24 hours apart.

Question 25

A patient with a severe head injury and a Glasgow Coma Scale score of 3 is transferred from the ED of Hospital A to the ED of Hospital B. The patient is then transferred to the ICU of Hospital B. Responsibility to refer the patient to the OPO belongs to which of the following staff?

Answer 25

The referral should be made at the time a patient meets the clinical trigger. Since the patient has a Glasgow Coma Scale score of 3 while at the ED of Hospital A, this staff has the responsibility of referral.

Question 26

HBsAG negative

anti-HBc positive

Answer 26

Hepatitis B immunization.

Negative reactivity to the Hepatitis B surface antigen and positive reactivity to the anti-Hepatitis B core antigen indicate four possible interpretations. The patient is likely recovering from acute HBC infection, there is susceptibility to infection coupled with false-positive anti-HBc reactivity, there is an undetectable level of HBsAg in the serum, or there is a distant immunity that is too low to be detected.

Question 27

Which of the following must be stated on a vessel label?

A. the date of recovery
B. nucleic acid test results
C. the recovering physician’s name
D. “For use in transplantation only”

Answer 27

According to OPTN policy, organ recovery date is the only option that is mandatory. Policy requires that a label or statement be included that mandates the product is for use in ORGAN transplantation only. Policy also requires serology results, which do not include nucleic acid test results.

Question 28

A 43-year-old male was declared brain dead following head injuries from a fall. During the medical/social history, the wife reported he had a skin cancer removed from his back 2 years ago, and reported no high-risk behavior. A procurement coordinator’s physical exam of the patient reveals raised, discolored bumps on the upper, inner thigh and white discolorations in the mouth. The coordinator should obtain

A. an ENT consult.
B. a pathology consult.
C. a dermatology consult.
D. an infectious disease consult.

Answer 28

Based on the combination of physical findings and the medical history of cancer, a dermatology consult is the best consult to confirm or rule-out the possibilities of malignant or sexually-transmitted diseases.

Question 29

A 44-year-old male, who is legally separated from his wife, is declared brain dead. His mother, fiancée, and adult son are at the hospital and are interested in organ donation. Which of the following has priority to give consent for donation?

A. son
B. spouse
C. mother
D. fiancée

Answer 29

Spouse

The UAGA legal hierarchy of consent states that until the time of divorce, legal consent rights belong to the legally-married spouse of the potential donor, followed by the adult son, then the mother.

Question 30

A procurement coordinator arrives on-site to evaluate a 23-year-old male who was involved in a motor vehicle crash. The patient is currently sedated, and the family has decided to withdraw ventilatory support. Pulmonary contusions, a C1 fracture, and positive pupil and corneal reflexes are noted during review of the patient’s chart. Which of the following should the coordinator do NEXT?

A. Offer the family the option of DCD.
B. Defer DCD due to the presence of sedation.
C. Offer the family the option of tissue donation.
D. Defer DCD due to the presence of C-level spinal fracture.

Answer 30

Offer the family the option of DCD.

Potential DCD donors are patients with progressive neuromuscular degeneration, who have a high spinal cord injury, and are dependent on ventilatory support.

Question 31

A procurement coordinator is evaluating a 54-year-old male donor who has been hospitalized for 4 days. The family has given consent for liver and kidney donation. Which of the following tests must be performed on the donor prior to recovery?

A. blood cultures
B. serum amylase
C. sputum Gram stain
D. bedside liver biopsy

Answer 31

According to UNOS policy, the minimal requirements to evaluate organ-specific function for all potential donors are blood and urine cultures to rule out hospital-acquired infections.

Question 32

A procurement coordinator is notified by the local surgeon that vessels procured from a donor are being transplanted into a different liver recipient at the physician’s institution. Which of the following is responsible for reporting final organ disposition to the OPTN?

A. hospital staff
B. recovering surgeon
C. implanting physician
D. procurement coordinator

Answer 32

To validate appropriate transplantation of recovered vessel tissue, regardless of the recipient, UNOS policy requires that the implanting physician give notification of organ disposition. This process ensures the ability to track the organ for any subsequent follow-up.

Question 33

A hospital organ donation council has decided to meet quarterly to discuss donation activity and initiatives within the hospital. At the first meeting, one of the donation champions from the medical ICU questions the statistics from the unit that quotes a conversion rate of 25%. Which of the following is the coordinator’s BEST initial action?

A. Schedule a meeting with the donation champion to review the cases together.
B. Set up education sessions for the medical ICU to improve the conversion rate.
C. Advise the donation champion that a conversion rate of 25% is typical for medical ICUs.
D. Concede that the number seems low, and review the statistics prior to the next meeting.

Answer 33

Schedule a meeting with the donation champion to review the cases together.

Increasing interaction between the OPO and donation champions through one-on-one case reviews contributes to consistent donation performance and can enhance professional collaboration.

Question 34

The donor is receiving normal saline at 150 mL/hr, and a pulmonary artery catheter has been placed. The left ventricle is demonstrating hypokinesis.

Declining left ventricular function indicates that the heart is beginning to fail. In order to ensure adequate perfusion of all transplantable organs, inotropic support consisting of either

Answer 34

dopamine (Intropin) or dobutamine (Dobutrex) should be initiated.

Question 35

During a multi-organ recovery, a procurement coordinator is hosting a local abdominal team and two visiting thoracic teams. The donor’s blood pressure begins to fall rapidly. The local team requests administration of phenylephrine (Neo-Synephrine). The visiting heart team becomes upset and verbally objects to the administration of the drug. The coordinator should

A. request an alternative vasopressor.
B. administer fluids until a decision can be made.
C. allow phenylephrine (Neo-Synephrine) administration.
D. request that the heart team leave until the patient is stabilized.

Answer 35

request an alternative vasopressor.

EXPLANATION:
Fluid administration could compromise the lungs and would likely have little effect in correcting the rapidly declining blood pressure. Administration of an alternative vasopressor would have the quickest effect on the blood pressure, while respecting the requests of the heart transplant team.

Question 36

A former DCD donor was declared brain dead 2 hours prior to recovery in the OR. The donor’s family has specific time constraints for completion of the organ recovery process. Which of the following should a procurement coordinator do NEXT?

A. Regenerate the match run list.
B. Initiate allocation of thoracic organs.
C. Proceed with recovery as scheduled.
D. Notify the family of a delay in recovery.

Answer 36

Regenerate the match run list.

EXPLANATION: A change in patient status from DCD to brain death requires a regeneration of the match run list unless extraordinary circumstances exist, including a lack of donor family approval or a donor condition that is unstable.

Question 37

Na 163
K 3.7
UO 200ml/hr

A procurement coordinator should FIRST

1. infuse 20 mEq of KCl over 1 hour.
2. initiate 1 L of 0.2% normal saline bolus.
3. administer 2 g of magnesium sulfate over 2 hours.
4. ensure that medications are mixed in 0.45% normal saline.

Answer 37

2 nad 4 only

The most important element to address with this patient is the hypernatremia indicated by the sodium level of 163 mEq/L. The other interventions will address laboratory values that are currently within normal limits.

Question 38

Which of the following tests are required on each potential donor?

A. HBsAb testing
B. EBV screening
C. NAT HIV screening
D. admission urinalysis

Answer 38

EBV screening

EXPLANATION: OPTN policy requires EBV testing for all donors, while the other options are not required by OPTN policy.

Question 39

A fibrinogen level of less than 100 mg/dL with associated severe blood loss from nose and mouth indicates the need

Answer 39

for transfusion of a fibrinogen-containing cryoprecipitate to increase clotting factors.

Question 40

During initial assessment of a donor, a procurement coordinator notes a firm and distended abdomen. A nasogastric tube is present. The coordinator should FIRST

Answer 40

The immediate intervention for the procurement coordinator is to determine if the nasogastric tube is properly placed by instilling air into the tube while auscultating the abdomen. Once placement is verified, an appropriate intervention to relieve the abdominal distension can be planned.

Question 41

An attending physician has determined a family is too grief stricken to be approached for organ donation and wants to remove life support. A procurement coordinator should

A. notify the hospital’s legal counsel of the situation.
B. address this issue with the hospital administrator.
C. discuss the Conditions of Participation with the physician.
D. notify the bedside nurse that donation efforts will be deferred.

Answer 41

C. discuss the Conditions of Participation with the physician.

EXPLANATION: The Conditions of Participation dictate that all families should be offered the option of organ donation despite the physician’s assessment of the family’s emotional disposition.

Question 42

A well-healed midline abdominal surgical scar is noted during physical examination of a donor. Which of the following should the coordinator consult to obtain information on the surgical procedure that was conducted?

1. radiologist
2. family members
3. family physician
4. staff general surgeon

Answer 42

2-3

EXPLANATION: The opinions of staff physicians well after the occurrence of a procedure would provide subjective and poor historical information. The family members and family physician familiar with the patient should be used to obtain the most accurate information regarding previous medical and surgical history.

Question 43

The potential referral pool for this OPO consists of both__________and ________.

***Read entire question and note

Answer 43

• referred and non-referred potential donors,
  If the table represents three-quarters of the annual total, that total must be divided by 75% to obtain the expected yearly total of 60 potential donors as follows: (Potential Referred + Potential Non-Referred) ÷ 75% = 60.

Question 44

Which of the following types of documentation must accompany each organ?

A. serological results
B. hospital donor chart
C. signed death certificate
D. pronouncement of death

Answer 44

A. serological results

KEYWORD: Accompany

EXPLANATION: According to OPTN policy, serology results are the only required documentation of the listed options.

Question 45

A procurement coordinator is notified by the local surgeon that the vessels procured from a donor are being sent to another local center for transplant. The physician should be informed that

Answer 45

To validate appropriate transplantation of recovered vessel tissue, UNOS policy requires that the implanting physician give notification of organ disposition. This process ensures the ability to track the organ for any subsequent follow-up.

Question 46

The ICU physician has approached the sister of a brain dead potential donor about donation, but she has declined. The patient’s brother has just arrived at the hospital and is distraught. The coordinator should FIRST

A. contact pastoral care to support the brother.
B. provide the sister with information about donation.
C. defer the case based on the sister’s lack of consent.
D. ask the ICU physician to approach the brother about donation.

Answer 46

A. contact pastoral care to support the brother.

While the potential for donation should not override compassionate care, research has demonstrated that developing an environment that supports family needs can create a greater chance of donor conversion.