PRACTICE QUESTIONS Flashcards
A 20 year old male heart transplant recipient is 2 days post transplant who is currently receiving daily ATG at 1 gram/kg and is 60 kg. His labs came back today with WBC at 5.0, platelets at 70, 0.1% lymphocytes and a HCT of 24 on his CBC. What are your initial next steps?
- Continue his daily ATG, contact transplant MD regarding HCT of 24
- Hold daily ATG, draw CBC in am, reassess CBC, contact MD regarding HCT of 24
- Give ½ dose of ATG, contact transplant MD regarding HCT of 24
- Continue daily ATG, repeat CBC in 12 hours
- ATG should be held. Platelets are too low, additional ATG will lower platelets even further, HCT already low, could be bleeding, need to look for possible source of bleeding, patient only has 1% of lymphocytes, so patient is covered at the moment for immunosuppression, also receiving steroids and mycophenolate .
A 20 year old female lung transplant recipient who is 6 months post transplant came in for routine clinic follow-up. Her immunosuppression regimen consists of
tacrolimus/mycophenolate/steroids. You are counseling her on tacrolimus side effects. You would include which of the following:
A. Hypomagmesium, hyperkalemia, hyperlipidemia
B. Hypomagnesium, hypokalemia, hyperlipidemia
C. Hypermagnesium, hyperkalemia, hypolipidemia
D. Hypermagnesium, hyperkalemia, hypolipidemia
A- tacrolimus will lower your magnesium, increase your potassium and increase your lipids
A 21 year old female kidney recipient 10 years post transplant was seen in your post transplant clinic. She has been on cyclosporine for the past 10 years. After reviewing her history and reviewing laboratory studies you note she has a creatinine 1.2 and a cyclosporine level of 250. She also has worsening gingival hyperplasia. You have a long discussion about options. Your next initial step will be to:
- Switch from cyclosporine to a non CNI as this is causing ongoing renal injury
- Start referral and evaluation for kidney re-transplant due to rise in creatinine
- Lower cyclosporine dose and repeat laboratory studies within the week
- Referral to oral surgeon for gingival hyperplasia
3- First will be to lower cyclosporine dose and repeat level and creatinine within the week. Normal levels at 10 years post transplant would be between 100-150 at most (would run lower with rising creatinine). A referral is warranted for the gingival hyperplasia which may need surgical intervention for appropriate hygiene (is not your initial step). You do not need to eval for re-transplant.
A 25 year old liver transplant recipient who is 10 years post transplant came in for routine labs. His immunosuppression regimen consists of tacrolimus/mycophenolate. A tacrolimus level was drawn. The patients calls to tell you he was placed on clarithromycin 4 weeks ago as he was diagnosed with lymes disease. Based on this information, you can expect his tacrolimus level to results to be:
A. Therapeutic between 15-20
B. Supratherapeutic over 20
C. Therapeutic between 5-10
D. Undetectable, less than <2.5
B- Clarithomycin will increase tacrolimus levels, dose will need to be adjusted and repeat levels, remember, all “mycins”, erythromycin clarithromycin, azithromycin- Zpak.
A 30 year old heart transplant was seen in your post transplant clinic. He has been on sirolimus for the past 3 years due to coronary artery disease. You are doing his annual laboratory studies which will include a urine analysis (UA). Your initial reason for screening is due to:
- Sirolimus can cause hematuria in your urine
- Monitoring for UTI bacteria in urine is required
- Sirolimus can cause protienurinia
- Monitoring for yearly viral studies in urine is necessary
3- sirolimus is associated with proteinuria. Patient may need to have dose lowered or taken off of sirolimus if noted to have high levels of protein in the urine.
A 30 year old male kidney transplant recipient is on tacrolimus, mycophenolate and prednisone 9 months post transplant. You are seeing him in clinic for his routine appointment. He has complaints of diarrhea and vomiting and a 5 pound weight loss. You have ruled out rejection and bacterial/viral cause for his symptoms. You are reviewing his medication list. Based on his immunosuppression medications, which is most likely causing the symptoms:
- Prednisone
- Tacrolimus
- Mycophenolate
- Sirolimus
- Mycophenolate has known side effects of nausea, vomiting and diarrhea and possible weight loss.
Based on the symptoms, you switched the 30 year old male kidney transplant recipient immunosuppression regimen. You took him off the tacrolimus, mycophenolate and prednisone due to the complaints of diarrhea and vomiting and a 5 pound weight loss. Since you believe the mycophenolate was the cause of the symptoms, what is the initial regimen you would switch to?
- Tacrolimus/Azathioprine/Prednisone
- Tacrolimus/Sirolimus/Prednisone
- Tacrolimus/Myfortic/Prednisone
- Cyclosporin/Myfortic/Prednisone
- Tacrolimus, myfortic and prednisone- you would first change to the enteric coated mycophenolate. It was developed to reduce the upper GI effects of mycophenolate. Unlike mycophenolate which releases in
the stomach, myfortic is released in the small intestine. You can still have some constipation and nausea with myfortic when released in the small intestines.
A 30 year old male kidney transplant recipient who is 5 years post transplant clinically stable outpatient has new rejection. The pathologist calls you with the results. He states the biopsy is characterized by vascular inflammation and damage. There is endothelial activation with intravascular macrophages and capillary destruction. There is complement and HLA deposition. Based on what you know about cellular and antibody rejection, you know the diagnosis and next steps will be:
- Cellular rejection and treat, admit with IV high dose steroids
- Antibody mediated rejection and treat with IVIG or Rituximab
- Cellular rejection and treat with oral high dose steroids
- Antibody mediated rejection and treat with bortezomib
- Description is for AMR, 1st line treatment is IVIG and Rituximab, may use pheresis 1st, bortezomib is not 1st line therapy
Immunosuppressive agents can include antibodies. An example of a polyclonal antibody used in solid organ transplantation to control allograft rejection is:\
- Alemtuzemab
- Rapamycin
- Tacrolimus
- Anti-thymocyte globulin
D
Hypertension is the most common medical problem post-transplantation. The apparent cause of this complication has been associated with which of the following drugs?
a. Steroids/prednisone
b. Mycophenolate mofetil
c. Cyclosporine
d. Calcium channel blockers
C
Leukopenia and GI disturbances are seen commonly with which antiproliferative agent?
A. Azathioprine
B. Rapamycin
C. Mycophenolate mofetil
D. Alemtuzemab
C
When given intra-operatively, prior to reperfusion, anti-thymocyte globulin has been shown to reduce the incidence of:
a. Chronic allograft rejection.
b. Immediate post-operative atelectasis.
c. Delayed graft function.
d. Post-transplant infectious complications on days 3-5.
C
Medications that are not removed by dialysis include all of the following except:
A. Tacrolimus B. Mycoophenolate C. Phenobarbital D. ATG E. Cyclosporine
C
You have a 20-year old intestinal transplant recipient on cyclosporine. He has severe gingival hyperplasia when you see him in clinic. The recommendation with severe gingival hyperplasia with gum overgrowth is:
A. Recommend at water pic
B. Referral for surgery
C. Recommend sodium bicarb rinses
D. Recommend improved brushing and flossing
B
You are providing education to a 30-year old liver transplant recipient who will be discharged home from the hospital this week. You are reviewing medications and drug levels. Your patient is on Tacrolimus capsules and mycophenolate tablets. Which of the following will cause sub-therapeutic drug levels:
A. Variation in the storage of meds
B. Grapefruit
C. Herbs
D. Antifungals
C
You are discussing medications with a 35-year old post intestinal transplant recipient. He has brought his wife to the clinic appointment. He has expressed concerns regarding impotence post transplant. You are reviewing his medication list. Which medication is known to have the side effect of impotence?
A. Lisinopril
B. Amlodipine
C. Atenolol
D. Lasix
C
When post transplant, sirolimus is synergistic with which medication
A. Cyclosporine
B. Fluconazole
C. Bactrim
D. Azathioprine
A
Which has the least impact on the White Blood Cell Count (WBC)s? A. Prednisone B. Cyclosporine C. Azathioprine D. Cyclophosphamide
B
Tacrolimus levels are drawn \_\_\_\_ or\_\_\_\_\_ hours after the last dose. A. 6 or 8 B. 10 or 12 C. 12 or 24 D. 6 or 12
C
- Which of the following agents is used to prevent cellular rejection within the first six months after transplantation and is given once at the time of transplantation?
a. Sirolimus
b. Alemtuzumab
c. basiliximab
d. tacrolimus
B
- which of the following combinations of medicines represents the classic and most often used triple drug maintenance immunosuppressive regimen?
a. Cyclosporine, azathioprine, methylprednisolone
b. tacrolimus, azathioprine, Prednisone
c. tacrolimus, mycophenolate mofetil, Prednisone
d. cyclosporine, everolimus, methylprednisolone
C
- Which of the following are acceptable agents to replace calcineurin inhibitors after transplantation?
a. Sirolimus
b. Belatacept
c. methotrexate
d. one only
e. one and two
f. two and three
g. one, two and three
B
- which of the following maintenance immunosuppressive agents requires a transplant recipient to be EBV I GG seropositive to minimize the risk of post transplant lymphoproliferative disorder?
a. Belatacept
b. Sirolimus
c. tacrolimus
d. Azathioprine
A
- which of the following immunosuppressive agents should only be used as induction immunosuppression?
a. ATG
b. Alemtuzumab
c. Belatacept
d. Basilizimab
C
- Which of the following maintenance immunosuppressive agents is associated with renal dysfunction due to worsening proteinuria?
a. Mycophenolate sodium
b. Azathioprine
c. sirolimus
d. cyclosporine
C
- which cortico steroid strategy is associated with the greatest risk/benefit profile after renal transplantation performed with rabbit antithymocyte globulin?
a. Early avoidance
b. slow taper
c. late minimization
d. chronic maintenance
A
- hypertension is common after transplantation and is likely associated with which of the following immunosuppressive classes of medicines?
a. Proliferation signal inhibitors
b. costimulatory inhibitors
c. induction immunosuppression
d. calcineurin inhibitors
D
- Which of the following immunosuppressive agents is not recommended for use immediately after heart or lung transplantation due to impaired wound healing?
a. Tacrolimus
b. cyclosporine
c. sirolimus
d. Azathioprine
C
- Voriconazole has significant drug-drug interactions. Which of the following immunosuppressive medicines requires dose adjustment for this drug interaction?
- Tacrolimus
- everolimus
- cyclosporine
a. 1 only
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3
D
- When a patient is notified of an organ offer from a donor identified as PHS increased risk, the patient:
a. must be told the donor status at the time of the organ or prior to transplant.
b. Must agree and consent to proceed with transplantation prior to the surgery.
c. May refuse the organ and be automatically removed from the candidate wait list.
d. A&B
e. all of the above
D
- a patient who is preparing for discharge after his final liver transplant. The transplant coordinator provides education about which of the following health maintenance activities to monitor side effects of the medications?
a. Daily blood pressure monitoring
b. daily weight monitoring
c. completing blood work as instructed.
d. Increase physical activity daily
e. A&B only
f. D only
g. A, B & C
G
- Patient education must meet the learning needs to the patient considering:
a. patient’s developmental level
b. readiness to learn
c. cultural values and beliefs
d. A&B only
e. all of the above
E
- The transplant nurse is planning an educational session with the liver transplant candidate and reviews the medical record. The patient is a 44 year old male with hepatitis C. His medication list includes lactulos. He completed 9th grade and has worked in a factory until three months ago when his illness progressed. Factors to consider include:
a. possible cognitive dysfunction related to liver disease.
b. If he qualifies for disability.
c. Ability to comprehend patient education materials.
d. Current hepatitis C treatment plan.
e. A&B
f. A and C
g. all of the above
F
- Successful patient education design principles include:
a. a single approach convenient for the transplant nurse.
b. Engagement of multidisciplinary team to teach patients.
c. Teaching critical information on the day of discharge.
d. Relate teaching points to the patient’s own experiences.
e. A&B
f. B&D
g. all of the above
F
- When teaching the post transplant patient about immunosupression all of the following would be included except:
a. transplant patients are more likely to become sick compared to non transplant patients
b. medication may be taken at different times each day
c. notify the transplant coordinator if a new medicine is prescribed by the patient’s primary care doctor
d. some foods and medicines may change the metabolism of immunosuppressive drugs
B
- While interviewing a patient who was discharged after his heart transplant last week, he describes his pain level as an 8 out of 10 every day as he is showering and dressing. The best response is:
a. assure him the pain is related to surgery and will subside overtime
b. advise him to take a warm shower to relieve the pain
c. suggest that he take pain medicine at least one hour before beginning adls
d. review his medication list to re educate him about which medications alleviate pain
C
- Psychological effects related to transplantation include all of the following except:
a. unrealistic expectations
b. guilt related to the donor’s death
c. certainty that health will be restored
d. disappointment with early outcome of transplant
C
- When preparing a patient and their caregiver for discharge about monitoring the surgical wound , it should include:
A. number of staples, color, and drainage.
B. Color, drainage, and odor
C. number of staples, depth of wound, and drainage
D. odor, number of staples, and drainage
B
- patients and caregivers need instruction about invasive monitoring in the postoperative period. Education should include:
a. invasive intravenous lines
b. ventilator
c. post operative drains
d. Foley catheter and NG tube
e. all of the above
E
- Which of the following statements regarding transplant immunizations is FALSE?
a. Transplant candidates and recipients are at increased risk for complications due to end organ failure and immunosuppression.
b. It is more appropriate to immunize patients in the latter phases of diseases that lead to organ failure
c. It is critical to update immunizations prior to transplant to minimize risk of a suboptimal response.
d. The ideal time frame in which to administer posttransplant vaccinations is unknown.
B
Which of the following potential organ donors would be considered as at increased risk for transmission of hepatitis, HIV, or other infectious diseases?
a. A person who has had sex with a person who has injected drugs by IV, IM, or SQ route for nonmedical reasons in the preceding 12 months
b. A person who has been in jail or prison for more than 72 hours in the preceding 12 months
c. A person who has been diagnosed with or has been treated for syphilis, gonorrhea. Chlamydia, or genital ulcers in the preceding 12 months
d. All of the above
D
- You are caring for a 39-year-old heart transplant recipient in the intermediate/transplant step- down unit who has been admitted for assessment and treatment for possible cryptococcal meningitis Which of the following manifestations would you expect to observe in your patient?
a. Menial status changes
b. Stiff neck
c. Headache
d. All of the above
D
- Which transplant recipients are most likely to develop CMV?
a. Recipient CMV seropositive, donor CMV seropositive
b. Recipient CMV seropositive, donor CMV seronegative
c. Recipient CMV seronegative, donor CMV seropositive
d. Recipient CMV seronegative, donor CMV seronegative
C
- Approximately 50% of recipients with HBV infection will have end stage liver disease and/or hepatocellular carcinoma at 10 years posttransplant.
a. True
b. False
A
Which of the following statements regarding polyomaviruses (BK and JC) is TRUE?
a. Approximately 80% of the general adult population is seropositive for the BK and JC viruses
b. Viruses tend to persist in the kidneys, ureters, brain, and spleen.
c. Both (a) and (b).
d. Neither (a) or (b).
C
- Pancreas transplant recipients are particularly susceptible to candidiasis due to:
- underlying diabetes mellitus.
- indwelling urinary catheters.
- poor nutritional status.
- drainage of exocrine secretions into the bladder.
a. 1,2. and 3
b. 1,2, and 4
c. 2, 3, and 4
d. 1,3, and 4
B
All of the following are Risk factors for the development of multi drug resistant gram negative bacteria in transplant recipients except:
a. shortened hospital length of stays.
b. surgery.
c. antibiotic therapy.
d. intensive care unit admissions.
A
- The most common portal of entry for fungal infection in a transplant recipient is:
a. gastrointestinal tract.
b. skin.
c. donor transmission.
d. respiratory tract.
D
A 40-year-old female presents to the ED approximately 8 weeks status post kidney
transplantation with complaints of severe pain at the surgical graft site. On admission, her temperature is 102.6’F (39.2#C). white blood cell count is 15,000/pL and urinary sediment is present. She denies urinary frequency, urgency, or dysuria Which of the following are suspected diagnoses for this patient?
- Acute cellular rejection
- Acute pyelonephritis
- Urinary tract infection
- Humoral rejection
a. I and 2 only
b. 2 and 3 only
c. 1 and 3 only
d. 2 and 4 only
B
- You are caring for a liver transplant recipient on the Intermediate (step-down) care unit on postoperative day 10. Your patient has had a complicated postoperative course. Your patient was colonized with vancomycin resistant Enterococcus (VRE) prior to transplant. There are two other patients on the unit who are colonized with VRE. Which of the following statements is LEAST accurate?
a. You should not be assigned to take care of one of the other VRE colonized patients
b. You should observe the abdominal incision for signs of infection
c. Your patient mav not develop a fever in response to an infection.
d. Because he was colonized with VRE prior to transplantation, your patient is less likely to
develop a VRE infection.
D
The major protozoal pathogens affecting transplant recipients are:
a. CMV and Enterococcus.
b. Toxoplama gondii and Cryptosporidium parvum
c. Histoplasma and Pseudonomas
d. Legionella and Nocardia.
B
You are caring for a 52-year-old male who is 7 months postrenal transplant who is reporting severe generalized myalgias. You review his medication list and see that he is taking tacrolimus, mycophenolate mofetil, prednisone, pravastatin, lisinopril, folic acid, and a multivitamin. What blood test would you anticipate to he ordered?
a. Tacrolimus level
b. Creatinine kinase (CK)
c. Blood urea nitrogen (BUN)
d. Random cortisol level
B
- Metabolic syndrome risk factors include:
- abdominal obesity
- dyslipidemia
- hypotension
- renal insufficiency
- hyperglycemia
a. 1, 2, and 5
b. 1, 2, and 3
c. 2, 3, and 4
d, 1, 2, and 4
A
Solid organ transplant recipients have a 50 to 100 times increased risk of non Melanoma skin cancer.
a. True
b. False
A
Which viral illness carries the greatest risk for PTLD?
A. CMV
B. HSV
C. EBV
D. PCP
C
You are teaching a recent transplant recipient about the risk of steroid use. When explaining the risk of osteoporosis you explain that vertebral bone loss is typically highest:
A. in the first five years post transplant
B. as long as the patient is on steroids.
C. after 5 years posttransplant
D. in the first 6 to 12 months posttransplant
D
The goal blood pressure for the transplant recipient is <140/90
a. True
b. False
A
- Your patient is prescribed a bisphosphonate for osteoporosis. You explain that the patient should:
- take this medication with 8 oz of plain water prior to ingesting any food.
- take this medication with carbonated beverage to help with absorption.
- remain upright for 30 minutes after taking this medication.
- take this medication at the same time you take your calcium supplement.
A. 1 and 2
B. 2 and 3
C. 3 and 4
D. 1 and 3
D
- Your pretransplant patient has a history of gout. Now posttransplant, you are aware that the patient has an increased risk of gout due to use of:
- prednisone
- diuretics.
- statins.
- calcineurin inhibitors.
a. 1 and 4
b. 2 and 4
c. I and 3
d. All of the above
B
Your patient is 12 months posttransplant and presents with leukopenia, nausea, diarrhea, and fever. The probable diagnosis with this presentation is:
a. HSV infection.
b. posttransplant lymphoproliférative disease.
c. CMV gastritis.
d. Clostridium dlfficile colitis.
A
- Which of the following medications are typically associated with the development of gingival hyperplasia?
- Cyclosporine
- Diuretics
- Anticonvulsants
- Antihyperlipidemic agents
- Calcium channel blockers
a. 1.3, and 5
b. 1.4. and 5
c. 2, 3, and 4
d. 1.2, and 3
A
- Which medications can be associated with sexual dysfunction?
a. Beta-blockers
b. Immunosuppressants
c. Antidepressants
d. Lipid-lowering agents
e. All of the above
A
- Which of the following cancers is the most common in solid organ transplant recipients?
a. Breast
b. Colon
c. Prostate
d. Squamous cell carcinoma
e. Basal cell carcinoma
D
A 65-year-old male transplant candidate is admitted to the hospital for decompensated heart
failure. His signs and symptoms would likely include:
a. serum creatinine > 2.0 mg/dL. serum sodium < 130, heart rate > 100 bpm, and systolic
blood pressure < 100 mm Hg.
b. serum creatinine > 2.0 mg/dL serum sodium > 145, and decreasing brain natriuretic
peptide level.
c. heart rate < 60 bpm, systolic blood pressure < 80 mm Hg, and decreasing brain natriuretic
peptide level.
d increasing peripheral edema, decreasing abdominal fullness, and increased responsiveness to diuretics.
A
- Absolute contraindications to heart transplantation would be:
- history of carcinoma within the last year.
- history of active alcohol abuse.
- recent pulmonary infarction.
- history of poor compliance with drug regimens.
a. 1 and 3.
b. 1 and 4.
c. 2 and 4.
d. 3 and 4.
e. all of the above.
E
- Ventricular tachycardia after giving diuretics in the heart failure patient is most likely due to:
a. hypercalcemia and/or hypophosphatemia.
b. hypokalemia and/or hypomagnesemia.
c. hyperkalemia and/or hypermagnesemia.
d. hypophosphatemia and/or hypernatremia.
B
- Heart failure medical treatment may include all of the following except:
- sodium restriction.
- immune suppression.
- inotropic drips.
- daily weights.
- fluid restriction.
a. all of the following except # 1.
b. all of the following except # 2.
c. all of the following except # 3.
d. all of the following except # 4.
e. includes all of the above.
B
- Which respiratory disorder is a risk factor that can worsen heart failure?
a. Asthma
b. COPD
c. Sleep apnea
d. Pneumonia
C
- A 32-year-old male transplanted 3 months ago is admitted from a clinic with new-onset fatigue, shortness of breath, and palpitations. 12-lead EKG shows aflutter with HR 142, and clinical exam reveals S3 gallop. Likely diagnosis is:
a. cardiac allograft vasculopathy.
b. renal failure.
c. cardiac tamponade.
d. rejection.
D
- A 52-year-old female is admitted to ICU post heart transplant. Within 24 hours, the patient develops bradycardia with HR down to 52 beats per minute. Anticipate orders for one or more of the following:
- AV sequential pacing via temporary epicardial pacing wires
- Chest x-ray
- Endomyocardial biopsy
- Initiation of isoproterenol (Isuprel)
a. 1 and 3
b. 2 and 4
c. 1 and 4
d. 3 and 4
C
- Right ventricular failure is common post heart transplant. Risk factors include:
a. ischemic injury or inadequate donor organ preservation.
b. pulmonary hypertension in the recipient due to prolonged heart failure.
c. smaller donor heart transplanted into larger recipient.
d. all of the above.
D
Cardiac allograft vasculopathy is considered a chronic rejection process. Treatment may
include:
1. drug-eluting stent to occluded vessels.
2. Change in immunosuppressive therapy
3. management of restrictive heart pathology
4. retransplantation.
a. 1 and 3.
b. 2 and 3.
c. 1 and 2.
d. All of the above.
D
- A 58-year-old woman received heart transplant 12 hrs ago and is recovering in ICU. Lab work shows acute rise in serum creatinine from 1.1 initially postoperatively to now 2.4. Expect orders for the following:
- Induction therapy to delay the initiation of calcineurin inhibitors
- Fluid replacement
- Initiation of renal dose dopamine at 2 to 3 mcg/kg/min
- Increase in corticosteroid dose
a. 1, 2, and 4
b. 1, 2, and 3
c. 2, 3, and 4
d. All of the above
B
- You are caring for a 55-year-old female heart transplant recipient who had severe liver
dysfunction prior to transplantation. On postoperative day 2, you assume care of this
patient at 7 am and you observe the following trends that occurred on the night shift:
decreasing hemoglobin and hematocrit, decreasing cardiac output and cardiac index,
increasing chest tube output, and increasing oxygen requirements. During your first
assessment, you note the following: cardiac index 2.8 L/min/m2, systolic pressure 88 mm Hg, HR 140 bpm, and chest tube output 200 mL/hour. You notify the physician and
anticipate orders for: - antirejection therapy.
- blood products.
- protamine.
- stripping of chest tubes.
- increased immunosuppression.
- preparation of patient for return to OR.
a. 1,2, and 3.
b. 1,4, and 5.
c. 2, 3, and 6.
d. 2, 3, and 4.
C
- A 56-year-old male transplant recipient develops metabolic acidosis secondary to hyperkalemia. His symptoms of hyperkalemia would likely include*
a. skeletal muscle weakness, irregular pulse, and inverted T waves on I CG
b. increased deep tendon reflexes, nausea, and vomiting.
c. constipation, small muscle hypoactivity, and irregular pulse
d. skeletal muscle weakness, tall peaked T waves on EGG , nausea, vomiting
D
- You are caring for a 44-year-old male heart transplant recipient in the step-down unit who
becomes bradycardic. You should anticipate an order for:
a. atropine.
b. isoproterenol.
c. nitroprusside.
d. digoxin.
B
- The clinical manifestations of heart rejection are likely to include:
- hypertension.
- fever >101 °F.
- hypotension.
- atrial dysrhythmias.
a. 1 and 2.
b. 3 and 4.
c. 2 and 4.
d. 1 and 4.
B
- Clinical manifestations of infection in a heart transplant recipient may include:
- fever (> 38°C/100.4#F).
- negative C-reactive protein.
- leukocytosis.
- elevated sedimentation rate.
a. 1,2, and 3.
b. 1,2, and 4.
c. 2, 3, and 4.
d. 1, 3, and 4.
D
- Premature atrial or ventricular contractions in a heart transplant recipient are most often due to:
a. hypokalemia and/or hypomagnesemia.
b. hypercalcemia and/or hypophosphatemia.
c. hyponatremia and/or hyperphosphatemia.
d. hypophosphatemia and/or hypernatremia.
A
- In your discharge leaching, you would tell patients to report which of the following signs and/or symptoms that might indicate complications after an endomyocardial biopsy?
- Severe pain at site of puncture wound
- Nausea or vomiting
- Shortness of breath
- Chest or arm pain
a. 1,2, and 4
b. 2, 3, and 4
c. 1,2, and 3
d. 1,3, and 4
D
- Coronary artery vasculopathy is thought to be a form of:
a. chronic graft rejection.
b. hyperacute rejection.
c. acute humoral rejection.
d. acute cellular rejection.
A
- In a heart transplant recipient, the clinical manifestations of a myocardial infarction
typically may include: - fatigue.
- dyspnea.
- angina.
- dysrhythmias.
a. 1,2, and 3.
b. 1,2, and 4.
c. 2, 3, and 4.
d. 1, 3, and 4.
B
You have been managing a 25 year old male outpatient on your heart transplant waitlist. He currently has been doing reasonably well with compensated cardiac function with biventricular systolic heart failure with NYHA class II symptoms and ACC/AHA stage D heart failure (previously supported on ECMO). He just has been admitted to the CICU for decompensated heart failure. His signs and symptoms would likely include:
- BNP 15,000, creatinine 2.0, heart rate > 100, blood pressure < 100
- BNP 100, creatinine 2.0, heart rate > 100, blood pressure < 100
- BNP 1500, creatinine 2.0, peripheral edema, decrease abdominal fullness
- BNP 100, blood pressure < 100, peripheral edema, increase abdominal fullness
- You will see a rise in BNP with heart failure, rise in creatinine due to end organ dysfunction, tachycardia and low blood pressure as this is decompensated heart failure
A 21 year old male on your heart transplant wait list was admitted to the hospital. He has the diagnosis of congenital heart disease. He was previously waiting at home without inotropes. He clinically deteriorated in the CICU and now has been placed onto ECMO. He continues to be an appropriate transplant candidate. The transplant coordinator should update his listing status. What was this patient’s listing status at admission and what should the candidate’s updated listing status be now?
- |status 6 at admission, update to status 1
- status 4 at admission, update to status 2
- |status 5 at admission, update to status 1
- status 4 at admission, update to status 1
- Patient was status 4 at admission (CHD), update to status 1 (VA ecmo), placed on ecmo at admission.
You just completed the evaluation of a 15 month old heart transplant candidate in the CICU. The committee agreed to move forward with listing and you have met with the family and completed all the necessary paperwork. You will be listing this patient today. The patient has a history of congenital heart disease and is on a high dose milrinone infusion. His blood type is O (isotiters are zero). How will you list this patient?
- ABO compatible, status 1A
- ABO compatible, status IB
- ABO incompatible, status 1A
- ABO incompatible, status IB
- Since this patient is under the age of 2 and has zero isohemogglutinin titers, he can be listed as ABO incompatible. He is status 1A as he is congenital heart disease on high dose milrinone infusion in the hospital
The patient continues to stabilize and is discharged from the hospital. You review the UNOS criteria for listing to see if you need to update the listing status. What should the patient’s listing status be for a 15 month old congenital heart disease outpatient on high dose milrinone?
- ABO compatible, status 1A
- ABO compatible, status IB
- ABO incompatible, status 1A
- ABO incompatible, status IB
- Since this patient is under the age of 2 and has zero isohemogglutinin titers, he can be listed as ABO incompatible. He is now status 1B as he is congenital heart disease on high dose milrinone infusion and discharged from the hospital.
❖ You are caring for a 25 year old male patient who is on the heart transplant wait list. He is clinically deteriorating and went to the cath lab. His hemodynamics are as follows:
Pulmonary artery pressure mean = 30, Pulmonary capillary wedge pressure = 22, Cardiac-output =2.0, Cardiac index 1.5. His creatinine is 3.2 and HR of 150s and SBP of 70. You can anticipate next steps to manage his heart failure will be:
- VA ecmo
- IV intropes
- LVAD support as bridge to transplant
- Consult renal and possible evaluate for kidney transplant
- Endomyocardial biopsy once return to cath lab
- All of the above
a. 1, 2 and 3
b. 1 only
c. 1 and 2 only
d. 1, 2, 3, and 4 only
e. All of the above
A- need to manage his heart failure, he is decompensated, needs inotropes, ecmo and transition to stable LVAD support as he waits for heart. He has end organ dysfunction as creatinine is 3.2. Need to correct.
❖ You are caring for a 25 year old candidate who is undergoing a heart transplant this evening. He is asking you questions about the procedure. In explaining the surgical procedure it is important to provide patients and families with information and diagrams/photos about which of the following?
A. The surgical incision B. Immunosuppression medications C. The various tubes and invasive monitoring that may be used D. A and C only E. All of the above
D- Question is asking about surgical procedure, not about immunosuppression.
You are caring for, a 40 year old male who l day post heart transplant. Right ventricular failure is common post heart transplant. You are educating a new coordinator regarding signs and symptoms. Risk factors include:
- Ischemic injury or inadequate donor organ preservation
- Pulmonary hypertension in the recipient due to prolonged heart failure
- Smaller donor heart transplant into larger recipient
- Increased number of lines and tubes
- Bypass effect
A. 1, 2 and only
B. 1, 3, and 5 only
C. 1, 2, 3, and 5 only
D. All of the above
C- number of tubes and lines do not impact increase right heart pressures, all others do
You are caring for a 25 year old male who is admitted to the CICU post heart transplant. Within 12 hours, his heart rate drops to 50 beats per minute. You anticipate orders for one or more of the following?
- AV sequential pacing via temporary epicardial pacing wires
- CXR
- myocardial biopsy
- Initiation of isoproterenol (Isuprel)
a. 1 and 3
b. 2 and 4
c. 1 and 4
d. 3 and 4
C. Pacing and isoproterenol- need heart rate to be between 100-120 for good cardiac output
You are caring for a 25 year old male recipient post op day 1 from heart transplant. You are taking over care on the night shift. Labs, hemodynamics and vitals are as follows:
Hemoglobin of 6, HCT 18, systolic BP of 88, HR of 150 and chest tube output at 250cc/hr. You notify the physician and anticipate orders for:
- Endomyocardial biopsy
- Immunosuppression medications
- Blood products
- Protamine
- Preparation of patient returning to the OR
- All of the above
a. 1, 2 and 3
b. 2. 3 and 5
c. 1, 3 and 4
d. 3, 4, and 5
e. All of the above
D- You are concerned about bleeding, you want to stop the bleeding, patient will be going back to OR
Your 44 year old heart transplant recipient just had his 1st endomyocardial biopsy. Your pathologist just called you with the biopsy results as you are walking your dog. The
results are as follows:
“The tissue has some areas of endothelial activation with intravascular macrophages & capillary destruction. It also has complement and HLA deposition.
Based on what you know about antibody mediated rejection, what grade rejection is this?
A. Grade 0: no rejection
B. pAMRlh or i suspicious- either histologic or immunologic evidence of AMR
c. pAMR2- both histologic and immunologic evidence AMR
d. pAMR3- severe findings of myocardial destruction
C. Grade 3- pAMR2- both histologic and immunologic evidence AMR- has some areas of both, would start treatment for AMR, treatment would range from plasmapheresis to IVIG to Rituximab, needs B-cell therapy
- You are caring for a 42-year old female heart transplant recipient. She is being
prepared for an endomyocardial biopsy. Which of the following should the
transplant coordinator explain to the recipient?
A. An echocardiogram is needed follow the biopsy
B. Endomyocardial tissue is obtained from the atrium
C. An overnight stay at the hospital is needed for observation
D. The internal jugular vein is the most common approach.
D
- You are discussing medications with a 35-year old post heart transplant recipient. He has brought his wife to the clinic appointment. He has expressed concerns regarding impotence post transplant. You are reviewing his medication list. Which medication is known to have the side effect of impotence?
a. Lisinopril
b. Amlodipine
C. Atenolol
D. Lasix
c=C
3. A heart transplant candidate is clinically deteriorating and is in the CICU. He was taken to the cath lab to reassess hemodynamics and possible intervention. The coordinator reviewed the listing status for this patient who is on a Mechanical Circulatory Support Device (MCSD) with device malfunction and mechanical failure. The correct status for this patient is: A. Status 1 B. Status 2 C. Status 3 D. Status 4 E. Status 5 F. Status 6
B
4. Four years post-heart transplant, a recipient with known coronary artery vasculopathy (CAV) calls to report sudden onset of shortness of breath, nausea, diaphoresis, and fatigue. Vital signs are: BP=160/94, HR=80, Temp= 36.8. The transplant coordinator should anticipate which of the following diagnostic procedures to be performed? A. chest CT scan B. echo C. V/Qscan D. Left heart catheterization
D
A 65 year old male is being evaluated for heart transplant. Absolute contraindications to heart transplantation would be:
- History of carcinoma within the last year
- History of alcohol abuse
- Recent pulmonary infarction
- Positive cytomegalovirus IgG antibody
a. 1 and 3
b. 1 and 4
c. 2 and 4
d. 3 and 4
A
- A 52 year old female is admitted to the CICU. The clinical manifestations of rejection are likely to include:
- Hypertension
- Fever >101° F
- Hypotension
- Atrial dysrhythmias
a. 1 and 2
b. 3 and 4
c. 2 and 4
d. land 4
B
- You are caring for a 30-year old female heart transplant candidate on the waiting list. She received a PRBC blood
transfusion. The recommended frequency of PRA testing post transfusion is:
A. In 1-2 weeks
B. In one month
C. In 3-6 months
D. At time of heart offer
A
- All of the following are true regarding antibody sensitization except:
A. Common thresholds for desensitization are PRA > 25% or cPRA > 50%
B. Sensitization is associated with post-transplant mortality, graft loss, CAV and rejection
C. L-VADs have a lower incidence of sensitization and decrease in the up-regulation of cytokine release during implantation
D. Sensitization can occur through exposure or viral infection and as a result of genetic predisposition.
C
- A 40-year old female heart candidate is undergoing a transplant evaluation. She underwent a stress test which had
abnormal result. What is the next test you will be ordering:
A. Echocardiogram
B. EKG monitor
C. Cardiac catheterization
D. Cardiac MRI
C
10. Your 43- year old female, 15 years post heart transplant, is admitted to the hospital for decompensated heart failure. Cardiac allograft vasculopathy is thought to be a form of: a. Chronic graft rejection b. Hyperacute rejection c. Acute humoral rejection d. Acute cellular rejection
A
You are mentoring a new transplant coordinator. You are explaining vaccines. ^Which of the following regarding transplant immunizations is a false statement?
- Transplant candidates and recipients are at increased risk for complications due to end stage organ failure and immunosuppression.
- It is important to immunize patients in the early phase of the disease which leads to organ failure
- It is critical to update immunizations prior to transplant to minimize the risk of suboptimal response
- It is important to wait 4 weeks after administering the HPV vaccine before proceeding with transplant
- It is important to wait 4 weeks after administering the MMR vaccine before proceeding with transplant
- HPV is not a live virus. Do not need to wait 4 weeks to accept a donor organ
You are caring for a 20 year old kidney transplant recipient in the ICU postoperative day 5. Your patient has had a complicated postoperative course. Your patient was colonized with vancomycin-resistant enterococcus (VRE) prior to transplant. There are two other patients on the unit who are colonized with VRE. Which of the following statements is the least accurate?
- You should not be assigned to take care of one of the other VRE-colonized patients
- You should observe the abdominal incision for sign of infection
- Your patient may not develop a fever in response to an infection
- Because she was colonized with VRE prior to transplant, your patient is less likely to develop a VRE infection
- An immunocompromised pt has an increased likelihood of developing infection following colonization.
You are mentoring /new transplant coordinator. You are explaining CMV. Which transplant recipients are most likely to develop CMV?
- Recipient CMV seropositive, donor CMV seropositive
- Recipient CMV seropositive, donor CMV seronegative
- Recipient CMV seronegative, donor CMV seropositive
- Recipient CMV seronegative, donor CMV seronegative
C. Recipient negative and donor positive is the highest risk for developing CMV.
A 21 year old male is 1 day post liver transplant. Your patient is CMV positive and Donor is CMV negative. Based on this information, what is the type of pattern for CMV infection for this patient?
- None
- Primary
- Reactivation
- Super
- Reactivation-Recipient is CMV seropositive- and the latent virus reactivates. The inflammatory process reactivated the virus, along with immunosuppression meds and sepsis.
A 21 year old female transplant recipient presents to clinic with a fever of 38.5. labs are drawn and results with total bili of 10.0, AST = 125 and ALT = 175. Patient goes for liver biopsy which resulted with CMV infection in tissue. The diagnosis that best describes this patient is:
- acute cellular rejection
- antibody mediated rejection
- CMV hepatitis
- CMV disease
- CMV hepatitis is described as elevated bili, liver function tests and positive biopsy results.
CMV disease would be a positive PCR, patient could have a positive PCR but that is not discussed in this scenario
A 40 year old male calls his coordinator with signs and symptoms of fever, night sweats and weight loss. He is 4 months post transplant. He was EBV negative at time of transplant and donor was EBV positive. His last EBV PCR was positive 30 days ago. You are suspicious for PTLD. In managing PTLD, what can a coordinator expect to be done with this patient over the next month?
- Repeat EVP PCR
- Lower immunosuppression
- CT imaging
- Tissue biopsy
- Chemotherapy
- Stop immunosuppression
- Retransplant
a. 1, 2, 3 only B. 1, 2, 3 and 5 c. 1, 2, 3, and 4 d. all of the above e. 1, 2, 3, 4, 5, and 6
E. All but retransplant is how you would manage PTLD
A 52 year old female transplant recipient develops shingles. She calls you. You look up her titers post transplant. She is VZV Ab positive. You advise her to get:
- A booster of the varicella vaccine
- Come in for IVIG
- Nothing, the symptoms will resolve over time
- She should get the shingle vaccine
- She should get the shingle’s vaccine- Shingrix.
She should still receive the vaccine to prevent future occurrences. It is not a live vaccine.
A 40 year old female heart transplant calls his coordinator with mono like signs and symptoms of fever, malaise, shortness of breath and lymphadenopathy. She is 3 months post transplant. She was negative recipient for toxoplasma, donor toxoplasma positive. You are suspicious for toxoplasma infection. In managing toxoplasma, what can a coordinator expect to be done with this patient?
- Pyrimethamine with folic acid and sulfadiazone
- Toxo Antibody titers
- Sulfa allergy- dapsone used instead of sulfa
- Stool testing
- CXR
- Endomyocardial biopsy
a. 1, 2, 4 only
B. 1, 2, 4 and 5
c. 1, 2, 3, 5 and 6
d. all of the above
C. Everything but stool testing. You are worried about myocarditis in this heart transplant recipient. will need biopsy. will do CXR d/t SOB
You are training a new transplant coordinator about infections post transplant.
Infections are a major cause of morbidity and mortality in transplant recipients. Factors associated with the development of infections in the immediate postoperative
period include which of the following?
a. Neutropenia secondary to immunosuppression
b. Invasive monitoring
c. Malnutrition
d. b and c
e. sed rate of 5.0
f. all of the above
g. a, b, c only
G. A, b, and c only are associated with infection. Sed rate of 5.0 is normal.
A 52 year old female transplant recipient is admitted to the ICU. All of the following are risk factors for the development of multidrug-resistant gram-negative bacteria in transplant recipients except:
- shortened hospital length of stays
- surgery
- antibiotic therapy
- intensive care unit admissions
- Shorten hospital length of stays will decrease the risk factor for the development of multidrug-resistant gram-negative bacteri
You are caring for a 30 year old heart transplant recipient. Signs and symptoms of infection in a heart transplant recipient may include:
- fever of 39.0 C
- CRP of 1.0
- leukocytosis
- sedimentation rate of 60
a. 1, 2, and 3
b. 1, 2, and 4
c. 2, 3, and 4
d. 1, 3, and 4
D. CRP of 1.0 is normal, everything else shows signs of infection in this heart transplant recipient.
A 30 year old female presents to the ED approximately 10 weeks status post kidney transplant with complaints of severe pain at the surgical graft site. On admission, her temperature is 103., WBC are 16,000, and urinary sediment is present. She denies urinary frequency, urgency, or dysuria. Which of the following are suspected diagnoses for this patient? 1. Acute cellular rejection 2. Acute pyelonephritis 3. Urinary tract infection 4. Antibody mediated Rejection a. 1 and 2 only B. 2 and 3 only c. 1 and 3 only d. 2 and 4 only
B. UTI and pyelo is the answer
You are training a new transplant kidney coordinator and explaining polyomaviruses. Which of the following statements regarding polyomaviruses (BK and JC) is true?
a. Approximately 80% of the general adult population is seropositive for the BK and JC viruses.
b. Viruses tend to persist in kidneys, ureters, brain, and spleen.
c. Both (a) and (b)
d. Neither (a) or (b)
C
A transplant recipient asks about infections. You explain that the major protozoal pathogens affecting transplant recipients are:
a. CMV and enterococcus
b. Toxoplasma gondii and Cryptosporidium
c. Histoplasma and pseudomonas
d. Legionella and Nocardia
B
The transplant coordinator is teaching his transplant recipient. The most common portal of entry for fungal infection in a transplant recipient is:
a. Gastrointestinal tract
b. Skin
c. Donor transmission
d. Respiratory tract
D
- You are caring for a 39-year-old heart transplant recipient in the intermediate/transplant step-down unit who has been admitted for assessment and treatment for possible cryptococcal meningitis. Which of the following manifestations would you expect to observe in your patient?
a. Mental status changes
b. Stiff neck
c. Headache
d. All of the above
D
- A pediatric transplant heart recipient was exposed to chicken pox 2 weeks ago and now has a rash. She did not receive
varicella as she was transplanted as an infant. Mom would like instructions on what to do next:
a. Isolate her child to another room
b. Report to emergency department for admission
c. Refer to PCP for vaccine
d. Come to transplant clinic for evaluation
B
- When educating a transplant recipient about smoking marijuana after he tested positive for THC, what can you explain that he is at risk for:
a. Legionella
b. Cryptosporidium
c. Aspergillus
d. Brain death
C
- A transplant recipient asks about traveling to Arizona for the winter and the infectious disease risk. You explain to them that they are at most risk for:
a. Enterococcus
b. Cryptosporidium
c. Coccidiomycosls
d. Nocardia
C
When providing a potential adult kidney recipient transplant education regarding HLA matching, the transplant coordinator knows the following information. Searching for a perfect 6 antigen match kidney, the likelihood of finding that perfect match with a sibling is?
- 100%
- 75%
- 50%
- 25%
- 25%
When providing education to a new transplant coordinator about crossmatching and sensitization, which of the following are true statements?
- Sensitization to HLA class I and class II antibodies provide a high risk of rejection and longer wait times on the transplant list
- Patients that have a positive retrospective crossmatch to the donor are at high risk for rejection and mortality
- Avoiding a positive crossmatch has the best long-term outcomes
- If a prospective or virtual crossmatch is unable to be obtained , it is okay to proceed and manage the retrospective crossmatch
- Virtual crossmatch is highly recommended to avoid a positive crossmatch. If virtual crossmatch cannot be performed in the event of a recent sensitization, a prospective crossmatch is recommended.
a. 1, 2, and 3
b. 1, 2, 3 and 5
c. 2, 3 and 5
d. All of the above
B. Retrospective crossmatch is not recommended. High risk of hyperacute rejection.
Which of the following statements is TRUE about ABO compatibility factors when accepting an organ for a candidate?
- Rh factor must be considered since the Rh factor resides on all tissues of the body
- Rh factor is not considered since the Rh factor is not found on lymphocytes
- Rh factor must be considered since the Rh factor resides on lymphocytes
- Rh factor is not considered since the Rh factor is present on all tissue cells
- Rh factor is not considered since the rh factor is not found on lymphocytes.
A transplant recipient with a history of steroid rejection and recent treatment with thymooglobulin calls to report a temperature of 38.5, nausea, vomiting, diarrhea and blood pressure of 88/60. The transplant coordinator should:
A. Reassure the recipient that these are normal symptoms post rejection treatment
B. Plan for recipient to come to the hospital for admission
C. Encourage the physician to follow-up with the recipient
D. Tell the recipient to call 911
E. Follow-up with the recipient in the next 8 hours to see if symptoms have resolved
B- Patients exhibiting a fever and toxic symptoms require hospitalization post thymo. Could be infection or reaction to medication. Needs organism testing and supportive care
Your heart transplant patient is short of breath and has fatigue. She ends up having a heart biopsy. The pathologist calls you with the results as you are driving home and describe the biopsy as follows:
“two areas of myocyte damage. Endothelial, parenchymal cell damage, interstitial inflammation with edema and mild hemorrhage”
Based on what you know about acute cellular rejection, what grade rejection is this?
a. Grade 0: no acute cellular rejection
b. Grade 1: minimal acute cellular rejection- Mild, low grade. Interstitial and/or perivascular infiltrate w/up to one focus of myocyte damage
c. Grade 2: Moderate, intermediate grade acute cellular rejection - two or more foci of infiltrate w/associated myocyte damage
d. Grade 3: severe acute cellular rejection- Severe, high grade, acute cellular rejection - diffuse infiltrate with multifocal myocyte damage ± edema, ± hemorrhage, ± vasculitis
C. Grade 2-patient would be treated with high dose steroids, IV or oral.
You are mentoring a new kidney transplant coordinator. Which of the following symptoms support a diagnosis of rejection in a kidney transplant recipient:
- malaise
- 3 pound weight gain in 24 hours
- Graft tenderness
- Increased urinary frequency
a. 1, 2, and 3 only
b. 1,2 and 4 only
c. 1,3 and 4 only
d. 2, 3 and 4 only
A. Symptoms of kidney rejection include malaise (discomfort), weight gain of 1-2 kg in 24 hours, tenderness over graft, and decreased urine output.
In reviewing the signs and symptoms of intestinal rejection, a transplant coordinator should instruct the recipient and family to notify and coordinator immediately if:
- The stoma has prolapsed
- An intermittent low-grade fever develops
- The consistency of stoma output has thickened
- There is high stoma output
a. l and 2 only
b. l and 3 only
c. 2 and 4 only
d. 3 and 4 only
C. There is no single symptom of intestinal rejection. Along with an increase in the stoma’s output, fever that is intermittent and continuous is a red flag for rejection. A prolapsed stoma happens, but is not indication of rejection. Stool that thickens is a sign of bowl adaptation.
You are a transplant coordinator mentoring a new hire. You are explaining rejection. Post lung transplantation, an inflammatory process of the small airways that results in narrowing and scarring of the bronchioles is called:
A. Hyperacute rejection
B. Acute rejection
C. Bronchiolitis obliterans or obliterative bronchiolitis
D. Cellular rejection of the alveoli
C. Bronchiolitis obliterans or obliterative bronchiolitis is the narrowing and scarring of the bronchioles.
- A potential donor has been identified for Recipient # 1 who has an elevated panel reactive antibody (PRA) that will require prospective crossmatch. Recipient # 2 is notified as the back up for the organ offer. Recipient # 1 will proceed to transplant if the crossmatch is:
A. T cell negative
B. B cell positive
C. ELISA class I positive
D. ELISA class II negative
A
- A 32-year old male has been called into the hospital for his heart transplant. He would like to do autotransplantation during his surgery. What is an example of autotransplantation:
A. Transplanting the organs from one species to another
B. Transplanting organs from one human to another human to another human
C. Transplanting a kidney from one identical twin to another
D. Transfusing a pint of the patients blood back into the same patient during the surgery.
D
- A transplant recipient asks you about the purpose of cyclosporine prescription. The transplant coordinator should responds by stating that cyclosporine:
A. Increases the number of circulating T helper cells
B. Prevents the body from recognizing the organ as foreign
C. Decreases the number of B cells
D. Enhances the ability to fight infections
B
4. You are caring for a 25-year old male heart transplant candidate on the heart wait list. His cPRA is 50%. He has had no recent blood exposure. He is not undergoing desensitization. How often would you monitor his HLA antibody analysis (cPRA)? A. every 1-2 weeks B. monthly C. every 3-6 months D. At time of heart offer
B
5. You are caring for a 32-year old female kidney transplant candidate in the ICU in kidney failure on dialysis. The test performed on all candidates that detects antibodies formed against a patient's HLA is called: A. Final crossmatch B. Tissue typing C. Panel of reactive antibodies D. FAB lymphocytes testing
C
6. You are admitting a 40- year old male to the CICU from his heart transplant surgery. He is having short runs of V-tach. The test performed by mixing donor lymphocytes or tissue from the donor spleen with white blood cells from the recipient Is called: A. PRA B. HLA tissue typing C. Trough level D. Crossmatch
D
7. A 22-year old female is admitted to the hospital for worsening liver failure. You screened first for hepatitis C (hep C PCR most reliable). Which type of rejection occurs in the 1st 6 months post transplant Is responsive to immunosuppression therapy? A. Accelerated B. Chronic C. Hyperacute D. Acute
D
- You have been asked to provide CMS education to the ICU and floor nurses at your institution. Which of the following concepts should be stressed during the education seminar for health care professionals?
A. Acute cellular rejection is usually reversible
B. The treatment for rejection is standardized
C. There are several methods for diagnosing rejection
D. The treatment for rejection requires hospitalization
A
As a transplant coordinator, you manage your liver waitlist. You have a 21 year old male
liver candidate with a history of hepatocellular carcinoma with a MELD of 26. You continue to update his listing status in UNET. How often do you recertify his listing?
1. Every 30 days with labs within 7 days
2. Every 7 days with labs within 48 hours
3. Every 90 days with labs within 14 days
4. Every 12 months with labs within 30 days
- Every 7 days recert for Meld over 25 and labs within 48 hours
Laboratory studies which are required for recertification in UNET for this liver patient with hepatocellular carcinoma and a MELD score of 26 includes the following?
- INR, c-peptide, bilirubin, creatinine
- INR, bilirubin, creatinine, albumin
- INR, c-peptide, bilirubin, albumin
- Bilirubin, creatinine, sodium, c-peptide
- INR, bilirubin, creatinine, sodium
5
You just completed the evaluation of a 2 year old liver transplant candidate in the ICU. The committee agreed to move forward with listing and you have met with the family and completed all the necessary paperwork. You will be listing this patient today. The patient has a history of Fulminant Liver Failure. His blood type is 0. His labs show ALT greater than or equal to 2000, INR 2. Total bilirubin of 12. How will you list this patient?
- PELD status 1A
- PELD status IB
- PELD exception
- MELD status 1
- MELD > 25
- Since this patient is under the age of 2 and has fulminant liver failure, he would be a peld status 1A
Lab values to determine ped status 1A: ALT greater than or equal to 2000
INR greater than or equal to 2.0
Total bilirubin greater than or equal to 10
You are a transplant coordinator working in the ICU taking care of a fresh transplant liver recipient. Which of the following is a false statement abolit a Blakemore tube:
A. Used in management of upper Gl hemorrhage
B. Is always used post transplant
C. Used to control esophageal varices
D. Is rarely used at present
E. Is a device inserted through the mouth or the nose
B. current practice is vanding with ERCP
As a transplant coordinator, you manage your liver waitlist. You have a 21 year old male liver candidate who will be going to the OR for the transjugular intrahepatic portosystemic shunt (TIPS) procedure. All of the following statements are true regarding the TIPS procedure except for which one statement?
- Can be used to treat complications of portal hypertension
- Can be used to treat variceal bleeding or bleeding from any veins that normally drain the stomach, esophagus or intestine into the liver
- Creates new connections between two blood vessels in your liver
- Catheter is inserted into your jugular vein and guided into your hepatic vein into your liver
- TIPS procedure can reverse liver cirrhosis and avoid transplantation
- 88% of people with cirrhosis and variceal bleeding who received the TIPS procedure survived for 2 years and 61% survived for at least 5 years
- TIPS procedure can reverse liver cirrhosis and avoid transplantation is a false statement The remainder are true statements.
A father was the living donor liver for his 6 month old son. He initially asked how his liver will be divided. The transplant coordinator informed the father that the surgeon will perform a:
- right lobectomy
- left lobectomy
- left lateral segmentectomy
- right lateral segmentectomy
- The left lateral segment is typically used in recipients of small size
The father that donated liver to his son then asks how long will it take for his liver to
grow back? The transplant coordinator should inform that the remaining organ will continue to regenerate for how many months?
1. 3
2. 6
3. 12
4. 18
- The liver has the capacity to regenerate immediately after resection. A majority of regeneration takes place in 2-3 months, however, the process continues up to 1 year.
A 21 year old liver transplant is 3 days post transplant. His PT is 25 sec, AST > 2,000 and ALT is 5,000. He will be going for a liver biopsy. It is thought he has primary graft nonfunction. Factors related to primary nonfunction of a new liver include which of the following
a. prolonged ischemic time
b. donor age
c. prolonged donor management/hospital stay
d. a and c only
e. b and c only
f. all of the above
F. All of the above are factors related to primary non-function
An 40 year old male that is old 6 months post liver transplant comes into clinic with mild abdominal pain and jaundice. His labs show and GTT = 300, and AST = 2000 and ALT = 2200. His liver enzymes were normal last week. All of the following statements are true regarding HAT except which one statement?
a. Dramatic increase in LFTs due to decreased blood flow through the hepatic vein to the new graft
b. Can occur in the early postoperative stage or many months later
c. Diagnosis is by angiography as this is the gold standard for diagnosis
d. The liver depends on the hepatic artery flow, HAT can lead to massive necrosis
e. Immediate return to the OR for revascularization of the organ
A. Dramatic increase in LFTs due to decrease blood flow through the hepatic artery, not vein, to the new graft.
An 18 year old is 1 week post liver transplant and is in the step down transplant unit. Your patient is complaining about abdominal pain and has bilious drainage from incision/drains. The
laboratory studies just resulted. The alk phos is elevated at 300, and GTT = 100. and AST = 1000 and ALT =1200 . All of the following statements are true regarding biliary leaks/obstructions
except which one statement?
a. In duct to duct anastomosis, small leaks may be treated with internal stents placed percutaneous or via ERCP.
b. Bile collections can be drained percutaneously and a pigtail drain inserted
c. Large leaks should be surgically repaired with construction of a Roux-en-Y choledochojejunostomy
d. A transient leak at the exit site of a T-tube site is quite common after removal and usually resolves spontaneously
e. Bile duct complications are uncommon and are rarely seen post liver transplant.
f. Delaying removal of T-tubes for up to 3 months post transplant allows for the biliary tract to mature, but even after this time, leaks can occur
E. Bile duct complications are common and may be seen at any time post liver transplant
A 50 year old 1 day post liver transplant had a INR of 8.0 and a PTT > 100. Bleeding
may occur in the 1st 24 hours post liver transplant due to which of the following factors?
1. improperly functioning drains
2. ascites developing from fluid management
3. poor functioning graft with underlying coagulopathy
4. poor renal function
- poor functioning graft with underlying coagulopathy-INR and PTT are elevated
A 21 year old liver recipient, 2 months postoperative, presents to clinic with the following complaints after 48 hour duration: temp of 39.0 C, chills, and cough. She reports dark- colored urine, light colored stools, yellow skin and a loss of appetite. The transplant coordinator should anticipate the following course of events in what order?:
- liver biopsy, blood cultures, routine blood work, CXR, abdominal US
- IV antibiotics, blood cultures, routine blood work, CXR, ERCP, abdominal US, hospital admission
- hospital admission, blood cultures, routine blood work, CXR abdominal US, liver biopsy
- liver biopsy, blood cultures, IV antibiotics, CXR, routine blood work, hospital admission
3- The coordinator should do less invasive test first, blood cultures, blood work, CXR to rule out pneumonia, abdominal US due to dark urine post liver transplant, if infection has not been ruled out, coordinator will have to rule out rejection, will be done during an admission
A 30 year old liver recipient, 6 months post transplant, presents to clinic with the
following complaints: temp of 39.0 C, chills, fatigue. He appears jaundice. You draw laboratory studies which show Bili = 10. ALT 500, AST 600 and GGT = 700. CRP 25. The transplant coordinator should anticipate the following orders for which diagnosis?:
- rejection, high dose steroids, blood culture, abdominal US, hospital admission, liver biopsy
- rejection, high dose steroids, IV antibiotics, blood cultures, routine blood work, abdominal US, hospital admission, liver biopsy
- cholangitis, IV antibiotics, blood cultures, abdominal US, hospital admission
- cholangitis, blood cultures, IV antibiotics, hospital admission, ERCP
- is the correct treatment for cholangitis, what this pt has.
You are mentoring a new transplant coordinator. Hyperglycemia in the first few days post liver transplant may be due to:
A. Calcineurin inhibitors
B. Steroids
C. A normal functioning liver that is converting glucose to glycogen
D. All of the above
D
- A transplant coordinator is educating a liver transplant candidate on surgical techniques. Most of the bile duct reconstructions after standard liver transplants are
A. Duct to duct choledocho-choledochostomy
B. Roux-en-Y hepaticojejunostomy
C. Side to side choledocho-choledochostomy
D. Choledochojejunostomy
A
- A 22-year-old male is one day post-liver transplant. You notice green-colored drainage in the JP drain during your morning assessment. This drainage may be a
sign of:
A. A fistula to the gallbladder
B. Bleeding from the anastomosis into the Gl tract
C. Bile leak or bile extravasation
D. Rejection
C
- You are caring for a 5-year-old female liver transplant recipient who has early indicators of Primary Non-Function. What do these include?
A. Hemodynamic instability
B. Coma
C. Quantity and quality of bile production
D. All of the above
E. a and b only
D
- A 50-year old female undergoes a successful deceased donor liver transplant. She is taken taken to the OR on postoperative day 1 for bleeding. During the surgery a
small amount of bile is seen leaking from the anastomosis. The most likely cause of the bile leak is:
A. Infection
B. Technical error at the time of the initial bile duct anastomosis
C. Post operative bleed
D. Acute cellular rejection
B
- A 7-month-old female underwent a deceased donor liver transplant for biliary atresia one week ago. The transplant surgeon states that he suspects the patient
has rejection. What are the most reliable indicators of liver rejection?
A. A rise in AST, ALT, and bilirubin
B. A rise in WBC and decrease in INR
C. Bleeding from the incision site
D. Elevated alkaline phosphatase
A
- You are following a 17-year old liver transplant recipient that is now 1-month post transplant who had a Roux-en-Y choledochojejumostomy anastomoses. As a coordinator, you are more concerned with a high fever and risk for infection with this type of anastomoses? True or False
A. True
B. False
A
8 . A transplant coordinator is educating a liver transplant recipient who is hepatitis C virus (HCV) positive about potential complications. Which of the following should be discussed.
A. Antirejection medications are usually lowered during episodes of rejection
B. Signs of rejection include fatigue and light colored stools
C. Infections after transplant can be common due to antihypertensive medications
D. The risk of recurrent hepatitis C is very low after a liver transplant
B
You are training a new transplant coordinator. When teaching her about intestinal transplant, which of the following is not true when describing intestinal failure?
- Can be due to motility or absorption disorders
- Nutrition is supplied primarily by TPN
- Most patient also have liver disease
- Inadequate gut mass to maintain fluid and nutritional requirements
- These pts do not have liver disease
-
A 30 year old intestinal recipient comes to clinic 1 month post transplant. In reviewing signs and symptoms of intestinal rejection, the transplant coordinator should instruct the recipient/family to notify the coordinator immediately if:
1. the stoma has prolapsed
2. an intermittent low-grade fever develops
3. the consistency of stoma output has thickened
4. there is high stoma output
A. 1 and 2 only
B. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only
C. There is no single symptom of intestinal rejection. Along with an increase in the stoma’s output, fever that is
intermittent^yid continuous is a red flag for rejection. A prolapsed stoma happens, but is not an indication of rejection. Stool that thickens is a sign of bowl adaptation.
You are caring for a 20-year-old female who is listed for a multivsiceral transplant. She is ill but stable and is hospitalized for supportive care as she waits for an organ transplant. Which of the following would preclude transplant when an organ is offered?
A. Positive blood culture with klebsiella
B. History of adherence issues
C. Ammonia level of 200umol/L
D. Seizure disorder controlled with phenytoin
A
- You are caring for a 10-year-old male following isolated intestine transplant on postoperative day 2. He has become increasingly tachycardie and his blood pressure is 80/55. JP drainage has increased serosanguineous fluid. The abdomen is mildly distended. His hemoglobin is 9.2. The ileostomy drainage is 40mL/kg/d and loose brown. What do you suspect?
A. Vascular thrombosis
B. Postoperative hemorrhage
C. Acute rejection
D. Leak at the anastomoses of the jejunum and duodenum
B
3. Your patient is a 40 year old male 3 weeks postintestinal transplant. Enteral feeds are going through a GT at 40cc/hr continuously. He is complaining of nausea and just vomited. He is afebrile what is the first thing you will do before calling your physician? A. Decrease the rate from 40 to 20cc/hr B. Order an abdominal ultrasound C. Stop the feeds D. Assess the ileostomy drainage
C
- In this patient (#6), what other issue might he considered in regard to nausea and vomiting?
a. Rejection
b. Decreased gastric motility
c. Food allergies
d. Oral aversion
B
- During the early postoperative period (weeks 1 to 6), surveillance endoscopies are usually performed:
a. when the stool output is 1 to 2 L/day in an adult.
b. if tacrolimus levels are <10 ng/mL.
c. twice weekly.
d. only if febrile.
C
- Your patient is a 35-vear-old female at 2 weeks post intestine transplant Enteral feedings via GT are ordered at 40 ml/hour continuously. Her complaints of nausea are increasing, and she has vomited a large amount of formula. she is afebrile. what is your first nursing intervention prior to informing the physician?
a. Stop the infusion of formula
b. Decease the rate to 20 ml-hour
c. Increase the IV fluid rate
d. Assess the ileostomy drainage
A
- You are caring for a 23-year-old female who is listed for a multivisceral transplant. She is ill but stable and is hospitalized for supportive care as she waits for an organ. Which of the
following would preclude transplant when an organ is offered?
a. Positive blood cultures with Klebsiella
b. History of nonadherence to medications and medical care
c. Ammonia level of 200 umol/L
d. Seizure disorder controlled with phenytoin
A
- You are caring for a 10-year-old boy following isolated intestine transplant on postoperative
day 2. He has become increasingly tachycardic and his blood pressure is 80/55. JP drainage
has increased serosanguineous fluid. The abdomen is mildly distended. His hemoglobin is
9 2 g% The ileostomy drainage is 40 mL/kg/d and watery brown. He is afebrile. What do you
suspect?
a. Vascular thrombosis
b. Postoperative hemorrhage
c. Acute rejection
d. Perforation of the intestine graft
suspected
B
- You are caring for a 10-year-old boy following isolated intestine transplant on postoperative
day 2. He has become increasingly tachycardic and his blood pressure is 80/55. JP drainage
has increased serosanguineous fluid. The abdomen is mildly distended. His hemoglobin is
9 2 g% The ileostomy drainage is 40 mL/kg/d and watery brown. IHe is afebrile. What do you
suspect?
a. Vascular thrombosis
b. Postoperative hemorrhage
c. Acute rejection
d. Perforation of the intestine graft
B
- Which of the following is not descriptive of intestinal failure?
a. Inadequate gut mass to maintain fluid and nutritional requirements
b. Always includes liver disease
c. Can be due to motility or absorptive disorders
d. Nutrition supplied primarily by TPN
B
Which of the following treatments/therapies could be used in a patient with intestinal failure?
- Omega-3 lipid formulation
- Teduglutide
- Serial transverse enteroplasty procedure
- Ethanol locks
a. 1, 2, 3
b. 2, 3, 4
c. 1, 2, 3
d. 1,2, 3, 4
D
- The risk for primary nonfunction of a liver after transplantation is
a. 10% to 15%.
b. 15% to 20%.
c. 1% to 2%.
d. 4% to 6%.
D
- Early indicators of primary nonfunction of the new liver may include which of the following
a. The quantity and quality of bile production
b. Extreme edema of the organ
c. Hemodynamic instability
d. a and b only
e. b and c only
f. All of the above
F
- De novo seizures may occur post liver transplant and may be related to which of the following factors?
a. Electrolyte imbalances
b. Cyclosporine or tacrolimus
c. Intracerebral abscesses
d. a and b only
e. b and c only
f. All of the above
F
- Green-colored drainage post liver transplantation may be a sign?
a. bleeding into the Gl tract.
b. bile leakage.
c. the development of a fistula to the gall bladder.
d. ruptured gall bladder.
B
- Bleeding may occur in the first 48 hours post liver transplantation due to which of the following factors?
a. Poor functioning graft with underlying coagulopathy
b. Improperly functioning drains
c. Ascites developing from fluid mismanagement
d. Poor renal function
A
- Patients with chronic liver disease may demonstrate which of the following hemodynamic states in the immediate transplant postoperative period?
a. Elevated cardiac output
b. Low systemic vascular resistance
c. Elevated cardiac index
d. a and b only
e. b and c only
f. All of the above
F
- Chronic hepatitis C is currently the leading cause of liver failure. What disease/syndrome is predicted to become the leading cause in the future?
a. Hepatitis B
b. Alcoholic cirrhosis
c. Nonalcoholic fatty liver disease (NAFLD)
d. Nonalcoholic steatohepatitis (NASH)
D
- Indicators of liver rejection post transplantation include which of the following?
a. A rise in AST, ALT, and bilirubin
b. A rise in WBC
c. Golden brown drainage from T tube
d. b and c only
A
- Factors related to primary non function of a new liver include which of the following
a. Prolonged ischemic lime
b. Donor age
c. Prolonged donor management/hospital stay
d. a and c only
e. b and c only
f. All of the above
F
10 Hypergylcemia in the first few days post liver transplantation may be related to which of the following?
a. Calcineurin inhibitors
b. Steroids
c. A normal functioning liver that is convening glucose into glycogen
d. a and b only
e. a and c only
f. All of the above
F
- In the immediate postoperative period, hypovolemia may be associated with rewarming. The patient may present with which of the following changes associated with hypovolemia?
a. Hypertension and elevated urine output
b. Hypotension and a decrease in CVP
c. Increased urine output and drop in AST and ALT levels
d. All of the above
B
❖ You are caring for a 25 year old candidate who is undergoing a lung transplant evaluation. He underwent a bronchoscopy as part of his routine evaluation. A pneumothorax is suspected in this patient. What is the first diagnostic test that you will be ordering?
- Chest CT
- PET scan
- Chest Xray
- MRI
- Pneumothorax is first diagnosed with a CXR. In some cases, a computerized tomography (CT) may be needed to provide more-detailed images.
❖ You are a transplant coordinator listing a lung transplant recipient. As you manage your patient on the waitlist, the lung allocation score (LAS) requires which of the following information updated in UNET every 6 months?
- serum creatinine
- 6 minute walk
- FVC
- FEV1
a. 1, 2, and 3 only
b. 1, 2, and 4 only
c. 1, 3, and 4 only
d. 2, 3 and 4 only
a. Serum creatinine, 6 minute walk, FVC are all required for LAS every 6 months. FEV1 is entered UNET but is not factored into the calculation of the LAS
You are caring for a 50 year old patient that is 1 day post lung transplant. Possible causes of primary graft dfîfunction in a lung recipient include which of the following?
a. Increased capillary permeability
b. Change in compliance and vascular resistance between donor and recipient
c. Edema from extended ischemic time
d. a and c
e. all the above
E
You are caring for a 40 year old patient that is 2 days post lung transplant. Tachycardia may be present in the immediate postoperative states due to which of the following problems?
a. Bleeding
b. Use of nebulizers
c. Pain, catecholamines release with stress
d. Fluid loss, diuretic therapy
e. Foley
f. a and b
g. all the above
h. a, b, c, and d
H
You are caring for a 50 year old patient that is 3 days post lung transplant. Administration of fluids to a lung transplant recipient in the immediate postoperative period should be done cautiously due to:?
a. the effect of high fluid volumes on anastomoses
b. increased capillary permeability in transplanted lung tissue
c. nephrotoxicity of anesthesias
d. hyporesponsiveness of alveoli in the immediate postoperative phase
B. Dont want to fill the lung with fluid
A lung transplant recipient calls you to report that she has developed a dry hacky cough. Her oxygen saturations are at 90%. Home microspirometry values have dropped by 15% over the last 3 days. She has also experienced increased fatigue. The coordinator should anticipate?
a. pulmonary function test
b. quantified V/Qscan
c. lung biopsy
d. chest CT
A- significant allograft dysfunction is a fractional decline in the FEV1 relative to baseline values. A drop I FEV1 of 10% for patients would be a reportable finding and would be confirmed by a formal pulmonary function test.
Your patient continues with a dry hacky cough, saturations at 90% and drop in microspirometry by 15% and fatigue. She ends up having a lung biopsy. The pathologist calls you with the results as you are driving home and describes the biopsy as follows:
“Dense perivascular mononuclear infiltrates commonly associated with endothelial; extension of inflammatory cell infiltrate into alveolar septa and airspaces”
Based on what you know about acute cellular rejection, what grade rejection is this?
a. Grade 0: no acute cellular rejection
b. Grade 1: minimal acute cellular rejection
c. Grade 2: mild acute cellular rejection
d. Grade 3: moderate acute cellular rejection
e. Grade 4: severe acute cellular rejection
D. Grade 3- pt would be treated with high dose steroids, IV or oral
You are caring for a 30 year old patient that is 10 days post lung transplant. Two major airway complications of lung transplant recipients are?
- alveolar collapse and rejection
- loss of surfactant and infections
- fungal infection and tracheal stenosis
- tissue necrosis and edema
- Post transplant airway complications are fungal infections and tracheal stenosis
- You are taking care of a 40 year old lung transplant recipient. In evaluating your patient’s hemodynamics, you know that pulmonary artery pressures are maintained within normal limits with which of the following?
a. Diuretic administration
b. Administration of inhaled nitric oxide
c. Intravenous administration of nipride
d. A and B
e. All of the above
D
- Cardiac dysrhythmias are not uncommon in the immediate postoperative period following lung transplantation. Atrial dysrhythmias are often associated with which of the following?
a. Systemic inflammatory processes related to chest surgery
b. Inflammation near pulmonary vein and atrial cuff suture lines
c. Early signs of hyperacute rejection
d. Low levels of sodium related to dehydration
B
- With en bloc and sequential anastomoses of lung transplantation, pulmonary artery wedge pressures are usually not done due to which of the following rationales?
a. Increase in arterial pressure may precipitate rupture of the anastomoses sites.
b. Increase in venous pressure may precipitate rupture of the anastomoses sites.
c. Increases in atrial pressures may precipitate rupture of the anastomoses sites.
d. Increases in ventricular pressures may precipitate rupture of the anastomoses sites.
A
- Your assignment today includes a 20 year old female who had a lung transplant 3 days ago. On your morning assessment, her parents tell you she seems different from the previous shift. Warning signs of primary graft dysfunction include which of the following symptoms?
a. Sudden rise in potassium levels
b. Frequent oxygen desaturation
c. Increased work of breathing
d. All of the above
e. b and c
E
- You are caring for a 50 year old man who is 7 months post lung transplant. He has been readmitted to your unit for fever and bronchitis. Acute rejection symptoms include which of the following?
a. Dyspnea
b. Elevation in temperature
c. Decrease in FEVi
d. All of the above
e. a and c
D
- You are training a new nurse on the transplant floor. A 35 year old female just arrived from the OR post lung transplant. What are the major airway complications of lung transplantation that you will instruct the new nurse to be aware of:
a. Bronchial dehiscence and tracheal stenosis
b. Alveolar collapse and rejection
c. Loss of surfactant and infections
d. Increased production of C02and an increase in reperfusion injury
A
- You are caring for a 21-year old male lung transplant candidate. When reviewing the operative procedure with the potential recipient, the coordinator should discuss all of the following except?
A. the possibility of blood transfusions
B. specific anesthetic medications
C. the location of the incision
D. the duration of the operation
B
- A 40-year old male transplant candidate is admitted to the hospital for worsening respiratory status. If a potential candidate’s chest x-ray shows an opacity in the right lower lobe, the transplant coordinator should expect which initial test to be ordered?
A. CT scan.
B. V/Q. scan
C. MRI scan
D. PET scan
A
- Atrial arrhythmias are a common complication of lung donation because of which of the following factors?
a. Surgery requires removal of % In of the left atrium.
b. Surgery requires dissection of the inferior pulmonary vein.
c. The development of atelectasis post-donation.
d. a and c
e. All of the above
B
- Two major airway complications of lung transplantation are:
a. bronchial dehiscence and tracheal stenosis.
b. alveolar collapse and rejection.
c. loss of surfactant and infections.
d. increased production of CO , and an increase in reperfusion injury.
A
- Acute rejection symptoms include which of the following?
a. Dyspnea
b. Elevation in temperature
C. Decrease in FEV1
d. a and c
e. All of the above
E
Possible causes of primary graft dysfunction include which of the following?
a. Increased capillary permeability
b. Change in compliance and vascular resistance between donor and recipient
c. Edema from extended ischemic time
d. a and c
e. All of the above
E
- Warning signs of primary graft dysfunction include which of the following symptoms?
a. Sudden rise in potassium levels
b. Frequent oxygen desaturation
c. Increased work of breathing
d. b and c
e. All of the above
D
- With en bloc and sequential anastomoses of lung transplantation, pulmonary wedge pressures are usually not obtained because:
a. increase in arterial pressure may precipitate rupture of the anastomoses sites.
b. increase in venous pressure may precipitate rupture of the anastomoses sites.
c. increases in atrial pressures may precipitate rupture of the anastomoses sites.
d. increases in ventricular pressures may precipitate rupture of the anastomoses sites.
A
- Administration of fluids to a lung transplant recipient in the immediate postoperative period
should be done cautiously due to:
a. the effect of high fluid volumes on anastomoses.
b. increased capillary permeability in transplanted lung tissue.
c. nephrotoxicity of anesthesias.
d. hyporesponsiveness of alveoli in the immediate postoperative phase.
B
- Cardiac dysrhythmias are not uncommon in the immediate post lung transplantation. Atrial dysrhythmias are often associated with
a. Systemic inflammatory processes related to chest surgery
b. Inflammation near the pulmonary vein and atrial cuff suture
c. Early signs of hyperacute rejection
d. low levels of sodium related to dehydration
B
- Tachycardia may be present in the immediate postoperative stages due to which of the
following problems?
a. Bleeding
b. Use of nebulizers
c. Pain, catecholamine release with stress
d. Fluid loss, diuretic therapy
e. a and b
f. All of the above
F
- The rationale for maintaining the pulmonary artery pressure within normal limits in the immediate postoperative period following lung transplantation is to:
a. protect anastomosis sites.
b. prevent immediate graft dysfunction.
c. prevent pulmonary edema.
d. a and c.
e. all of the above.
D
- Pulmonary artery pressures are maintained within normal
following?
a. Diuretic administration
b. Administration of inhaled nitric oxide
c. Intravenous administration of Nipride
d. a and b
e All of the above
D
- Following a renal biopsy, the most important nursing intervention(s) are:
a. ensuring that the patient is lying on the opposite side of the biopsy site.
b. applying pressure to the biopsy site by having the patient lie on that side.
c. checking for new-onset hematuria or the presence of clots in the urine.
d. a and c.
e. b and c.
E
Prior to a renal biopsy, which of the following tests should be evaluated?
a. Platelet count
b. Coagulation studies
c. Hematocrit
d. a and b
e. b and c
D
- Edema in the lower extremity on the same side of the renal transplant could indicate which of the following problems?
a. Acute rejection
b. Deep vein thrombosis (DVT)
c. Lymphocele
d. b and c
e. All the above
D
- To prevent hypoperfusion of the kidney during the immediate postoperative phase, the central venous pressure (CVP) should be maintained:
a. between 4 and 6 mm H2O
b. between 6 and 8 mm H2O.
c. between 6 and 12 mm H20.
d. >12 mm H20.
C
Potential complications following renal transplantation during the immediate postoperative phase include which of the following?
- Urine leaks, ATN
- Ureteral obstruction
- Infections
- Lymphoceles
a. I and 4
b. I. 2. 3
c. 1 and 3
d. All of the above
D
- ATN presents as renal failure in the absence of rejection or obstruction. Signs of ATN include which of the following?
- Increased BUN and creatinine
- Anuria or oliguria
- Pulmonary edema
- Elevated potassium and magnesium levels
a. 1.2,3
B. 1, 2, 4
C. 1 and 2
D. All of the above
D
- Acute tubular necrosis (ATN) may occur in kidney recipients during the immediate postoperative phase. Donor factors that may affect the development of ATN in the newly transplanted kidney include which of the following?
- Hypotension during the donor management phase
- Cardiac or respiratory arrest
- Ventilator-associated pneumonia
- Fluid overload during donor management
a. 1 and 3
b. I and 2
c. 2 and 3
d. 3 and 4
B
- The severity of T-cell rejection is rated using the Banff 97 with 2007 update Grading System. The severity of T cell rejection is determined by the degree of:
A. Proliferating B cells
B. Circulating donor antibodies
C. Tubulitis and arteritis
D. Tubular atrophy
C
- Clinical systemic symptoms that may develop with CKD include which of the following?
- Amenorrhea, impotence
- Pallor, puritis
- Hyperkalemia, acidosis
- Muscle twitching, seizures
a. 1,3,4
b. 1,2,3
c. 1 and 3 only
d. All of the above
D
The most common causes of chronic kidney disease (CKD) include which of the following disorders?
- Hypertension
- Congestive heart failure
- Diabetes
- Glomerulonephritis
a. 1,2,3
b. 2, 3, 4
c. 1,3,4
d. All of the above
C
- Nursing management of a pancreas transplant recipient with sepsis includes which of the following interventions?
a. Strict monitoring of blood glucose levels
b. Management of drains
c. Strict intake and output
d. Strict hand-washing techniques
e. a and d only
f. All of the above
F
Pancreatic transplant patients with an anastomotic leak may present with which of the following symptoms?
A. Sharp increase in blood glucose levels B. Increase in while blood cells c. Abdominal pain d. Elevated serum creatinine e. a and c f. b, c, and d
F
- A post pancreas transplant patient experiencing vascular thrombosis may present with which of the following symptoms?
a. Elevated blood glucose levels
b. Elevated serum amylase level
c. Acute abdominal pain
d. Acute thrombosis of the hepatic artery
e. b, c, and d
f. a, b, and c
F
