Organ Transplantation/Donation Flashcards
Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of the rash?
A. The donor T cells are attacking the patient’s skin cells
B. the patient needs treatment to prevent hyperacute rejection
C. The patient’s antibodies are rejecting the donor bone marrow
D. the patient is experiencing a delayed hypersensitivity reaction
A
Rationale: the patient’s history & symptoms indicate that the patient is experiencing graft-versus-host disease, in which the donated T-cells attack the patient’s tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity
The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?
A. “I need to be monitored closely for development of malignant tumors”
B. “After a couple of years I will be able to stop taking the cyclosporine”
C. “If I develop acute rejection episode, I will need additional types of drugs”
D. “The drugs are combined to inhibit different ways the kidney can be rejected”
B
Rationale: cyclosporine, a calcineurin inhibitor, will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics
An older adult patient has a prescription for cyclosporine following a kidney transplant. Which information in the patient’s health history has implications for planning patient teaching about the medication at this time?
A. The patient restricts salt to 2 grams per day
B. The patient eats green leafy vegetables daily
C. The patient drinks grapefruit juice every day
D. The patient drinks 3 to 4 quarts of fluid each day
C
Rationale: grapefruit juice can increase the toxicity of cyclosporine. The patient should be taught to avoid grapefruit juice. Normal fluid and sodium intake or eating green leafy vegetables will not affect cyclosporine levels or renal function
A patient is admitted to the hospital with acute rejection of a kidney transplant. Which intervention will the nurse prepare for this patient?
A. Testing for human leukocyte antigen (HLA) match
B. Administration of immunosuppressant medications
C. Insertion of an arteriovenous graft for hemodialysis
D. Placement of the patient on the transplant waiting list
B
Rationale: acute rejection is treated with the administration of additional immunosuppressant drugs each as corticosteroids. Because acute rejection is potentially reversible, there is no indication that the patient will require another transplant or hemodialysis. There is no indication for repeat HLA testing.
The charge nurse is assigning semiprivate rooms for new admissions. Which patient could safely be assigned as a roommate for a patient who has acute rejection of an organ transplant?
A. A patient who has viral pneumonia
B. A patient with second-degree burns
C. A patient who is recovering from an anaphylactic reaction to a bee sting
D. A patient with graft-versus-host disease after a recent bone marrow transplant
C
Rationale: There is no increased exposure to infection from a patient who had an anaphylactic reaction. Treatment for a patient with acute rejection includes administration of additional immunosuppressants and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns
A nurse has obtained donor tissue typing information about a patient who is waiting for a kidney transplant. Which results should be reported to the transplant surgeon?
A. Patient is Rh positive and donor is Rh negative
B. Six antigen matches are present in HLA typing
C. Results of patient-donor crossmatching are positive
D. Panel of reactive antibodies (PRA) percentage is low
C
Rationale: positive crossmatching is an absolute contraindication to kidney transplantation because a hyperacute rejection will occur after the transplant. The other information indicates that the tissue match between the patient and potential donor is acceptable.
Which information in a patient’s history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation?
A. The patient has type 1 diabetes
B. The patient has metastatic lung cancer
C. The patient has a history of chronic hepatitis C infection
D. The patient is infected with HIV
B
Rationale: Disseminated malignancies are a contraindication to transplantation. The conditions of the other patient’s are not contraindications for kidney transplant.
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation?
A. postural hypotension
B. recurrent tachycardia
C. knee and hip joint pain
D. increased serum creatinine
C
Rationale: aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
A 38-year-old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone. Which assessment data will be of most concern to the nurse?
A. skin is thin and fragile
B. blood pressure is 150/92
C. a nontender axillary lump
D. blood glucose is 144 mg/dL
C
Rationale: a nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, skin change, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider?
A. the urine output is 900 to 1100 mL/hr
B. the patient’s central venous pressure (CVP) is decreased
C. the patient has a level 7 incisional pain
D. the blood urea nitrogen and creatinine levels are elevated
B
Rationale: the decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider?
A. heart rate
B. urine output
C. creatinine clearance
D. blood urea nitrogen (BUN) level
B
Rationale: fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.
A 53-year-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most accurate?
A. “Your heart failure has not reached the end stage yet.”
B. “You could not manage the multiple complications of that surgery.”
C. “The suitability of a heart transplant for you depends on many factors.”
D. “Because you have diabetes, you would not be a heart transplant candidate.”
C
Rationale: indications for a heart transplant include end-stage heart failure (stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Patients with diabetes who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, there are no data to suggest that the patient could not manage the care.
Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago?
A. dry palpebral and oral mucosa
B. crackles at bilateral lung bases
C. temperature 100.8 F
D. no bowel movement for 4 days
C
Rationale: the risk of infection is high in the first few months after liver transplant, and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions and might be communicated to the health care provider, but they do not indicate a need for urgent action
A nurse is considering which patient to admit to the same room as a patient who had a liver transplant 3 weeks ago and is now hospitalized with acute rejection. Which patient would be the best choice?
A. patient who is receiving chemotherapy for liver cancer
B. patient who is receiving treatment for hepatitis C
C. patient who has a wound infection after cholecystectomy
D. patient who requires pain management for chronic pancreatitis
D
Rationale: the patient with chronic pancreatitis does not present an infection risk to the immunosuppressed patient who had a liver transplant. The other patients either are at risk of infection or currently have an infection, which will place the immunosuppressed patient at risk for infection.
What two calcineurin inhibitors are the most effective?
cyclosporine & tracrolimus
What does cyclosporine and tracrolimus prevent?
cell-mediated attack
Do cyclosporine and tracrolimus cause bone marrow suppression or alter normal inflammatory response?
No
What is a potential complication of cyclosporine and tracrolimus?
nephrotoxicity
What do you not give with cyclosporine & tracrolimus?
Grapefruit, grapefruit juice
What are signs of GI toxicity with mycophenloate mofetil
N/V, diarrhea
Tissue donation must be initiated within ____ hours of death
24
What organs can a deceased donor give?
kidneys, pancreas, liver, lungs, heart, intestinal organs, hands, face
