PRACTICE QUESTIONS Flashcards
1
Q
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
A
- 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 .
2
Q
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
A- tacrolimus will lower your magnesium, increase your potassium and increase your lipids
3
Q
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
A
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.
4
Q
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
A
B- Clarithomycin will increase tacrolimus levels, dose will need to be adjusted and repeat levels, remember, all “mycins”, erythromycin clarithromycin, azithromycin- Zpak.
5
Q
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
A
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.
6
Q
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
A
- Mycophenolate has known side effects of nausea, vomiting and diarrhea and possible weight loss.
7
Q
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
A
- 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.
8
Q
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
A
- Description is for AMR, 1st line treatment is IVIG and Rituximab, may use pheresis 1st, bortezomib is not 1st line therapy
9
Q
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
A
D
10
Q
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
A
C
11
Q
Leukopenia and GI disturbances are seen commonly with which antiproliferative agent?
A. Azathioprine
B. Rapamycin
C. Mycophenolate mofetil
D. Alemtuzemab
A
C
12
Q
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.
A
C
13
Q
Medications that are not removed by dialysis include all of the following except:
A. Tacrolimus B. Mycoophenolate C. Phenobarbital D. ATG E. Cyclosporine
A
C
14
Q
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
A
B
15
Q
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
A
C
16
Q
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
A
C
17
Q
When post transplant, sirolimus is synergistic with which medication
A. Cyclosporine
B. Fluconazole
C. Bactrim
D. Azathioprine
A
A
18
Q
Which has the least impact on the White Blood Cell Count (WBC)s? A. Prednisone B. Cyclosporine C. Azathioprine D. Cyclophosphamide
A
B
19
Q
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
A
C
20
Q
- 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
A
B
21
Q
- 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
A
C
22
Q
- 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
A
B
23
Q
- 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
A
24
Q
- which of the following immunosuppressive agents should only be used as induction immunosuppression?
a. ATG
b. Alemtuzumab
c. Belatacept
d. Basilizimab
A
C
25
6. 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
26
7. 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
27
8. 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
28
9. 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
29
10. Voriconazole has significant drug-drug interactions. Which of the following immunosuppressive medicines requires dose adjustment for this drug interaction?
1. Tacrolimus
2. everolimus
3. cyclosporine
a. 1 only
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3
D
30
1. 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
31
2. 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
32
3. 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
33
4. 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
34
5. 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
35
6. 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
36
7. 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
37
8. 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
38
9. 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
39
10. 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
40
1. 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
41
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
42
1. 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
43
4. 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
44
5. 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
45
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
46
7. Pancreas transplant recipients are particularly susceptible to candidiasis due to:
1. underlying diabetes mellitus.
2. indwelling urinary catheters.
3. poor nutritional status.
4. 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
47
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
48
9. 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
49
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?
1. Acute cellular rejection
2. Acute pyelonephritis
3. Urinary tract infection
4. Humoral rejection
a. I and 2 only
b. 2 and 3 only
c. 1 and 3 only
d. 2 and 4 only
B
50
11. 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
51
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
52
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
53
2. Metabolic syndrome risk factors include:
1. abdominal obesity
2. dyslipidemia
3. hypotension
4. renal insufficiency
5. hyperglycemia
a. 1, 2, and 5
b. 1, 2, and 3
c. 2, 3, and 4
d, 1, 2, and 4
A
54
Solid organ transplant recipients have a 50 to 100 times increased risk of non Melanoma skin cancer.
a. True
b. False
A
55
Which viral illness carries the greatest risk for PTLD?
A. CMV
B. HSV
C. EBV
D. PCP
C
56
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
57
The goal blood pressure for the transplant recipient is <140/90
a. True
b. False
A
58
7. Your patient is prescribed a bisphosphonate for osteoporosis. You explain that the patient should:
1. take this medication with 8 oz of plain water prior to ingesting any food.
2. take this medication with carbonated beverage to help with absorption.
3. remain upright for 30 minutes after taking this medication.
4. 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
59
8. 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:
1. prednisone
2. diuretics.
3. statins.
4. calcineurin inhibitors.
a. 1 and 4
b. 2 and 4
c. I and 3
d. All of the above
B
60
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
61
10. Which of the following medications are typically associated with the development of gingival hyperplasia?
1. Cyclosporine
2. Diuretics
3. Anticonvulsants
4. Antihyperlipidemic agents
5. Calcium channel blockers
a. 1.3, and 5
b. 1.4. and 5
c. 2, 3, and 4
d. 1.2, and 3
A
62
10. 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
63
10. 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
64
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
65
2. Absolute contraindications to heart transplantation would be:
1. history of carcinoma within the last year.
2. history of active alcohol abuse.
3. recent pulmonary infarction.
4. 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
66
3. 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
67
4. Heart failure medical treatment may include all of the following except:
1. sodium restriction.
2. immune suppression.
3. inotropic drips.
4. daily weights.
5. 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
68
5. Which respiratory disorder is a risk factor that can worsen heart failure?
a. Asthma
b. COPD
c. Sleep apnea
d. Pneumonia
C
69
6. 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
70
7. 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:
1. AV sequential pacing via temporary epicardial pacing wires
2. Chest x-ray
3. Endomyocardial biopsy
4. Initiation of isoproterenol (Isuprel)
a. 1 and 3
b. 2 and 4
c. 1 and 4
d. 3 and 4
C
71
8. 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
72
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
73
10. 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:
1. Induction therapy to delay the initiation of calcineurin inhibitors
2. Fluid replacement
3. Initiation of renal dose dopamine at 2 to 3 mcg/kg/min
4. 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
74
11. 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:
1. antirejection therapy.
2. blood products.
3. protamine.
4. stripping of chest tubes.
5. increased immunosuppression.
6. 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
75
12. 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
76
15. 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
77
16. The clinical manifestations of heart rejection are likely to include:
1. hypertension.
2. fever >101 °F.
3. hypotension.
4. atrial dysrhythmias.
a. 1 and 2.
b. 3 and 4.
c. 2 and 4.
d. 1 and 4.
B
78
18. Clinical manifestations of infection in a heart transplant recipient may include:
1. fever (> 38°C/100.4#F).
2. negative C-reactive protein.
3. leukocytosis.
4. elevated sedimentation rate.
a. 1,2, and 3.
b. 1,2, and 4.
c. 2, 3, and 4.
d. 1, 3, and 4.
D
79
19. 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
80
21. 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?
1. Severe pain at site of puncture wound
2. Nausea or vomiting
3. Shortness of breath
4. 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
81
21. 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
82
23. In a heart transplant recipient, the clinical manifestations of a myocardial infarction
typically may include:
1. fatigue.
2. dyspnea.
3. angina.
4. dysrhythmias.
a. 1,2, and 3.
b. 1,2, and 4.
c. 2, 3, and 4.
d. 1, 3, and 4.
B
83
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:
1. BNP 15,000, creatinine 2.0, heart rate > 100, blood pressure < 100
2. BNP 100, creatinine 2.0, heart rate > 100, blood pressure < 100
3. BNP 1500, creatinine 2.0, peripheral edema, decrease abdominal fullness
4. BNP 100, blood pressure < 100, peripheral edema, increase abdominal fullness
1. 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
84
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?
1. |status 6 at admission, update to status 1
2. status 4 at admission, update to status 2
3. |status 5 at admission, update to status 1
4. status 4 at admission, update to status 1
4. Patient was status 4 at admission (CHD), update to status 1 (VA ecmo), placed on ecmo at admission.
85
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?
1. ABO compatible, status 1A
2. ABO compatible, status IB
3. ABO incompatible, status 1A
4. ABO incompatible, status IB
3. 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
86
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?
1. ABO compatible, status 1A
2. ABO compatible, status IB
3. ABO incompatible, status 1A
4. ABO incompatible, status IB
4. 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.
87
❖ 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:
1. VA ecmo
2. IV intropes
3. LVAD support as bridge to transplant
4. Consult renal and possible evaluate for kidney transplant
5. Endomyocardial biopsy once return to cath lab
6. 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.
88
❖ 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.
89
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:
1. Ischemic injury or inadequate donor organ preservation
2. Pulmonary hypertension in the recipient due to prolonged heart failure
3. Smaller donor heart transplant into larger recipient
4. Increased number of lines and tubes
5. 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
90
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?
1. AV sequential pacing via temporary epicardial pacing wires
2. CXR
3. myocardial biopsy
4. 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
91
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:
1. Endomyocardial biopsy
2. Immunosuppression medications
3. Blood products
4. Protamine
5. Preparation of patient returning to the OR
6. 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
92
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
93
1. 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
94
2. 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
95
```
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
96
```
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
97
A 65 year old male is being evaluated for heart transplant. Absolute contraindications to heart transplantation would be:
1. History of carcinoma within the last year
2. History of alcohol abuse
3. Recent pulmonary infarction
4. Positive cytomegalovirus IgG antibody
a. 1 and 3
b. 1 and 4
c. 2 and 4
d. 3 and 4
A
98
6. A 52 year old female is admitted to the CICU. The clinical manifestations of rejection are likely to include:
1. Hypertension
2. Fever >101° F
3. Hypotension
4. Atrial dysrhythmias
a. 1 and 2
b. 3 and 4
c. 2 and 4
d. land 4
B
99
7. 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
100
8. 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
101
9. 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
102
```
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
103
You are mentoring a new transplant coordinator. You are explaining vaccines. ^Which of the following regarding transplant immunizations is a false statement?
1. Transplant candidates and recipients are at increased risk for complications due to end stage organ failure and immunosuppression.
2. It is important to immunize patients in the early phase of the disease which leads to organ failure
3. It is critical to update immunizations prior to transplant to minimize the risk of suboptimal response
4. It is important to wait 4 weeks after administering the HPV vaccine before proceeding with transplant
5. It is important to wait 4 weeks after administering the MMR vaccine before proceeding with transplant
4. HPV is not a live virus. Do not need to wait 4 weeks to accept a donor organ
104
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?
1. You should not be assigned to take care of one of the other VRE-colonized patients
2. You should observe the abdominal incision for sign of infection
3. Your patient may not develop a fever in response to an infection
4. Because she was colonized with VRE prior to transplant, your patient is less likely to develop a VRE infection
4. An immunocompromised pt has an increased likelihood of developing infection following colonization.
105
You are mentoring /new transplant coordinator. You are explaining CMV. Which transplant recipients are most likely to develop CMV?
1. Recipient CMV seropositive, donor CMV seropositive
2. Recipient CMV seropositive, donor CMV seronegative
3. Recipient CMV seronegative, donor CMV seropositive
4. Recipient CMV seronegative, donor CMV seronegative
C. Recipient negative and donor positive is the highest risk for developing CMV.
106
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?
1. None
2. Primary
3. Reactivation
4. Super
3. Reactivation-Recipient is CMV seropositive- and the latent virus reactivates. The inflammatory process reactivated the virus, along with immunosuppression meds and sepsis.
107
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:
1. acute cellular rejection
2. antibody mediated rejection
3. CMV hepatitis
4. CMV disease
3. 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
108
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?
1. Repeat EVP PCR
2. Lower immunosuppression
3. CT imaging
4. Tissue biopsy
5. Chemotherapy
6. Stop immunosuppression
7. 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
109
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:
1. A booster of the varicella vaccine
2. Come in for IVIG
3. Nothing, the symptoms will resolve over time
4. She should get the shingle vaccine
4. She should get the shingle's vaccine- Shingrix.
| She should still receive the vaccine to prevent future occurrences. It is not a live vaccine.
110
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?
1. Pyrimethamine with folic acid and sulfadiazone
2. Toxo Antibody titers
3. Sulfa allergy- dapsone used instead of sulfa
4. Stool testing
5. CXR
6. 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
111
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.
112
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:
1. shortened hospital length of stays
2. surgery
3. antibiotic therapy
4. intensive care unit admissions
1. Shorten hospital length of stays will decrease the risk factor for the development of multidrug-resistant gram-negative bacteri
113
You are caring for a 30 year old heart transplant recipient. Signs and symptoms of infection in a heart transplant recipient may include:
1. fever of 39.0 C
2. CRP of 1.0
3. leukocytosis
4. 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.
114
```
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
115
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
116
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
117
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
118
4. 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
119
5. 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
120
6. 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
121
7. 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
122
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?
1. 100%
2. 75%
3. 50%
4. 25%
4. 25%
123
When providing education to a new transplant coordinator about crossmatching and sensitization, which of the following are true statements?
1. Sensitization to HLA class I and class II antibodies provide a high risk of rejection and longer wait times on the transplant list
2. Patients that have a positive retrospective crossmatch to the donor are at high risk for rejection and mortality
3. Avoiding a positive crossmatch has the best long-term outcomes
4. If a prospective or virtual crossmatch is unable to be obtained , it is okay to proceed and manage the retrospective crossmatch
5. 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.
124
Which of the following statements is TRUE about ABO compatibility factors when accepting an organ for a candidate?
1. Rh factor must be considered since the Rh factor resides on all tissues of the body
2. Rh factor is not considered since the Rh factor is not found on lymphocytes
3. Rh factor must be considered since the Rh factor resides on lymphocytes
4. Rh factor is not considered since the Rh factor is present on all tissue cells
2. Rh factor is not considered since the rh factor is not found on lymphocytes.
125
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
126
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.
127
You are mentoring a new kidney transplant coordinator. Which of the following symptoms support a diagnosis of rejection in a kidney transplant recipient:
1. malaise
2. 3 pound weight gain in 24 hours
3. Graft tenderness
4. 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.
128
In reviewing the signs and symptoms of intestinal rejection, a transplant coordinator should instruct the recipient and family to notify and 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. 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.
129
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.
130
1. 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
131
2. 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
132
3. 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
133
```
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
134
```
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
135
```
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
136
```
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
137
8. 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
138
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
2. Every 7 days recert for Meld over 25 and labs within 48 hours
139
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?
1. INR, c-peptide, bilirubin, creatinine
2. INR, bilirubin, creatinine, albumin
3. INR, c-peptide, bilirubin, albumin
4. Bilirubin, creatinine, sodium, c-peptide
5. INR, bilirubin, creatinine, sodium
5
140
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?
1. PELD status 1A
2. PELD status IB
3. PELD exception
4. MELD status 1
5. MELD > 25
1. 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
141
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
142
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?
1. Can be used to treat complications of portal hypertension
2. Can be used to treat variceal bleeding or bleeding from any veins that normally drain the stomach, esophagus or intestine into the liver
3. Creates new connections between two blood vessels in your liver
4. Catheter is inserted into your jugular vein and guided into your hepatic vein into your liver
5. TIPS procedure can reverse liver cirrhosis and avoid transplantation
6. 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
5. TIPS procedure can reverse liver cirrhosis and avoid transplantation is a false statement The remainder are true statements.
143
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:
1. right lobectomy
2. left lobectomy
3. left lateral segmentectomy
4. right lateral segmentectomy
3. The left lateral segment is typically used in recipients of small size
144
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
3. 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.
145
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
146
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.
147
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
148
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
3. poor functioning graft with underlying coagulopathy-INR and PTT are elevated
149
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?:
1. liver biopsy, blood cultures, routine blood work, CXR, abdominal US
2. IV antibiotics, blood cultures, routine blood work, CXR, ERCP, abdominal US, hospital admission
3. hospital admission, blood cultures, routine blood work, CXR abdominal US, liver biopsy
4. 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
150
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?:
1. rejection, high dose steroids, blood culture, abdominal US, hospital admission, liver biopsy
2. rejection, high dose steroids, IV antibiotics, blood cultures, routine blood work, abdominal US, hospital admission, liver biopsy
3. cholangitis, IV antibiotics, blood cultures, abdominal US, hospital admission
4. cholangitis, blood cultures, IV antibiotics, hospital admission, ERCP
4. is the correct treatment for cholangitis, what this pt has.
151
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
152
2. 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
153
3. 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
154
4. 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
155
5. 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
156
6. 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
157
7. 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
158
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
159
You are training a new transplant coordinator. When teaching her about intestinal transplant, which of the following is not true when describing intestinal failure?
1. Can be due to motility or absorption disorders
2. Nutrition is supplied primarily by TPN
3. Most patient also have liver disease
4. Inadequate gut mass to maintain fluid and nutritional requirements
3. These pts do not have liver disease
160
-
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.
161
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
162
2. 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
163
```
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
164
5. 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
165
6. 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
166
3. 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
167
4. 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
168
4. 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
169
1. 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
170
Which of the following treatments/therapies could be used in a patient with intestinal failure?
1. Omega-3 lipid formulation
2. Teduglutide
3. Serial transverse enteroplasty procedure
4. Ethanol locks
a. 1, 2, 3
b. 2, 3, 4
c. 1, 2, 3
d. 1,2, 3, 4
D
171
6. 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
172
6. 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
173
4. 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
174
4. 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
175
3. 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
176
2. 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
177
1. 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
178
9. 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
179
8. 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
180
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
181
11. 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
182
❖ 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?
1. Chest CT
2. PET scan
3. Chest Xray
4. MRI
3. Pneumothorax is first diagnosed with a CXR. In some cases, a computerized tomography (CT) may be needed to provide more-detailed images.
183
❖ 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?
1. serum creatinine
2. 6 minute walk
3. FVC
4. 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
184
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
185
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
186
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
187
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.
188
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
189
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?
1. alveolar collapse and rejection
2. loss of surfactant and infections
3. fungal infection and tracheal stenosis
4. tissue necrosis and edema
3. Post transplant airway complications are fungal infections and tracheal stenosis
190
1. 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
191
2. 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
192
3. 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
193
4. 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
194
5. 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
195
6. 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
196
7. 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
197
8. 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
198
9. 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
199
10. 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
200
9. 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
201
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
202
7. 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
203
6. 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
204
3. 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
205
4. 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
206
5. 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
207
1. 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
208
1. 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
209
10. 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
210
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
211
8. 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
212
7. 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
213
Potential complications following renal transplantation during the immediate postoperative phase include which of the following?
1. Urine leaks, ATN
2. Ureteral obstruction
3. Infections
4. Lymphoceles
a. I and 4
b. I. 2. 3
c. 1 and 3
d. All of the above
D
214
5. ATN presents as renal failure in the absence of rejection or obstruction. Signs of ATN include which of the following?
1. Increased BUN and creatinine
2. Anuria or oliguria
3. Pulmonary edema
4. Elevated potassium and magnesium levels
a. 1.2,3
B. 1, 2, 4
C. 1 and 2
D. All of the above
D
215
4. 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?
1. Hypotension during the donor management phase
2. Cardiac or respiratory arrest
3. Ventilator-associated pneumonia
4. Fluid overload during donor management
a. 1 and 3
b. I and 2
c. 2 and 3
d. 3 and 4
B
216
3. 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
217
2. Clinical systemic symptoms that may develop with CKD include which of the following?
1. Amenorrhea, impotence
2. Pallor, puritis
3. Hyperkalemia, acidosis
4. Muscle twitching, seizures
a. 1,3,4
b. 1,2,3
c. 1 and 3 only
d. All of the above
D
218
The most common causes of chronic kidney disease (CKD) include which of the following disorders?
1. Hypertension
2. Congestive heart failure
3. Diabetes
4. Glomerulonephritis
a. 1,2,3
b. 2, 3, 4
c. 1,3,4
d. All of the above
C
219
10. 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
220
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
221
8. 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
222
7. Postoperative ileus with nausea and vomiting is not uncommon following pancreas transplantation, These complications are attributed to which of the following pretransplant problems?
a. Peripheral neuropathy
b. End-stage renal disease
c. Gastroparesis
d. All of the above
C
223
4. Which of the following are benefits of pancreas transplantation?
a. Insulin independence
b. Reversal of end-stage renal disease
c. Stabilize retinopathy
d. Improved neuropathy
e. a, b, and c
f. a, c, and d
F
224
4. Approximately 15% to 20% of BD recipients undergo a surgical procedure called 'enteric conversion, ' which is best described as:
a. sterilization of the bowel to minimize risk of posttransplant infections.
b. the development of a postoperative ileus with nausea and vomiting.
c. damage to the organ during cold ischemia preservation.
d. movement of the duodenal segment from the bladder to the bowel.
D
225
4. Bladder drainage of exocrine secretions may predispose the patient to which of the following complications?
a. Dehydration
b. Metabolic acidosis
c. Volume overload
d. Cystitis
e. b, c. and d
f. a, b, and d
F
226
1. The benefit of bladder drainage is that rejection episodes can be detected more readily by measuring which of the following in the urine?
a. Sodium and potassium
b. Solutes
c. Amylase
d. Glucose
C
227
1. In a bladder-drained pancreas recipient, what are the signs of rejection?
a. Decreased urine amylase
b. Increase blood (serum) amylase
c. Increased urine amylase
d. a and b
D
228
3. Indications for pancreas or combined kidney/pancreas transplant include which of the following complications of type 1 diabetes?
a. Hypoglycemic unawareness
b. End-stage renal disease
c. On insulin and C-peptide of = 2 ng/mL
D. All of the above
D
229
You are mentoring a new transplant coordinator. The most common causes of chronic kidney disease (CKD) include which of the following?
1. Hypertension
2. Congestive heart failure
3. Diabetes
4. Glomerulonephritis
a. 1,2,3
b. 2, 3,4
c. 1,3,4
d. All of the above
C. 1, 3, and 4, not congestive heart failure
230
Which of the following risk factors requires frequent re-evaluation for patients on the kidney wait list?
1. Females over 40
2. History of smoking 3 months ago
3. receiving dialysis for less than 2 years
4. high-density lipoprotein (HDL) of less than 35 mg/dL
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
C. Smoking 3 months ago and HDL less than 35
231
❖ A sibling is scheduled for a left donor nephrectomy. The healthy kidney will be transplant into his sister who is blood type B negative. You are the coordinator reviewing the final preoperative assessment. Which of the following donor findings would make it necessary to postpone the donation surgery?
1. Blood type is positive
2. BMI has increased from 25-31%
3. Urinalysis reveals microscopic hematuria
4. THC use is positive
3. In the absence of any specific abnormalities, microscopic hematuria could associate with hereditary kidney diseases.
232
A 21 year old female kidney underwent kidney transplant for polycystic kidney disease (PKD). On post-op day #2, your patient asked if she still had her not functioning kidney. You responded that her kidney was removed. With PKD, the removal of kidney can be done for the following reasons except for which statement?
1. Kidney had progressive cyst formation
2. Intractable pain
3. hematuria
4. infection
5. enlargement
6. patient preference
6. Patient preference is not a reason for kidney removal, all others are reasons why native kidney is removed for PKD
233
❖ When providing a new transplant coordinator education regarding early post- operative complications post kidney transplant, you discuss ATN during the immediate post operative phase. Donor factors that may affect the development ofATN in the newly transplanted kidney include which of the following?
1. Hypotension during the donor management phase
2. Cardiac or respiratory arrest
3. Ventilator-associated pneumonia
4. Fluid overload during donor management
a. 1 and 3
b. 1 and 2
c. 2 and 3
d. 3 and 4
B: Hypotension and Cardiac/Respiratory arrest
234
❖ A 21 year old female kidney recipient is 5 years post kidney transplant and is seen in your outpatient clinic. You take her blood pressure and it is 190/100 despite her taking her antihypertension medications. Her creatinine is 2.0. There is a bruit (whooshing sound as blood flows through a narrowed vessel) over the anastomosis. What is most likely this patient's diagnosis?
1. Ureteral obstruction
2. Renal artery stenosis
3. Lymphocele
4. Graft thrombosis
5. Urine Leak
6. Rejection
2- Renal artery Stenosis- Technical complications at the anastomosis, occurs months to years after transplant, uncontrolled hypertension, impaired renal function, bruit over anastomosis, will have angioplasty to dilate stenotic area or surgical repair
235
❖ A 21 year old female kidney recipient is 1 month post right iliac fossa kidney transplant and is seen in your outpatient clinic. She reports fever of 39 for the past 24 hours, decreased urine output and right leg swelling. Labs result with a BUN of 60 and creatinine of 2.1. What do you suspect?
1. Acute cellular rejection
2. Thrombophlebitis
3. Lymphocele
4. Antibody mediated rejection
3- Lymphocele- suspect fluid collection around the kidney, characterized by elevated creatinine, leg edema on same side of kidney transplant and fever
236
The transplant coordinator should anticipate which of the following in this patient. ATN present as renal failure after rejection and obstruction were ruled out. Signs and symptoms of ATN include which of the following?
1. Increased BUN and creatinine
2. Anuria or oliguria
3. Pulmonary edema
4. Elevated potassium and magnesium levels
5. Decreased weight
a. 1, 2, 3
b. 1, 2, 4
c. 1, 2 and 5
d. 1, 2, 3, and 4
e. all of the above
D- everything except for 5, you will gain weight
237
A 45 year old female kidney recipient is 1 month post kidney transplant and will be undergoing a renal biopsy. Prior to biopsy, which lab tests should you be ordering?
a. Platelet count
b. PT/INR
c. Hematocrit
d. a and b
e. a and c
f. all of the above
d. Check platelets and coagulation studies prior to biopsy- both have to do with bleeding. Don't want bleeding when doing biopsy
238
❖ A 40 year old kidney transplant recipient came to clinic with a 2 day history of low grade fever and fatigue. Labs resulted with a creatinine of 3.2. You arranged for a renal biopsy. The severity of cellular rejection based off the Banff updated 2017 system is determined by the degree of
1. proliferating B cells
2. circulating donor antibodies
3. tubulitis and arteritis
4. tubular atrophy
3. tubulitis and arteritis is T cell or cellular rejection
239
When teaching your transplant recipient about the kidney biopsy prior to the procedure, you provide them with the following information
a. after the procedure, they will be lying on the opposite side of the biopsy site
b. pressure will be applied to the biopsy site by having the patient lay on that side
c. urine will be monitored for new onset hematuria and presence of clots in the urine
d. a and c
e. b and c
e. Pressure will be applied to the site by laying on that side, in addition, urine monitored for blood
240
A 21 year old female kidney recipient that is 5 years post transplant comes to clinic emergently due to anuria (no urine output). A stat renal ultrasound confirmed renal vein thrombosis. The patient is taken to the operating room STAT for allograft nephrectomy. Which of the following should the transplant coordinator immediately anticipate?
1. Anticoagulation
2. UNOS listing for transplant
3. Need for dialysis
4. ineligibility for future living donor transplant
a. 1 and 3 only
b. 1 and 4 only
c. 2 and 3 only
d. 2 and 4 only
C. When renal venous thrombosis occurs, the kidney cannot be salvaged. The patient will be required to return to dialysis and retransplanted.
241
You are providing education to a 25-year old female kidney transplant recipient with chronic glomerulonephritis in your outpatient clinic. At clinic today, her height is 5 foot 1 inch and 225 pounds. What are you going to recommend for your patient?
A. Antibiotics
B. Referral to the dietician
C. A structured exercise plan
D. A behavioral modification plan
B. Referral to the dietician- the need modifications in their diet for salt, potassium and protein
242
You are caring for a 25-year old kidney transplant recipient who is at home with uncontrolled hypertension. After talking with your physician, the first test that you will be ordering on this patient is?
A. Renal biopsy
B. 24 hour urine collection
C. Nephrectomy
D. CXR
B- instruct patient to do a 24 hour urine, will look for protein in the urine, least invasive, next step would be biopsy if necessary
243
You are caring for a 25-year old heart transplant recipient who had renal insufficiency early post transplant. All of the following information is given to the referring physician about the recipient except:
A. Results of laboratory tests
B. Physical assessment of the recipient
C. Results of diagnostic studies
D. The donor's operative report
D. Everything is given to the referring provider except for the donor's op report.
244
1. Your patient is 10 years post kidney transplant. Clinical systemic symptoms that may develop with chronic kidney disease (CKD) include which of the following?
1. Amenorrhea, impotence
2. Pallor, pruritus
3. Hyperkalemia, acidosis
4. Muscle twitching, seizures
A. l, 3, 4
B. 1, 2, 3
C. All of the above
D. l and 3 only
C
245
2. In your discharge teaching, you would tell patients to report swelling in the lower extremities. 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. All of the above
E. B and C
```
E
246
3. You are caring for a 21- year old kidney transplant candidate. The following situations make finding a well-matched kidney more difficult:
a. previous transplants and pregnancy
b. transfusions
c. patient compliance
d. length of time on dialysis
e. a and b
f. a, b, c
g. all of the above
E
247
4. You are discharging 40- year old kidney transplant candidate from the med/surgical unit. You are providing discharge education regarding kidney allocation and wait list time. Priority when offering deceased donor kidneys is:
a. pediatric patients, longest waiting pts, highly sensitized patients
b. patients who are 0mm with donor, pediatric patients, longest waiting patients
c. highly sensitized patients, patients who are 0mm with donor, pediatric patients
C
248
5. In your teaching session with the patient and family, you would discuss HLA matching. Good HLA matching between donor and recipient is preferred for:
a. pediatric patients
b. first transplants for pediatric patients and adults not on dialysis
c. patients who have had prior transplants
d. patients who have waited a long time on the deceased donor list
e. A and B
f. A and D
E
249
6. You are educating your 35-year old patient and his family during his evaluation for a kidney transplant. Included in your teaching is the need for compliance with long-term follow-up to monitor kidney function. Your patient is concerned about how long his kidney is expected to work as this is his third kidney transplant. His most likely cause of renal disease would be:
a. Prune belly syndrome and hypertension
b. Focal segmental glomerulosclerosis and anemia
c. Polycystic kidney disease and Type II DM
d. Calcineurin toxicity and prostatic hypertrophy
B
250
7. You are reviewing medications with your kidney transplant patient who is 2-days post-transplant. His inpatient course has been uneventful and his kidney is functioning well and his creatinine is 2.0 mg/dL. He wants to know when he can return to his job as a trainer and continue his dietary and herbal supplements. One of his pre-transplant supplements was St. John's Wort which he took on a daily basis. You should explain that he should not take this because:
a. It will increase his anxiety and desire for sugar
b. It can contribute to the development of diabetes
c. It can decrease calcineurin levels
d. It can increase calcineurin levels
C
251
8. You are educating your potential kidney recipient during his evaluation. His kidney disease is secondary to membranoproliferative glomerulonephritis type 3 (MPGN3). You know that this disease can recur in the transplanted kidney. You explain that the following kidney donor options would be offered to him:
a. Only deceased donor kidney according to UNOS policy
b. Deceased donor or living donor kidney transplant according to the individual transplant center policy
c. Only living donor transplant according to UNOS policy
d. He is not eligible for a kidney transplant
B
252
9. Your patient who is waiting for a deceased donor kidney transplant called you and asked how long he would have to wait for a kidney as he has been listed for 3 years. You explain that there are a number of factors that influence how kidneys are allocated. The most important factors in determining kidney allocation are:
a. BMI, cPRA, and age of recipient
b. cPRA and EPTS of recipient and KDPI of donor
c. length of time on wait list, medical co-morbidities of
recipient and diabetes
d. recipient serum albumin and Karnofsky score
B
253
10. You are very excited to hear that your patient was transplanted with a deceased donor kidney. He is a 43-year old man with ESRD secondary HTN. He also has a history of Hepatitis C, anti-phospholipid syndrome and thrombocytopenia. On post-op day 2 you review his inpatient progress. His lab values indicate a creatinine of 11.6 mg/dL which is unchanged from the day before, potassium of 5.6 mmol/L, platelet count of 41K/ cu mm and Hgb of 8.0 g/aL. His urine output over the past 8 hours is 65 cc. His transplant ultrasound showed a slight increase in resistive index of the artery and a patent vein and slight per-nephric fluid. You expect the patient is experiencing:
a. Dehydration
b. Bleeding
c. Acute tubular necrosis
d. Acute rejection
C
254
You are caring for a 73-year old female patient who is 36 hours post-kidney transplant, has a systolic BP of 90-100 mm Hg over the past 2 hours. Urine output is 25cc/hr. Her only complaint is being very tired. Your initial assessment is that the patient may be:
a. Hypovolemic
b. Comfortable and pain free
c. Overly sedated
d. Stable with a satisfactory urine output
e. B and D
f. A, B and C
g. A and D
F
255
12. Health screening for patients being evaluated for a kidney transplant would include the following:
a. Pap smear, PSA, ECG and CXR
b. Troponin, CK, ESR and CA-125
c. Cystoscopy, Colposcopy, Colonoscopy and barium swallow
d. EGD, upper Gl, MRI, 6 minute walk
A
256
```
You are teaching the new coordinator about indications for pancreas or combined kidney/pancreas transplant. Indications for pancreas or combined kidney/pancreas transplant include which of following complications of type 1 diabetes?
A. Hypoglycemic unawareness
B. End-stage renal disease
C. On insulin and C-peptide of < 2mg/ml
D. Congestive Heart failure
E. a, b, and c only
F. All of the above
```
E. Hypoglycemic unawareness, End-stage renal disease, On insulin and C-peptide of < 2mg/ml
257
«
You are teaching the new coordinator about bladder drainage (BD). Approximately 20% of BD recipients undergo enteric, which is best described as:
A. Systemic-bladder drainage technique
B. Exocrine drainage through the urinary bladder
C. Damage to the organ during cold ischemia preservation
D. Movement of the duodenal segment from the bladder to the bowel
D- Movement of the duodenal segment from the bladder to the bowel
258
A 21 year old female pancreas recipient 3 months post transplant and comes to the emergency department with sudden severe abdominal pain over her graft site. Labs show blood glucose = 400, amylase = 500. A patient experiencing vascular thrombosis may present with which of the following symptoms
1. Elevated blood glucose
2. Elevated serum amylase level
3. Acute abdominal pain
4. Acute thrombosis of the hepatic artery
a. a. 2, 3, and 4
b. 1, 2, and 3
c. all of the above
B. High blood sugar, elevated amylase, and abdominal pain all signs of vascular thrombosis
259
A pancreas recipient presents to the emergency department 4 months post transplant with abdominal discomfort and a fever of 39.0 C. Diagnostic tests were done. CT scan reveals an intra-abdominal fluid collection, and a percutaneously aspirated culture was done which is positive for Candida. Which of the following complications should the transplant coordinator anticipate?
A. Acute tubular necrosis
B. Pancreatic allograft rejection
C. Urethral stenosis/obstruction with leak
D. intra-abdominal abscess
D- abscess- need IV antifungals
260
A pancreas recipient, 1 year post transplant, presents to the emergency department (ED) and is concerned she is in rejection. The ED has drawn laboratory studies. In a bladder-drained pancreas recipient, what are the signs of rejection?
```
A. Decreased urine amylase
B. Increased serum amylase
C. Increased urine amylase
D. A and b
E. B and c
```
D-decreased urine amylase and increase serum amylase are signs or rejection
261
1. The benefit of bladder drainage is that rejection episodes of the pancreas can be detected more readily by measuring which of the following in the urine?
```
A. Sodium and potassium
B. Solutes
C. Amylase
D. Glucose
E. All of the above
```
C
262
2. Bladder drainage of exocrine secretions may predispose the patient to which of the following complications?
```
A. Dehydration
B. Metabolic acidosis
C. Volume overload
D. Cystitis
E. A, B, D
```
E
263
3. Patients with an anastomotic leak may present with which of the following symptoms?
```
A. Sharp rise in blood glucose levels
B. Increase in white blood cells
C. Abdominal pain
D. Elevated serum creatinine
E. A and C
F. B, C, and D
```
F
264
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 handwashing techniques
E. All of the above
F. A and D only
```
E
265
❖
You are a transplant coordinator taking donor call for the heart transplant program. You receive an offer for your recipient: Based on the information below and discussing with your surgeon or medical director, why was this offer turned down for your recipient?
Recipient Donor
Height 185 cm Height 160 cm
Weight 125 kg Weight 78 kg
Age 19 years Age 50 years
Blood Type A Blood type 0
Waiting at home EF = 40%
Status 4 Troponin = 12.0
CVP = 19
1. The donor was too large
2. The recipient was too large
3. The heart function was marginal (EF)
4. This was an ABO incompatible transplant
5. The troponin was normal
6. The CVP was low
7. The donor was too old
2, 3, 7
266
Can you accept a heart from an infant where the mom is an IV drug user and breastfeeds the infant?
■Donor classified as meeting PHS increased risk criteria (breastfed infant whose mother has risk factors for HIV)
■ This puts recipient at risk for HIV and hepatitis C transmission.
■Answer: Yes, if you do the following:
• Must discuss the risk with recipient parents and infectious disease (ID) prior to organ acceptance. If, ID felt the transmission rate was extremely low and felt donor heart was still acceptable.
• Obtain consent and document in electronic health record
• Monitor recipient for HIV and HepC according to transplant center protocols per OPTN policy.
267
1. A 20- year- old liver candidate is notified of an organ offer from a donor identified as PHS increased risk. The patient:
A. Must be made aware of the donor's status at the time of the organ offer and prior to transplant
B. Must agree and consent to proceed with transplant prior to surgery
C. May refuse the increased- risk organ and will be automatically removed from the waitlist
D. May refuse the increased- risk organ and will be automatically made inactive on waitlist
E. a and b
F. a, b and c
G. a, b and d
E
268
2. According to PHS guidelines, which of the following donor groups is considered having increased risk?
A. persons who had nonmedical injection of drugs in the last 12 months
B. men who had sex with other men 10 years ago
C. persons who engaged in sex for money or drugs 10 years ago
D. men incarcerated 5 years ago
A
269
3. A local OPO forwards a letter in an envelope written by a donor family to the transplant coordinator with the request to forward it to the recipient. The coordinator should first:
A. call the OPO to request permission to open the letter.
B. remove all donor-identifying information in the letter.
C. return the letter to the OPO to be sent back to the donor family.
D. alert the recipient about the letter.
D
270
4. You are a coordinator taking donor call. You receive an organ offer for a 27-year old female kidney recipient on your waitlist. While talking to your patient who lives out of state ( 6 hours away), she notifies you that she has a fever, vomiting, and diarrhea for the past 3 days. You notify your transplant MD. What is your next step?
A. Notify the OPO and decline the offer
B. Call the next patient on the wait list
C. Notify the hospital and proceed with the transplant
D. Call patient to come into the hospital
A
271
5. A transplant center has been offered organs from a 50 year old donor. Medical history reveals cholecystectomy, metastatic prostate cancer 2 years ago, 30 pack/year smoking history, daily alcohol use and controlled hypertension x 10 years. Serologies resulted as EBV +, CMV +, HIV +. The donor should be refused on the absolute contraindications that includes:
A. CMV positive, HIV positive, and EBV positive
B. Metastatic cancer and HIV
C. History or hypertension, HIV positive and CMV positive
D. Metastatic cancer and EBV positive
B
272
6. A transplant center has been offered organs from a 30 year old donor. Medical history reveals migraines, seizures, IBS, bipolar and treatment for genital herpes within the last month. As a transplant coordinator, how would you proceed with this donor information?
A. Not considered PHS increased risk, would not need to disclose donor history to recipient
B. Considered PHS increased risk, would disclose bipolar and genital herpes to recipient
C. Considered PHS increased risk, would need to disclose complete medical history to recipient
D. Considered PHS increased risk, would need to disclose genital herpes to recipient
D
273
7. The role of the transplant coordinator includes arranging preoperative procedures and tasks for the recipient which include all of the following except:
A. Arranging necessary diagnostic studies
B. Ordering appropriate laboratory studies
C. Obtaining consent for transplant procedure
D. Arranging plasmapheresis if necessary
E. Ordering appropriate medications
C
274
8. Successful patient and family education design principles include which of the following:
A. a single approach convenient for the transplant team
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 and b
F. b and d
G. All of the above
F
275
9. The transplant coordinator received an organ offer and reviewed with the surgeon. Decision was made by surgeon to accept the liver. You call your listed candidate at home (who lives out of state) that you have accepted an organ. He informs you he is sick with fever and Gl symptoms. After notifying your transplant surgeon, what is your first step?
A. Notify the OPO that you are accepting the liver, it is okay to have a fever
B. Call in next patient on wait list as next patient will be coming up soon
C. Notify OPO that you are not taking liver for this patient
D. Call in your patient with fever and treat illness
C
276
10. The transplant coordinator was invited to educate on transplant candidacy to ICU nurses at a large donor hospital. You would include all the information in your education except?
A. Psychosocial issues
B. Deceased donor management
C. Side effects of Immunosuppression
D. Consent form for the donor family
D
277
As a coordinator, you participate in research studies in your department and are completing your online training. In the US, institutional approval by the IRB of a research study must be completed before the:
A. Study is published
B. Study is implemented
C. Data are analyzed
D. Study is presented at a professional conference
D
278
Heath Insurance Portability and Accountability Act (HIPAA) enforces standards for health information. Protected health information includes information about:
A. An individual's past, present, or future physical or mental health
B. Any health care that has been provided to an individual
C. The past, present, or future payment for an individual's health care
D. De-identified information
E. All of the above
F. A, B, and C
F
279
« The American Board for Transplant Certification (ABTC) provides certification for which of the following practice areas:
1. Certified Procurement Transplant Coordinator (CPTC)
2. Certified Transplant Nurse Coordinator (CCTC)
3. Certified Clinical Transplant Nurse (CCTN)
4. Certified Transplant Perfusionist Coordinator (CTPC)
5. Certified Transplant Preservationists (CTP)
A. 1,2,3, and 4
B. 1,2, 3, and 5
C. All of the above
B
280
A psychosocial evaluation should include questions pertaining to the patient's history of psychiatric disturbances. This should include problems such as which of the following?
```
A. Serious sleep disorders
B. Suicide attempts
C. History of hospitalizations for mental health reasons
D. Panic attacks
E. Financial ability to pay for services
F. All of the above
G. B, C, and D only
H. A, B, C, and D only
```
F
281
The social worker and psychologist do an extensive evaluation on the transplant candidate. The ultimate goals of the psychosocial evaluation are which of the following:
A. Provide education to the patient on pain management related to post-transplant care
B. Provide the transplant team with information on the candidate's support system
C. Find them a job post transplant
D. Identify potential compliance issues
E. All of the above
F. B and D
F
282
A 45 year old male is in the process of a heart transplant evaluation. Once the social worker has assessed the candidate for transplant, the determination may be made for referral to which of the following services:
```
A. Chemical dependency consult
B. Neuropsychiatry
C. Endocrinology
D. Cardiac surgery
E. All of the above
F. A and B
```
F
283
You are providing education to a liver transplant candidate and their family. While awaiting transplantation, patients have reported concerns about which of the following?
A. Becoming a burden to friends and family
B. Financial issues
C. Dying while awaiting a suitable donor organ
D. Becoming too well and not needing transplant
E. All of the above
F. A, B and C
F
284
Family burden may increase as the patient's health deteriorates while awaiting a suitable organ for transplantation. Spouses may experience which of the following during the waiting period?
A. Anxiety related to separation from the individual hospitalized while awaiting transplantation
B. A need to return to work to support the family
C. Difficulty coping with added responsibilities that were once shared
D. Too much support and available resources
E. All of the above
F. A, B, and C only
F
285
Heart transplant candidates may often be hospitalized while awaiting a suitable donor heart. Social workers and nurses help to create a supportive environment with interventions such as which of the following?
A. Educational programs for patients and families
B. Support groups with other patients awaiting transplantation
C. Weekly dinners together with other patients on the unit
D. Weekly excursions to the shopping mall with IV inotropes
E. A, B and C only
E
286
Patients who are hospitalized for several months pre-and posttransplant may experience which of the following upon discharge from the hospital?
A. Heightened anxiety about leaving the hospital environment
B. Insecurity related to fear of complications
C. Fear about changes in personal relationships with family members during the extended absence
D. Role confusion
E. Excitement of a new life will overcome all fears
F. All of the above
G. A, B, C and D only
G
287
You are a kidney pre-transplant coordinator at your program. Due to budget cuts, your
manager has asked you to also be the Independent Living Donor Advocate (ILDA) for one of your listed patients. From what you know about the responsibilities of ILDA, what is your best response?
1. Yes, I would love to be the ILDA. Anything for the program.
2. Yes, I would love to be the ILDA, however, I can no longer be a pre-transplant coordinator.
3. Sorry, not at this time. An ILDA does not allow me to do transplant activities in addition to the role of ILDA.
4. No. I cannot. I must wait one full year between switching between transplant coordinator and ILDA.
5. Yes, I would love too and will do both as I am a super coordinator.
3. ILDA's cannot be involved in transplant activities.. The ILDA cannot be a pre-kidney coordinator and an ILDA at the same time.
288
You are caring for a 25 year old patient who has 2 siblings that are undergoing testing
to be potential donors. The mother of your patient calls for the test results as she is so
excited for her children. Who will be informed first about the potential donor test results?
1. The recipient
2. The mother
3. Sibling #1
4. All family members at the same time
5. Sibling #2
6. Each sibling individually when the test results come in
6. Potential donor must be updated first with information, not mother or recipient.
Each sibling separately. Can't update mom due to HIPPA violation and cannot give her any information on the phone no matter how excited she is ©
289
A 20 male is POD #2 from living donor liver transplant. Living donation is not without risk. Which of the following severe complications have been reported in living liver donors?
1. Liver failure resulting in a donor needing a liver transplant
2. Death of the donor
3. Renal failure resulting in kidney transplant
4. Wound dehiscence
5. Cardiac failure leading to heart transplant
6. Pulmonary emboli
a. 1, 2 and 3 only
b. 1, 2, 4 and 6 only
c. 1, 2, and 5 only
d. all of the above
b. As per previous slides. Complications include possible re-transplant, death, wound dehiscence, and pulmonary emboli
290
1. You are providing teaching for a 28-year old potential living kidney donor. You are explaining the surgical technique. An open nephrectomy for living kidney donors using a retroperitoneal approach rarely includes removal of which of the following?
a. Appendix
b. Gallbladder
c. Portion of a rib
d. a and b
C
291
2. You are providing teaching for a 50-year old potential living liver donor. You are explaining the complications to the surgery. Which of the following symptoms may indicate a bile leak in a living liver donor?
a. Severe abdominal pain
b. Diarrhea
c. Referred pain to the shoulder
d. a and b
e. a and c
E
292
3. You are providing teaching to the parents of a 3-year undergoing a liver
transplant. Dad will be the donor. You are explaining the surgical aspects of the case. For living liver donation in pediatric transplantation, which of the following lobes will be used?
a. Right lateral segment
b. Right frontal segment
c. Left lateral segment
d. Left posterior segment
C
293
4. Immediately prior to surgery, an apprehensive living donor expresses concerns about proceeding with donation. How should the coordinator respond?
A. "I will be with you, so you will be fine/'
B. "You are under no obligation to complete the donation at this time."
C. "You have already signed the consent and the recipient is already in surgery."
D. "There is nothing to worry about. Your family will be waiting for you after surgery."
B
294
5. The transplant recipient is financially responsible for everything except ?
a. Medications
b. Research Studies
c. Donor charges
d. UNOS charges
B
295
An important part of the donor evaluation includes all of the following except?
a. Assessment of competence
b. Assessment of immunological compatibility
c. Assessment of medical history
d. Assessment of financial ability of pay for surgery
e. Assessment of infectious disease screening
f. Assessment of organ specific testing
g. Assessment of age appropriate cancer screening
D
296
7. The role of the living donor advocate includes determining that a live donor is:?
1. Mentally competent and is willing to donate
2. Has received payment for the organ prior to surgery
3. Medically and psychosocially suitable
4. Fully informed of the risk, benefits and alternative treatments available to the recipient
a. 1, 2 and 3 only
b. 1, 3, and 4 only
c. 2, 3, and 4 only
d. all of the above
B
297
A 20 year old transplant candidate is waiting on heart transplant list. He is on a Heartware device (a full-support, durable ventricular assist device (VAD) that is being used as a bridge to transplant). You are the coordinator calling back labs on this patient. This candidate is on Coumadin for anticoagulation and his INR is 1.1. Based on this result, which of the follow should the coordinator immediately anticipate:
1. No action- INR is normal
2. Hold Coumadin- INR is elevated and repeat level tomorrow
3. Increase Coumadin - INR is low, normal INR is 2.0-3.5 and recheck level in next 3-5 days until therapeutic
4. Increase Coumadin- INR is low, normal INR is 2-3.5 and recheck level in next 1-2 weeks until therapeutic
Answer #3- Recheck in 3-5 days. You need this level to be therapeutic between 2-3.5. If the INR is too low you are at risk for clot. If the INR is too high, you could experience bleeding.
298
You are training a new coordinator at your institution. It is important for the coordinator to know the purpose for evaluating candidates of solid organ transplant includes which of the following:
A. To determine if there are other options for managing the current disease
B. To determine if there are comorbidities contraindicated for transplantation
C. To evaluate the patients' ability to comply with long-term follow-up requirements
D. All of the above
E. A and B only
D
299
«Patient and family education on transplantation begins with the first interaction with a nurse (phone or in person). Patients and families need to learn about the transplant process early in the evaluation phase to provide them with tools for all of the follow except:
A. Making informed decisions
B. Process for contacting donor family after transplant
C. Information to share with school or work
D. Donor information when organ becomes available (demographics, location, etc)
D is a hippa violation- cannot disclose
300
Transplant Coordinator education during the evaluation phase should include information about transplantation including all of the following except:
A. Results of physical exam, labs and tests
B. Determining best option based on evaluation, surgical risks and potential complications
C. Suitability for transplant
D. Relevance of psychosocial issues
E. Expected survival rates
B is determined by surgeon, not by coordinator
301
In your teaching with patients prior to transplantation, the candidate should receive information about the following except:
A. Signs and symptoms of rejection and infection
B. Wound care management
C. Activity limitations
D. Return to work
E. Writing a letter to the donor with your name, transplant center and surgeon
E no specifics can be given about yourself, your hospital or surgeon
302
Prior to initiating educational sessions for a patient, the nurse first assesses:
A. Patient physical therapy schedule
B. Patient learning style
C. Date of hospital discharge
D. Insurance
B
303
You are training a new transplant coordinator and will be drawing transplant labs on a new patient for evaluation. One of the labs includes a Panel Reactive Antibody (PRA). As you are explaining the PRA, you would include everything except:
A. This can determine the likelihood of developing acute and/or chronic rejection following transplant
B. The PRA must be zero to proceed with transplant
C. Serum of prospective recipient is tested against a panel of lymphocytes for presence of circulating antibodies reactive against HLA antigens
D. The higher the PRA, the higher the sensitization and more difficult it can be to find a donor match
B PRA does not need to be zero to proceed with transplant. Crossmatch much be zero for transplant.
304
You are educating a lung transplant candidate. In reviewing the potential medical risks of transplant with the patient and their family, you should discuss all of the following except:
A. Wound infection
B. Blood clot formation
C. Organ rejection, failure, or re-transplant
D. Lifetime immunosuppression medications
E. Death
F. Multi-organ failure
G. Anesthesia medications and IV access
G coordinator's role in not to review Anesthesia medications and IV access on day of surgery. This will be done by the anesthesiologist. Role of coordinator is to educate on surgical wound, possible blood clot, rejection, organ failure, retransplant, immunosuppression, multisystem organ failure and possible death post transplant, (core curriculum page 57).
305
The transplant coordinator is responsible for reviewing risk factors that could affect the success of the graft and the health of the patient. This also includes the health status of the donor organ. The transplant coordinator should inform the candidate that risk of disease transmission could include all except:
```
A. Human immunodeficiency virus
B. Hepatitis B virus
C. Hepatitis C virus
D. Cryptosporidium
E. Cancer
F. Malaria
```
D Cryptosporidium is not a donor risk disease transmission, all the others are considered. Disease may not be detectable at time of donor recovery.
After an organ offer is made, transplant program discusses with patient the possible risks associated with transplant ofthat
specific organ. The discussion of risks should include any issues ofthat organ including increased risk due to behaviors in donor's background. Patient has the right to refuse transplant or withdraw consent (core curriculum page 58).
306
You are providing education for a 45 year- old lung transplant candidate who is undergoing a transplant evaluation. He is asking about coverage regarding medications post transplant. Which of the following is a true statement:
A. His private insurance will pay for his medications post transplant
B. Medicare part B covers 80% of immunosuppression post transplant
C. Medicare part B covers 100% of immunosuppression post transplant
D. Medicare part C covers 100% of immunosuppression post transplant
B per medicare guidelines
307
❖ You are providing discharge education to a transplant recipient that is legally blind. He suffers from hand tremors from increased tacrolimus levels. He has received no formal special needs training. Which of the following should the transplant coordinator do to ensure long-term medication adherence?
1. consult ophthalmology for an evaluation
2. contact adult protective services to monitor home situation
3. teach family member or friend the medication administration regimen
4. initiate nursing home placement
3. Teach a family member or friend the medication administration regimen. The lack of family or friends to provide assistance or support is a specific predictor of nonadherence.
308
❖ You are providing education to a recipient and her husband regarding the common side effects of azathioprine. She has been on the medication for 10 years and you are providing a refresher as she is having some side effects. The transplant coordinator should explain that azathioprine may cause:
1. thrombocytopenia
2. hemorrhagic cystitis
3. paraesthesias
4. tremors
1. Thrombocytopenia (low platelets), petechial, nose bleeds, etc...You can also have decreased WBCs low RBCs all related to bone marrow suppression, nausea, hair loss and pancreatitis.
309
«
❖ You are a liver transplant coordinator. Your patient is a 45 year old liver recipient that is 1 year post liver transplant. He had a negative colonoscopy 2 years prior totransplant. He father had color cancer at age 55. Curing your post transplant clinic
visit, the need for colorectal screening is discussed. This recipient will require:
1. Annual fecal occult blood tests only
2. A annual flexible sigmoidoscopy after the age of 50
3. a colonoscopy every 5 years after age 50
4. more frequent screening since he is at higher risk
4. Risk of colorectal cancer is increased in people with a family history of colorectal cancer in 1st degree relatives. Risk is increased in immunosuppressed people.
310
Four years post-heart transplant, a recipient with know coronary artery disease (CAV) calls with sudden onset of shortness of breath, nausea, diaphoresis and fatigue. Vital signs are: BP 160/94, HR 100, Temp: 36.8.
The transplant coordinator should anticipate which of the following diagnostic procedures to be performed?
a. Chest CT
b. Echocardiogram
c. Right heart catheterization
d. Right and left heart catheterization
e. V/Qscan
d. Right and left heart catheterization- right heart cath is the hemodynamics (pressures), and left heart will be looking at the coronaries.
311
You are entering data on a 1 year follow-up TIEDI recipient form. What information is required on all follow-up forms across any organ?
a. graft status, incidence of malignancy, and zip code
b. non-compliance, home address, and weight
c. rejection, EBV status, hospitalizations
d. immunosuppression medications, primary insurance, referring physician
a. Graft status, incidence of malignancy, and zip code are required on all Tiedi follow-up forms for all organs and ages. Home address, EBV status, and referring physician are not required information on the forms.
312
You a post transplant kidney coordinator taking care of a 50 year old woman 10 years post kidney ant. A bone density scan (DEXA) scan should be obtained on all post-menopausal women with:
1. coronary disease
2. chronic steroid use
3. hyperlipidemia
4. systemic hypertension
5. chronic use of Lasix and diuril
a. 1,2, and 4 only
b. 2 and 5 only
c. 2,3, and 4 only
d. all of the above
b. Steroids and chronic diuretics would be reason for dexa scan, reduce bone formation and Increase resorption leading to osteoporosis
313
A transplant recipient with a creatinine clearance of 48ml/min has a DEXA scan. The results are T score of -1.7 in the lumbar spine and -2.57 in the hip. The transplant coordinator should conclude that this recipient has:
a. osteoporosis of the hip and osteopenia of the spine, but bisphosphonate therapy should not be initiated
b. normal bone mineral density and should take calcium supplement
c. normal bone mineral density and no further action is needed at this time
d. osteoporosis of the hip and osteopenia of the spine and should be receiving bisphosphonate therapy
D. Osteopenia is classified as a bone mineral density between 1 standard deviation and 2.5 standard deviation between the mean bone mineral density of an adult woman. Osteoporosis is classified as a bone mineral density greater than 2.5 SD below the mean bone mineral density of an adult woman.
314
1. The most common cardiovascular complication across all types of solid organ transplantation Is:
a. Coronary artery disease
b. Peripheral vascular disease
c. Myocardial infarction
d. Hypertension
D
315
2. You are mentoring a new transplant coordinator and are teaching her about kidney disease. Clinical manifestations of renal insufficiency include:
1. Increased serum potassium level
2. Decreased serum potassium level
3. Increased serum creatinine
4. Decreased serum creatinine
5. Increased sodium excretion
6. Decreased sodium excretion
a. 2, 4, and 5
b. 1, 3, and 6
c. 1, 3, and 5
d. 1, 4, and 5
B
316
3. An adult male received a kidney transplant six months ago. He is at risk for post-transplant diabetes mellitus
because he has the following:
1. History of steroid-treated rejection
2. Recipient < 45 years of age
3. Recipient > 45 years of age
4. Recipient of Caucasian and Asian ethnicity
5. Recipient of African-American and Hispanic ethnicity
a. 1, 2, and 5
b. 1, 2, and 4
c. 1. 3, and 5
d. 2, 4. and 5
C
317
4. A 52-year-old lung transplant recipient was just diagnosed with the most common malignancy In solid organ transplant recipients. She was diagnosed with what type of cancer?
a. Lung
b. Skin
c. Colon
d. Bladder
B
318
5. A 56-year-old male transplant recipient is admitted to the hospital for worsening heart failure. Of the following types of antihypertensive medications, which type is most likely to affect cyclosporine or tacrolimus levels:
a. ß-blockers
b. Calcium channel blockers
C. Angiotensin-converting enzyme inhibitors
D. Alpha-adrenergic receptor blockers
B
319
6. Which of the following medications are typically associated with the development of gingival hyperplasia?
1. Cyclosporine
2. Diuretics
3. Anticonvulsants
4. Antihyperlipidemic agents
5. Calcium channel blockers
a. 1, 3, and 5
b. Î, 4, and 5
c. 2, 3, and 4
d. 1, 2, and 5
A
320
You are providing education to a 45-year old kidney transplant recipient who is 5 years post transplant. You just scheduled this patient for a DEXA scan. You begin by explaining that this test in non-invasive and measures bone mineral density to assess if a person is at risk of osteoporosis or fracture. In addition, which of the following is TRUE about this test:
a. an IV is required
b. The patient needs to be off steroids prior to the scan
c. Calcium should be taken prior to the scan
d. The amount of radiation is low
D
321
8. Patients should be aware of potential complications in the immediate post- transplant period. Complications that should be discussed with patients prior to surgery include:
A. Possible need for dialysis for kidney recipients
B. Potential prolonged ventilation for patients following heart or lung transplantation
C. Bleeding and the need to return for corrective surgery following transplantation
D. Osteoporosis
E. A, B, and C only
F. A, B, C, and D
E
322
9. You are completing teaching with a 25 year old lung transplant recipient about immediate post-operative routines. Your education should include which of the following:
A. Need for coughing, deep breathing and leg exercises
B. Importance of immunosuppression medications
C. Which venipuncture site will be used for each IV
D. All of the above
A
323
A 30-year-old male completed his outpatient heart transplant evaluation. It was
determined he was not a candidate for transplant due to noncompliance with
cardiac medications, doctor appointments and substance abuse. You had a long
discussion with him and his family. Your next initial step will be to:
1. Sign him up for an outpatient drug treatment program
2. Send him a letter along with the referring provider within 10 days that
states he is not a transplant candidate and the reason
3. Schedule him for a follow-up appointment in cardiology
4. Reschedule another evaluation in 3 months to reassess compliance
2- initial step is to send out letter that he is not a candidate within 10 days- this is a UNOS policy. The remainder can be done after.
324
❖ A 20-year-old transplant candidate is waiting on heart transplant list. He has moved from Minnesota to Wisconsin and remains active on the Minnesota transplant list. He has contacted your center and would like to be evaluated. How should the transplant coordinator first respond?
1. Per UNOS policy, transplant programs do not accept candidates with multiple registrations or wait time transfer
2. Obtain the transplant candidates insurance information to see if program accepts patient's insurance
3. Transplant coordinator should review Wisconsin's transplant program multiple registration/wait time transfer policy to see if candidate can transition.
4. Evaluate the patient first, once patient is a suitable candidate, will make decision regarding wait time transfer or multiple registrations.
2. Need to obtain insurance approval first. Once obtained, then it will be # 3. Review your program's policy regarding wait time transfer and if there will be multiple registrations.
325
A 35-year-old male heart transplant candidate is currently listed status 1 on the
wait list, and is now in multisystem organ failure in the CICU. In reviewing the
UNOS policy, the transplant coordinator knows all of the following are appropriate
except:
1. If the patient is unsuitable for transplant, inactivate candidate so patient
will not receive organ offers (status 7)
2. Keep patient status 1 so patient continues to receive offers and
accumulates time on list in case he recovers
3. Document change in status in electronic health record
4. Change in status should be made and documented within 24 hours of the change in medical condition
Answer is 2- patient cannot continue to be listed as status 1, needs to be inactivated within 24 hours of the change in medical status, as not accepting offers on patient.
326
1. You are training a new coordinator within your program and describing roles and responsibilities
for this position. A transplant coordinator is responsible for which of the following:
A. ensuring that patients have insurance
B. referring patient to the financial coordinator
C. negotiating contacts with insurance companies
D. educating patients on insurance companies
B
327
2. A 56-year old male heart transplant candidate. Which of the following data are required on the Listing Candidate Registration TIEDI form?
A. Ethnicity, Incidence of malignancy, and address
B. Ethnicity, citizenship, and functional status
C. Functional status, incidence of malignancy, and medications
D. Primary diagnosis, insurance and referring physician
B
328
3. The multidisciplinary team just met to review a 21- year old potential candidate for lung transplant. The team determined he was not a candidate due to nonadherence due to smoking. Who should be notified 1st after a patient has been turned down for transplant due to nonadherence?
A. dialysis staff
B. social worker
C. referring provider
D. patient's family
C
329
A 20-year old male kidney transplant candidate. Which of the following data are required on the Listing Candidate Registration TIEDI form?
A. Home address, state, and zip code
B. Citizenship, insurance, and functional status
C. Rejection episodes, cognitive, and motor development
D. Academic, insurance and immunosuppression
B
330
5. A 40 year old liver transplant candidate was removed from the waitlist as he was no longer a candidate. You will be notifying the patient in writing that they were removed from the waitlist. Removing a patient (except for death or transplant) from the waitlist according to UNOS policy requires all of the following except?
A. OPTN Contractor's Patient Information Letter
B. Letter sent within 7 days
C. Reason candidate was removed in letter
D. Information about other center(s) where candidate may seek second opinion
E. Local provider must be copied on removal letter
B
331
6. You have completed your teaching and reviewed all the listing paperwork with a 30-year old male liver transplant candidate. The candidate says he will read the material when he gets home, sign, and bring back to the hospital in the next few days. As a coordinator, you find this concerning. Your next step will be to:
A. Consider the candidate to be illiterate and provide another teaching session
B. Contact the social worker
C. Put a referral into psychology
D. Contact the patient's PCP
B
332
A 30 year old female needs to be listed for heart and liver transplant. The heart transplant coordinator is meeting the patient for the first time for a heart transplant evaluation. How should the coordinator proceed?
1. The patient must be evaluated by each team separately (liver and heart teams)
2. The heart coordinator can do both evaluations to save time for the patient
3. The patient will be registered on each waitlist separately for each organ
4. When a donor organ becomes available, organ offer will appear on at least one of the match runs or the required organs
5. Priority is given to multi-organ candidates
A. 1,3,4 and 5 only
B. 1,2,3 and 5 only
C. 2,3,4 and 5 only
D. 1,2 and 5 only
A
333
10. Tests most commonly used to evaluate potential heart candidates include which of the following?
a. MUGA or ECHO to determine ejection fraction
b. MVOj to determine functional capacity
c. left heart catheterization to determine pulmonary pressures
d. Right heart catheterization to determine pulmonary pressures
e. a, b, and c
f. a, b, and d
F
334
9. High-risk kidney transplant candidates include which of the following?
a. Those of advanced age
b. Obese individuals
c. Patients with diabetes as a comorbidity
d. Patients with coronary disease
e. b and e only
F. All of the above
F
335
8. The Lung Allocation Score requires updates every 6 months on which of the following tests:
a. Forced viral capacity (FVC)
b. Serum creatinine
c. 6-minute walk
d. a and c only
e. All of the above
E
336
7. Patients referred for transplantation are evaluated by a social worker and/or psychologist in order to:
a. Assess the patient's ability to give informed consent.
b. Assess the patient's social support network.
c. Determine if the patient likes the transplant team.
d. Determine if the patient has the money to pay for a transplant.
e. a and b only
E
337
6. Simultaneous liver/kidney transplantation is indicated if the patient has the following:
A. End stage renal disease (acute HRS excluded) with cirrhosis
B. Liver failure with chronic kindey disease and GFR < 30mL/min and acute kidney injury or HRS with Creat >/= 2.0 mg/mL
C. Dialysis for >8 weeks or liver failure with CKD and renal biopsy demonstrating >30% glomerulosclerosis or >30% fibrosis
D. a and b only
E. all of the above
E
338
5. A ventilation/perfusion (V/Q) scan is ordered for patients being considered for lung transplantation to determine
a. The lung with the best ventilation and perfusion.
b. A mismatch between ventilation and perfusion.
c. Which lung to replace.
d. The difference in lung function between right and left lungs.
e. b and c only
f. all of the above
E
339
HIV testing is done by enzyme immunoassay at many centers. Equivocal or positive results are confirmed by which of the following methods?
a. Enzyme-linked immunosorbent assay (ELISA)
b. Complement-dependent cytotoxic assay
c. flow cytometry
d. Western blot
D
340
There are no surgical alternatives other than lung transplantation for which of the following diseases?
```
a. Pulmonary hypertension
b Cystic fibrosis
c Pulmonary fibrosis
d Emphysema
e. a, b. and c only
f. all of the above
```
E
341
1. The purpose for evaluating patients for solid organ transplantation includes which of the
following?
a. To determine if there are other options for managing the current disease
b. To determine if there are comorbidities that would contraindicate transplantation
c. To evaluate the patient's ability to comply with long-term posttransplant follow up requirements
d. a and b only
e. All of the above
E
342
2. Most patients will have an intradermal skin lest for tuberculosis. However, some patients
may be anergic due to the severity of their illness. In such cases, the patients will have controls
placed. The two most commonly used skin test controls are.
a. Bacillus Calmette-Guerin (BCG) and human T-lymphotrophic virus 1
b. Candida and mumps.
c- Measles and influenza,
d- Mumps and BCG.
B
343
3. 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 and b only.
e. all of the above.
E
344
3. The transplant nurse is planning an educational session with a liver transplant candidate
and reviews the medical record. The patient is a 44-year-old male with hepatitis C. His
medication list includes lactulose. He completed 9th grade and has worked in a factory until
3 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 and b.
f. a and c.
g. all of the above.
F
345
3. 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 and b
F. B and d
g. all of the above
F
346
2. A patient who is preparing for discharge after his first liver transplant. The transplant coordinator provides education about which of the following health maintenance activities to monitor side effects of medications?
a. Daily blood pressure monitoring.
b. Daily weight monitoring.
c. Completing Bloodwork as instructed.
d. Increase physical activity daily.
e. a and b only.
f. d only.
g. a. b, and c.
G
347
1. 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's status at the time of the organ or prior to transplant.
b. must agree/Consent to proceed with transplantation prior to the surgery.
c. may refuse the organ and be automatically removed from the candidate waitlist.
d. a and b.
e. all of the above.
D
348
6. When teaching the posttransplant patient about immunosuppression 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 if prescribed by the patient's primary care doctor.
d. some foods and medications may change the metabolism of immunosuppressant drugs.
B
349
7. While interviewing a patient who was discharged after his heart transplant last week, he describes his pain as a level 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 over time.
b. advise him to take a warm shower to relieve the pain.
c. suggest that he take pain medication at least I hour before beginning ADLs.
d. review his medication list to re-educate him about which medicines alleviate pain.
C
350
8. Psychological effects related to transplantation include ail 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
351
9. 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
352
10. Patients and caregivers need instruction about invasive monitoring in the post operative period. Education should include
```
a. invasive intravenous lines
b ventilator
c. postoperative drains (chest tubes. jPs. etc.),
d. foley catheter and NG tube.
e. all of the above
```
E
353
1. An important part of the donor evaluation includes all of the following EXCEPT:
a. assessment of immunological compatibility-
b. assessment of competence.
c. assessment of financial ability to pay for surgery.
d. assessment of medical history.
C
354
1. An important part of the LD consent process is.
1. understanding the risks of the surgery.
2. disclosure that it is a federal crime to be paid for donation
3. disclosure of the recipient patient and graft survival at the transplant program
4. ensuring the confidentiality of the process
a. 1,2, and 3
b. 1, 2, and 4
c. 2, 3, and 4
d. All of the above
D
355
3. Which of the following may be a sign of a bile leak in a liver donor
1. Black stools
2. Right shoulder pain
3. Left lower quadrant pain
4. Disorientation
a. 1 and 3
b. 3 and 4
c. 2 only
d. All of the above
C
356
4. Which of the following patients may be at increased risk for ESRD post kidney donation?
1. African American male
2. Caucasian male with a history of inguinal hernia
3. Female with a body mass index of 36
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. All of the above
B
357
5. Which of the following severe complications have been reported in living liver donors?
1. Liver failure resulting in a donor needing a liver transplant
2. Death of the donor
3. Pulmonary emboli
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. All of the above
D
358
For living liver donation in pediatric transplantation, which of the following lobes is used?
a. Right lateral segment
b. Right frontal segment
c. Left lateral segment
d. Left posterior segment
C
359
9. Upon discharge, the nurse should ensure the donor has been given instructions on:
a. wound care.
b. diet information.
c. information on when to call the transplant team.
d. all of the above.
D
360
8. The role of the living donor advocate includes determining that a live donor is:
1. mentally competent and willing to donate.
2. free from coercion.
3. medically and psychosocially suitable
4. fully informed of the risks and benefits as a donor.
5. fully informed of the risks, benefits, and alternative treatment available to the recipient.
a. 1, 2, and 3
b. 1, 2, 3, and 4
c. 1, 2, 3, and 5
d. All of the above
D
361
Which of .he following can be a complication of kidney donation?
1. Bleeding
2. Ileus
3. Deep vein thrombosis
a. l and 2
b. 2 and 3
c. 1 and 3
d. All of the above
D
362
The donor and recipient operations are undertaken on the same day at similar times in parallel operating rooms staffed by two full teams of OR personnel. This is done for which of the following reasons?
1. Convenience of family and staff
2. Ensure there are no unforeseen problems with the recipient that prevent transplant.
3. Minimize warm ischemic time
4. Minimize cold ischemic time
a. 1 and 2
b. 2 and 3
c. 3 and 4
d. 2 and 4
D
363
10. Transplant nurses at the bedside should have no voice in unit decisions
True
False
False
364
9. The goals of clinical ethics are to
1. facilitate decision making that focuses on the patient.
2. promote collaboration with all relevant professionals
3. alliance organizational commitment and cooperation such that all involved parties
develop and implement plans in support of the patient.
a. I and 2
b. 2 and 3
c. I and 3
d. 1, 2. and 3
D
365
.Informed content it defined at obtaining the patient » signature on the consent form.
a. True
b. False
False
366
7. When transplant nurses discuss a procedure or a resarch study with a pt/family and provide information in a way that the patient family understand and give them enough information to make an informed citation, they are practicing the principle of
a. autonomy
b. beneficence.
c. justice.
d. beneficence and lattice
A
367
• Novice transplant nurses can improve the quality of care by:
a. becoming familiar with their patients' preferred learning styles.
b. leading a conference on leadership and its impact on nursing
c knowing the unit ! goals and how the care they provide impacts those goals
d. a and c.
e. b and c.
D
368
5. Environmental health and safety is defined as all the physical, chemical, and biological factors external to a person and all the related factors impacting behaviors
a- True
b. False
A
369
4. Collegiality is important for (choose all that apply):
1. Interprofessional team work
2. Quality and safety in practice
3. Mentoring
4. Giving and receiving feedback
5. Maintaining professional standards
a. 1.3. and 4
b. 2. 3. and 5
c . 1.4. and 5
d. all of the above
D
370
. Novice transplant nurses typically lead unit performance improvement meetings, identify
outcomes for improvement analyze data, and make recommendations for action and
sharing findings across the organization through facility-wide programs
»a. True
b. false
B
371
; Which of the following guide transplant nursing evaluation
1. Scope and standards of nursing
2. American Nurses Association. Guide to the COde of Ethics for Nurses
3. Scope and Standards of Transplant Nursing Practice
4. Core Competencies for Transplant Nursing
a. I and 2
b I and 3
c. 3 and 4
d All of the above
D
372
Certification to available for which of the following practice areas?
1. Procurement Coordinator
2. Transplant Nurse Coordinator
3. Clinical Transplant Nurse
4. Transplant Preservationist
a |. 2. and 3
b 1.3. and 4
c. 2. 3. and 4
d All of the above
D
373
1. Signs of rejection following pediatric kidney transplant include which of the following symptoms?
a. Increased heart rate jaundice and SOB
b. HTN, pain over graft site and hematuria
c. Proteinuria and increase in weight
d. b and C
e. All of the above
D
374
2. You are assigned to care for a 12-year-old recipient of a renal transplant that look place 4 days ago. In evaluating your patient's laboratory work results you note that the serum creatinine today is 3.4 but was recorded as 1.8. 2 .0. and 2.1 on previous days. Which of the following tests would be most important today to evaluate for rejection?
a. Urine for electrolytes
b. Renal ultrasound
c. Spiral CT scan
d. Renal biopsy
e. Urine culture for RK viral inclusion cells
D
375
10. Posttransplant lymphoproliferative disorder (PTLD) is most commonly diagnosed in
children following thoracic transplants. Risk factors for the development of PTLD include
which of the following?
a. Young age at the time of transplantation,
b Higher doses of immunosuppression.
c. Recipient is EBV negative at the time of transplant.
d b and c
e. All of the above
E
376
9. 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. all of the above
E
377
8. Following lung transplantation, an inflammatory process of the small airways described as narrowing and scarring of the bronchioles is called:
a. hyperacute rejection.
b. acute rejection.
c. bronchiolitis obliterans or obliterative bronchitis. .
d. cellular rejection of the alveoli.
C
378
7. in the immediate postoperative care of a child with a lung transplant, you know that
suctioning is important because:
a. lungs are denervated after transplantation.
b. lung recipients lack a cough reflex below the site of anastomosis.
c. secretions can lead to a severe pulmonary infection.
d. b and c.
e. All of the above.
E
379
A liver biopsy has been ordered on a 2-year-old recipient of a living liver transplant from he
mother. In preparing the child for a liver biopsy, which of the following tests would be most
important?
a. Liver enzymes
b. PT/PTT
c. Hemoglobin level
d. Protein S
B
380
5. Your assignment today includes a 6-year-old child who had a liver transplant 3 days ago
She has been reported to be responsive to verbal commands On your morning assessment,
the child is somnolent and difficult to arouse. You check her bilirubin and note a rise from
yesterday s findings. Her transaminase is also three times greater than yesterday She is febrile.
You know that these signs are most likely indicative of:
a. hyperacute liver rejection.
b. portal vein thrombosis.
c. hepatic artery thrombosis.
d. posttransplant sepsis.
C
381
In evaluating a heart transplant recipient for rejection, the most accurate way to determine rejection is:
a. an elevation in the amplitude of the EKG tracing
b. an endomyocardial biopsy.
c. an echocardiogram to assess left and right ventricular ejection fractions
d. a MUGA scan to assess left ventricular ejection fraction
B
382
You are assigned to a 4 year old female heart transplant recipient. Her transplant was performed
4 days ago, and she has been quite unstable with variable vital signs, fever and alterations in
hemodynamics In your initial assessment of the child, you find her cardiac output to be 2.4
and central venous pressure to be 14. She it slightly febrile with a temperature of 38.1 at 8 am. Her
heart rate is 124 and blood pressure is 88/60 You report your findings to the intensivists
and deduce from your knowledge of transplantation that this child mas have which of the following problems?
A. Hyperacute rejection
B. Chronic rejection
C. Acute rejection
D. Bacterial endocarditis
C
383
8. Heart transplant candidates may often be hospitalized while awaiting a suitable donor
heart. Social workers and nurses help to create a supportive environment with interventions such as which of the following?
a. Educational programs for patients and families
b. Support groups with other patients awaiting transplantation
c. Weekly dinners together with other patients on the unit
d. Weekly excursions to the shopping mall with their IV inotropes
e. a. b. and c
f. All of the above
E
384
8. Patients who are hospitalized for several months pre- and posttransplant may experience which of the following upon discharge from the hospital?
a. Heightened anxiety about leaving the hospital environment
b. Insecurity related to fear of complications
c. fear about changes in personal relationships with family members during the extended absence
d. Role confusion
e. a, b, and d
f. All of the above
F
385
8. Upon returning to a routine home environment, patients and families are often surprised to find which of the following?
a. Day-to-day pretransplant problems resurface and begin to cause conflict.
b. The excitement of a new life overcomes all fears.
c. Transplantation has fixed all the pre-transplant family problems
d. The personality change in the recipient has made life more tolerable.
A
386
Family burden may increase as the patient's health deteriorates while awaiting a suitable organ for transplantation. Spouses may experience which of the following during the waiting period?
a. Anxiety related to separation from the individual hospitalized while awaiting transplantation
b. A need to return to work to support the family
c Difficulty coping with added responsibilities that were once shared
d. All of the above
D
387
6. While awaiting transplantation, patients have reported concerns about which of the following?
a. Becoming a burden to friends and family
b. Financial issues
c. Dying while awaiting a suitable donor organ
d. a and c
e. All of the above
E
388
5. Research has demonstrated that patients with posttraumatic stress disorders (PTSD) were 13 times more likely to:
a. have chronic rejection episodes.
b. die within 3 years posttransplantation.
c. require a retransplant within 3 years.
d. develop chronic renal failure.
B
389
Research on heart transplant recipients has demonstrated that individuals with consistently elevated levels of depression, anger, and hostility have a four to eight times greater likelihood tor developing which of the following?
a- Primary graft failure
b. Alcoholism
c. Coronary artery disease
d. Chronic graft rejection
e. Chronic renal failure
C
390
Once the social worker has assessed a patient for transplantation, the determination may be made for referral to which of the following services?
a. Chemical dependency consult
b. Neuropsychiatry
c. Endocrinology
d. Cardiac surgery
e. a and b
f. All of the above
E
391
A psychological evaluation should include questions pertaining to the patient's history of psychiatric disturbances. This should include which of the following problems?
a. Serious sleep disorders
b. Suicide attempts
c. History of hospitalizations for mental health reasons
d. Panic attacks
e. b and c
f. All of the above
F
392
The ultimate goals of the psychosocial evaluation are to.
a. provide education to the patient on pain management related to posttransplant care
b. provide the transplant team with information on the candidate's support system.
c. identify gaps in the patient s insurance plan.
d. identify potential compliance issues
e. b,c, and d.
f. all of the above.
E
393
50. A transplant coordinator received the following tuberculosis (TB) skin test report for a transplant candidate:
Mumps- erythematous 10 mm area of induration PPD- no erythema or induration
A. Valid and negative
B. valid and positive
C. inconclusive
D. no anergic response
A
394
46. A transplant recipient with a creatinine clearance of 46 ml/min ha a OEXA scan. The results are T score of -1.7 in the lumbar spine and -2.57 in the hip The transplant coordinator should conclude that this recipient has:
A. osteoporosis of the hip and osteopenia of the spine, but bisphosphonate therapy should not be initiated
B. normal bone mineral density and should take calcium supplements
C. normal bone mineral density and no further actions is needed at this time
D. Oteoporosis of the hip and osteopenia of the spine and should be receiving bisphosphonate
D
395
47. A kidney transplant candidate has a potential living donor. Which of the following statements is true?
A. candidate must be listed for transplant prior to donor workup
B. donor must be evaluated by the candidate's nephrologist
C. The candidate must be receiving dialysis prior to transplantation
D. The donor and recipient must be evaluated separately
D
396
48. A kidney transplant recipient reports fatigue and fever for the past 2 days. Laboratory reports show a WBC count of 4.000 c/mm3 Which of the following should the transplant coordinator suspect?
A. acute rejection
B. Chronic rejection
C. CMV infection
D. drug toxicity
C
397
49. A recent recipient asks about the purpose of a cyclosporine prescription The transplant coordinator should respond 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 circulating B cells
D. enhances the ability to fight infections
B
398
42. Immediately prior to surgery, an apprehensive living donor express concerns about proceeding with donation How should the transplant coordinator respond?
A. I will be with you in the operating room, so you will be fine
B. You are under no obligation to complete the donation at this time
C You have already signed the surgical consent and the recipient is already in surgery
D. There is nothing to worry about Your family will be waiting for you in the PACU after surgery
B
399
43. In reviewing the signs and symptoms of intestinal rejection, a 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
400
45. A lung transplant recipient calls a transplant coordinator to report that her home micro spirometry values have dropped by 15% over the last 3 days. She has also experienced increased fatigue. The coordinator should anticipate a:
A. pulmonary function test
B. quantified V/Q Kan
C. open lung biopsy
D. Chest CT Kan
A
401
44. A liver transplant coordinator should inform a potential living liver donor that the remaining organ continues to regenerate for how many months?
A. 3
B. 6
C. 12
D 18
C
402
38. Ten days post operatively, a living liver donor calls the on-call transplant coordinator with complaints of abdominal pain and a fever that started yesterday afternoon. How should the coordinator respond?
A. Take acetaminophen and call back if the pain persists
B. Abdominal pain and fever are normal 10 days after donation
C. You should call the clinic to schedule a clinic appointment
D. You need to go to the emergency department immediately
D
403
39. At the time of the initial hospital discharge following transplant, the recipient and/or parents should be instructed about the importance of documenting:
1. blood pressure
2. oral intake
3. temperature
4. urine output
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
A
404
41. The lung allocation score (IAS) requires which of the following information to be updated in UNET every 6 months?
1- serum creatinine
2. 6-minute walk distance
3. FVC
4. FEV1
A. l. 2. and 3 only
B. 1, 2, and 4 only
C. 1. 3. and 4 only
D. 2. 3 and 4 only
A
405
40. When providing a recipient and family education regarding the common side effects of prescribed medications, the transplant coordinator should explain that azathioprine may cause:
A. thrombocytopenia
B. hemorrhagic cystitis
C. Paraesthesias
D. Tremors
A
406
34. A local OPO forwards a letter in an envelope written by a donor family to the transplant
coordinator with the request to forward it to the recipient. The coordinator should first:
A. call the OPO to request permission to open the letter
B. remove all donor Identifying information in the letter
C. return the letter to the OPO to be sent back to the donor family
D. Alert the recipient about the letter
D
407
35. A potential donor has been identified for Candidate A. who has an elevated panel reactive antibody (PRA) that will require prospective crossmatch. Candidate B Is notified as the "back up" for the organ offer. Candidate A will proceed to transplant If the crossmatch is:
A. T cell negative
B. B cell negative
C. ELISA class 1 positive
D. ELISA class 2 negative
A
408
37. If a candidate's chest x-ray shows an opacity in the right lower lobe, the transplant coordinator should expect which of the following to be ordered?
A. Ct scan
B V/Qscan
C. gallium scan
D. PET scan
A
409
36. According to recommendations proposed by the American Society of Transplant, which of the following risk factors necessitates more frequent reevaluation for those on the Kidney wait
list?
1. Female older than 40 years of age
2. current cigarette smoking
3. receiving dialysis for less than 2 years
4. high density lipoprotein (HOL) of less than 35 mg/dl
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
C
410
32. A heart/lung transplant recipient complains of shortness of breath. The recipient's chest
x-ray is unchanged. Which of the following should the transplant coordinator INITIALLY
recommended?
A. echocardiogram
B. electrocardiogram
C. transbronchial biopsy
D. pulmonary function test
D
411
31. Which of the following should be include in transplant education for a potential kidney donor?
A. Multiple potential living donors may complete the evaluation process simultaneously
B. ABO compatibility testing is not required in living related donation
C. The left kidney is the preferred kidney for donation
D. The incidence of major and minor complications after donation is 15-20%
C
412
33. A transplant center has been offered organs from a 50-year-old decreased donor. Medical history reveals cholecystectomy, metastatic prostate cancer 10 years ago. a 30 pack/year smoking history, daily alcohol use. and controlled hypertension x 10 years.
```
Confirmatory serologies are as follows:
EBV IgG positive
CMV IgG positive
HBsAB negative
HBsAG negative
HCV positive
HIV Positive
RPR/VDRl positive
```
The donor should be refused on the absolute CONTRAINDICATION that includes
A CMV positive, HIV positive, and EBV IgG positive
B. Metastatic cancer and HIV positive
C. history of hypertension. HIV positive, and CMV positive
D. HIV positive. RPR/VDRL positive, and HCV positive
B
413
27. when sirolimus is added to a recipient's posttransplant medication regimen, the transplant coordinator should instruct the recipient that sirolimus:
A is a comparatively inexpensive medication
B Is unaffected by food ingestion
C potentiates the effects of prednisone ¿
D. Levels are increased when taken with cyclosporine
D
414
26. According to PHS guidelines, which of the following donor groups Is considered having increased risk?
A. person who had nonmedical injection of drugs in the last 12 months
B. men who had sex with other men 10 years ago
C persons who engaged in sex for money or drugs 10 years ago
D. men incarcerated 5 years ago
A
415
28. A father is being evaluated as a living liver donor for his 6-month-old son. The father asks how his liver will be divided. The transplant coordinator should inform the father that the surgeon will perform a:
A. left lateral segmentectomy
B right lobectomy
C. left lobectomy
D. right lateral segmentectomy
A
416
29. which of the following deceased donors is considered an expanded criteria donor?
A. 49-year-old with stroke and terminal creatinine of 1.7 mg/dl
B. 55-year-old with myocardial infarction and hypertension
C. 57 year-old with intracranial hemorrhage and known vascular disease
D. 60 year-old with blunt head trauma with a history of squamous cell carcinoma
D
417
30. a transplant recipient with a history of steroid resistant rejection and recent treatment with thymoglobulm calls to report a temperature of 38.5C <101.3 F), nausea, vomiting, diarrhea, and low blood pressure. The transplant coordinator should:
A. reassure the recipient that these symptoms are normal
B. plan for recipient hospital admission
C. encourage the physician to follow up with the recipient
D. tell the recipient to call 911
B
418
22. A patient received a living related donor kidney transplant 2 days ago. Urine output has abruptly stopped. A stat renal ultrasound confirmed renal vein thrombosis. The patient is rushed back to the operating room for allograft nephrectomy. Which of the following should the transplant coordinator immediately anticipate?
1. anticoagulation therapy
2. UNOS listing for transplant
3. need for dialysis
4. ineligibility for future living donor transplant
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
C
419
24. A Kidney/pancreas candidate with type 1 diabetes is blind and underwent a left below knee amputation 6 months ago. He is not receiving dialysis and has had frequent issues with hyperglycemia and ketoacidosis. His HgbAlc is 12% and BMl is 20. The transplant coordinator should explain that he is no longer a transplant candidate due to his:
A BMl of 20
B. HgbAlc of 12%
C. blindness and BKA
D. non-dialysis status
B
420
23. A 23-year-old male was evaluated as a donor for his sibling. After successfully completing the evaluation, he calls the transplant coordinator stating that he changed his mind and does not want to be a donor. Initially, the coordinator should:
A. support the decision of the potential donor
B. instruct the potential donor to inform his sibling
C encourage the potential donor to reconsider his decision
D. inform the recipient that the potential donor is unsuitable
A
421
25. A living liver donor contacts a transplant center 2 weeks following surgery to report fatigue The transplant coordinator should advise the donor that:
A. immediate admission is required for evaluation
B. An evaluation for thrombocytopenia should be scheduled
C. Fatigue is common following donation
D. a weight-lifting program is needed to improve endurance
C
422
Liver recipient. 2 months postoperative, presents to a clinic with the following complaints
hour duration: temp 38.5c (101.3 F). chills, and cough He reports dark colored urine, light
-colored stools, yellow skin, and a loss of appetite. The transplant coordinator should anticipate
the following cause of events in what order?
A. hospital admission, blood cultures, routine blood work. CXR. abdominal ultrasound, liver
biopsy
B liver biopsy, blood cultures, routine blood work, CXR, abdominal ultrasound
C. IV antibiotics, blood cultures, routine blood work. CXR, ERCP, abdominal ultrasound, hospital admission
D. Liver biopsy, blood cultures, IV antibiotics. CXR, routine blood work, hospital admission
A
423
20 When teaching a candidate about Iiving related donor transplant, which of the following concepts are important to include?
1. Transplant is a cure
2. Less immunosuppression is typically required.
3. expected length of the operation
4. potential for graft loss
A. 1 and 2 only
B 1 and 4 only
C. 2 and 3 only
D. 3 and 4 only
D
424
21. A transplant coordinator is educating a liver transplant recipient who is Hep C 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 Hep C is very low after liver transplant
B
425
15. Which of the following symptoms support a diagnosis of rejection in a kidney transplant recipient?
1. Malaise
2. , 1.3 kg (3 lb.) weight gain over 24 hours
3. graft tenderness
4. 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
426
16. During the pretransplant workup, a bone densitometry scan should be obtained in all postmenopausal women as well as potential transplant candidates with:
A. coronary artery disease
B. chronic corticosteroid use
C. hyperlipidemia
D. systemic hypertension
B
427
17. A heart transplant recipient is being prepared for an endomyocardial biopsy. Which of the following should the transplant coordinator explain to the recipient?
A. an echocardiogram is needed following the biopsy
B. endomyocardial tissue is obtained from the atrium
C. overnight stay at the hospital is needed for observation
D. internal jugular vein is the most common approach
D
428
18. In most transplant centers, the recommended frequency of PRA testing in a transplant
candidate with a PRA of 15% is:
A. every 3 months
B monthly
C every 2 weeks
D. only with organ offer
B
429
12. A sibling is scheduled for a left donor nephrectomy; the healthy kidney will be transplanted into his sister, who is blood type B negative The transplant coordinator is reviewing the final preoperative assessment. Which of the following donor findings would make it necessary to postpone that the donation surgery?
A. blood type is 0 positive
B. TMC use is positive
C. BMl has increased from 25% to 31%
D. Urinalysis reveals microscopic hematuria
D
430
11. A transplant coordinator is responsible for which of the following concerning a candidate's financial suitability?
A ensuring that patients have insurance
B. referring patients to the financial coordinator
C negotiating contrasts with insurance companies
D. educating patients on insurance companies
B
431
13. Which of the following is the most critical criterion to identify while evaluating a potential living kidney donor and recipient?
A. potential recipient has PRA less than 20%
B. donor has bilateral multiple renal arteries
C. donor and recipient have negative T cell crossmatch
D. potential recipient and donor have had previous transfusions
C
432
14. A heart candidate is clinically deterioration in the ICU, and the transplant team anticipates placing a ventricular assist device within 72 hours. In the interim, a right heart cath was preformed and a swan ganz catheter and intra aortic balloon pump were placed The transplant coordinator should verify the candidate's UNOS listing as a:
A. 1A
B. 1b
C. 2
D. 7
A
433
7. A 45-year old recipient had a negative colonoscopy 2 years before transplantation. His father had colon cancer at age 55 During a posttransplant clinic , the need for colorectal screening is discussed This recipient will require:
A. annual fecal occult blood tests only
B an annual flexible sigmoidoscopy after age 50
C. a colonoscopy every 5 years after age 50
D. more frequent screening since he is at a higher risk
D
434
8 A 2 3-year-old recipient is 2 years post bilateral lung transplantation On routine follow-up the flowing information Is available
6 months ago
FVC- 4 34 L (106% predicted)
FEV1-4 24 (104% predicted)
Chest x-ray clear
Current
FVC- 4 36 L (107% predicted)
FEV1- 3 78 (87% predicted)
CXR- increased interstitial markings
```
The transplant coordinator should anticipate which of the following procedures?
A. chest CT scan
B open lung biopsy
C. transbronchial lung biopsy
D. repeat pulmonary function studies
```
C
435
10. when educating a transplant candidate on long term complications of transplantation, the coordinator should inform the candidate that he Is at high risk for what type of cancer?
A. Breast
B. skin
C colon
D prostate
B
436
9. A formerly independent transplant Is now legally blind. He suffers from tremors and neuropathy, and recently has had marked Increased tacrolimus levels He has received no formal special needs training. Which of the following should the transplant coordinator do to ensure long term medication adherence?
A. consult an ophthalmologist for evaluation
B call adult protective services to monitor the home situation
C teach a family member or friends the medication administration regimen
D Initiate nursing home placement
C
437
4. A pancreas recipient presents to the emergency department 4 months posttransplant abdominal discomfort and a fever of 34 8 C (101.2 F). Diagnostic tests reveal the following:
WBC 188 Cr 2.0 BUN 40
Glucose 105 Amylase 114 Lipase 35
A CT scan reveals intra-abdominal fluid collection, and a percutaneously aspirated culture is positive for Candida. Which of the following complications should the transplant coordinator anticipate?
A. acute tubular necrosis
B. pancreatic allograft rejection
C urethral stenosis/obstruction with leak
D. intra abdominal abscess
D
438
6. A living donor wishes to donate to a recipient who is ABO + and CMV negative. Which of the following results precludes donation?
A. ABO O*
B. HIV-negative
C. CMV-positive
D. HBsAG-positive
D
439
5. Following renal transplant, an ultrasound indicates that there is a mass that appears to be fluid-filled, retroperitoneal, and adjacent to the transplanted kidney. The recipient is experiencing lower extremity edema on the side of the transplant. The transplant coordinator should suspect the recipient has:
A. a lymphocele
B. a hematoma
C. an abscess
D. a pseudocyst '
A
440
1. Which of the following arc acceptable cold ischemia times for the following organs?
1. Heart 4 hours
2. Liver 12 hours
3. Small intestines 12 hours
4. Lung 6 hours
A. 1. 2. and 3 only
B. 1. 2, and 4 only
C 1. 3. and 4 only
D. 2, 3, and 4 only
B
441
2. Which of the following data are required on the TIEDI recipient follow up form?
A. graft status, incidence of malignancy, and zip code
B. non-compliance, home address, and weight
C. rejection episodes, EBV status, and hospitalization
D. . immunosuppressive needs, primary insurance, and referring physician
A
442
3. Four years post-heart transplantation, a recipient with known coronary artery vasculopathy (CAV) calls to report sudden onset of SOB. nausea, diaphoresis, and fatigue. Vital signs are.
BP 160/94 HR 80
Temp 36 8 C (98 4 F)
The transplant coordinator should anticipate which of the following diagnostic procedures to be performed?
A. Chest CT scan
B echocardiogram
C. V/Q scan
D. left heart cath
D
443
Immunosuppressive agents can be classified under two major categories: antibodies and small molecular preparations. An example of a polyclonal ab used in solid orang transplant to control allograft rejection is:
A. Alemtuxemab
B. Rapamycin
C. Tacrolimus
D. Anti-thymocyte globulin
D
444
HTN is the most common medical problem post-transplant. 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
445
Leukopenia and GI disturbances are seen commonly with which antiproliferative agent?
A. Azathioprine
B. Rapamycin
C. Mycophenolate mofetil
D. Alemtuzemab
C
446
When given intra-operatively, prior to repurfusion, ATG has been shown to reduce the incidence of:
A. Chronic allograft rejection
B. Immediate post-op atelectasis
C. Delayed graft function
D. Post transplant infectious complications on days 3-5.
C
447
Which of the following statements regarding polyomavirus (BK and JC) is true?
A. Approx 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
448
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
449
The most common portal of entry for fungal infection in a transplant recipient is:
A. GI tract
B. Skin
C. Donor transmission
D. Respiratory Tract
D
450
You are caring for a 39 y/o heart transplant pt in the intermediate/transplant step down unit who has been admitted of assessment and treatment for possible cryptococcal meningitis. Which of the following manifestations would you expect to observe in your pt?
A. Mental status changes
B. Stiff neck
C. Headache
D. All of the above.
D
451
A 43 y/o female, 5 years post heart transplant is admitted to the hospital for decompensated heart failure. Cardiac allograft vasculopathy is though to be a form of:
A. Chronic rejection
B. Hyperacute rejection
C. Acuter humoral rejection
D. Acute cellular rejection
A
452
A 32 y/o male has been called into the hospital for his hear transplant. He would like to do autotransplantation during his surgery. You explain to him that this will not be possible. What is an example of autrotransplantation?
A. Transplant the organs from one species to another
B. Transplant the organs from one human to another
C. Transplanting a kidney from one identical twin to another
D. Transfusing a pint of the patients blood back into the same patient.
D
453
You are mentoring a new coordinator on the cell structure of the immune system. The messengers of the immune system that tell cells to proliferate in response to foreign cells are called:
A. CD*+ cells
B. Cytokines
C. CD$+ cells
D. Signal cells
B
454
Examples of antigen presenting cells include:
A. Macrophages, monocytes, erythrocytes
B. Dendritic cells, macrophages and monocytes
C. Erythrocytes, lymphocytes and platelets
D. Mitochondria, macrocytes and thrombocytes.
B
455
You are caring for a 32 y/o female kidney transplant candidate in the ICU in kidney failure on dialysis. The test performed on all candidates that detects antibodies formed against a pts HLA is called:
A. Final crossmatch
B. Tissue typing
C. Panel of reactive antibodies
D. FAB lymphocytes testing
C
456
You are admitting a 40 yo 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 levels
D. Crossmatch
D
457
A 22 y/o female is admitted to the hospital for worsening liver failure. You screened first for hepatitis c. Which type iof rejection occurs in the 1st 6 months post transplant is responsive to immunosuppression therapy?
A. Accelerated
B. Chronic
C. Hyper acute
D. Acute
D
458
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 educations 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
459
You are caring for a 42 yar 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 echo is needed following the biopsy
B. Endomyocardial biopsy is obtain from the atrium
C. An overnight stay at the hospital is needed
D. The internal jugular vein is the most common approach
D
460
A pediatric heart candidate is clinically deteriorating in the IICU and the transplant team anticipates placing a VAD within 72 hours. IN the interim, a right heart Cath was performed and a Swan Ganz Cath and IABP were placed. The transplant coordinator should verify the candidates UNOS listing as
A. 1A
B. 1B
C. 2
D. 7
A
461
Aboslute contraindiactions to heart transplat would be;
1. History of carcionoma within the last year
2. History of alcohol abuse
3. recent pulmonary infart
4. Postiive CMV IgG AB
A. 1 and 3
B. 1 and 4
C. 2 and 4
D 3 and 4
A
462
Clinical manifestations of heart transplant rejection include:
1. HTN
2. Fever >101
3. Hypotension
4. Atrial dysrhythmias
A. 1 and 2
B. 3 and 4
C. 2 and 4
D. 1 and 4
B
463
Most of the duct reconstructins 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
464
A 22 y/o 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. Fistula to the gallbladder
B. Bleeding form the anastomosis into the GI tract
C. Bile leak or bile extravasation
D. Rejection
C
465
You are caring for a 5 year old female liver transplant recipient who has early indications 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
```
E
466
A 50 year old female undergoes a successful liver transplant. She is taken back to the OR on postoperative day 1 for bleeding. During the surgery a small amount of bile is seen leaking form the anastomosis. This is caused by:
A. Infection
B. Technical error at the time of anastomosis
C. Post op bleeding
D. Acute cellular rejection
B
467
A 7 month old underwent a liver transplant for biliary atresia on week ago. The transpknat surgeon states that he suspects the pt has rejection. What are the most reliable indicators of liver rejection.
A. A rise in AS< ALT and bili
B. A rise in WBC and decrease in INR
C. Bleeding from the incision site
D. Elevated alk phos
A
468
You are caring for a 20 y/p who is listed for multivisceral transplant. She is ill but stable and is hospitalized while she waits. 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 200
D. Seizure disorder controlled with phenytoin
A
469
You are caring for a 10 y/p following intestine transplant on post op day 2. He has become increasingly tachycardias and his BP is 80/55. JP drainage has increased serosanguineous fluid. His Abd is mildly distended. His hemoglobin in 9.2 The ileostomy draining is 40 mL/kg/d and loose brown. What do you suspect?
A. Vascular thrombosis
B. Post op hemorrhage
C. Acute rejection
D. Leak at the anastomosis site
B
470
Who are taking care of a 40 year old lung transplant recipient. In evaluating your patients 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&B
E. all of the above
D
471
Cardiac dysrhythmias are not uncommon in the immediate postoperative. Following lugg 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 hyper acute rejection
d. low levels of sodium related to dehydration
B
472
With en block and sequential anastomosis 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 anastomosis sites
B. increase in venous pressures may precipitate rupture of the anastomosis sites
C. increase in atrial pressures may precipitate rupture of the anastomosis sites
D. increases in ventricular pressures may precipitate rupture of the anastomosis sites
A
473
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. increase work of breathing
D. all of the above
E. B&C
```
E
474
Who 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 any nurse to be aware of?
A. Bronchial Dehiscence and tracheal stenosis
B. alveolar collapse in rejection
C. loss of surfactant and infections
D. increased production of CO2 and an increase in reperfusion injury
A
475
In the US institutional review of research study must be completed before the :
A. study is published
B. study is implemented
C. data are analyzed
D. study is presented at a professional conference
B
476
Protected health information includes information about:
A. an individual's past, present, or future physical or mental health
B. any health care that has been provided to an individual
C. the past, present, or future payment for an individual health care
D. all of the above
D
477
A psychosocial evaluation should include questions pertaining to the patient's history of psychiatric disturbances. This should include problems such as which of the following?
```
A. serious sleep disorders
B. suicide attempts
C. history of hospitalizations for mental health reasons
D. panic attacks
E. all of the above
F. B&C
```
E
478
The ultimate goals of the psychosocial evaluation are which of the following:
A. provide education to the patient on pain management related to posttransplant care
B. provide the transplant team with information on the candidate support system
C. identify gaps in the patient's insurance plan
D. identify potential compliance issues
E. all of the above
F. B, C&D
F
479
You are training a new coordinator at your institution. It is important for the coordinator to know the purpose for evaluating candidates as solid organ transplant include which of the following:
A. to determine if there are other options for managing the current disease
B. to determine if there are comorbidities contraindicated for transplant
C. to evaluate the patient's ability to comply with long term follow-up requirements
D. all of the above
E. A&B only
D
480
Patients should be aware of potential complications in the immediate post transplant Phase. Complications that should be discussed with patients prior to surgery include:
A. possible need for dialysis for kidney recipients
B. potential prolonged ventilation for patients following heart or lung transplant
C. bleeding and the need to return for corrective surgery following transplant
D. osteoporosis
E. a, B &C only
E
481
Prior to initiating educational sessions for a patient, the nurse first assesses which of the following:
A. patient physical therapy schedule
B. patient learning style
C. date of discharge
D. all of the above
B
482
In explaining the surgical procedure it is important to provide patients and families with information and diagrams or photos about which of the following:
```
A. the surgical incision
B. immunosuppressive medications
C. the various tubes and invasive monitoring that may be used
D. A and C only
E. all of the above
```
D
483
You are completing teaching for a 25 year old lung transplant recipient about postoperative routines. Your education should include which of the following:
A. need for coughing deep breathing and leg exercises
B. importance of immunosuppressive medications
C. which if venipuncture site will be used for each IV
D. all of the above
A
484
A 56 year old male heart transplant recipient is four years post heart transplant which of the following data are required on the tiedi recipient follow-up form?
A. Graph status, incidence of malignancy, and zip code
B. noncompliance, home address, and weight
C. rejection episodes, EBV status and hospitalization
D. immunosuppressive needs, primary insurance and referring physician
A
485
You are training a new heart transplant coordinator within solid organ transplant and are asked to explain acceptable ischemic times period the following are acceptable cold ischemic times for the following organs
A. heart 4 hours
B. liver 12 hours
C. small intestine 12 hours
D. lung six hours
C. small intestine 12 hours it's false. Acceptable cold ischemic time is 8 hours.
486
A 40 year old male transplant candidate is admitted to the hospital for worsening respiratory status. If a potential candidate is chest X ray shows an opacity in the right lower lobe , the transplant coordinator should expect which initial tests to be ordered?
A. CT scan
B. V Q scan
C. MRI
D. PET scan
A
487
A transplant center has been offered organs from a 55 year old deceased donor. Medical history reveals cholecystectomy, metastatic prostate cancer 10 years ago , a smoking history, daily alcohol use, and hypertension times 10 years. The donor should be refused on the absolute contraindication that includes:
A. ebv positive, HIV positive, and ebv IgG positive
B. metastatic cancer
C. history of hypertension, HIV positive, and ebv positive
D. HIV positive, RPR positive, and HCV positive
B
488
You are a transplant coordinator reviewing laboratory results from an evaluation. A living donor wishes to donate to a recipient who is abo a positive and CMV negative which results precludes donation?
```
A. Abo O+
B. HIV negative
C. ebv positive
D. hepatitis B surface antigen positive
E. CMV positive
```
D
489
Atrial arrhythmias are a common complication of lung donation because which of the following factors?
A. Surgery requires removal of 1/4 inch 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
490
```
You are providing teaching to a 50 year old potential living liver donor. You are explaining the complications to the surgery. Which of the following symptoms may indicate a bio leak in a living liver donor?
A. Severe abdominal pains
B. diarrhea
C. referred pain to the shoulder
D. A&B
E. A and C
```
E
491
The indications of liver function values of the AST, ALT, total bilirubin, and PT INR will peak abnormally high one to two days postoperatively. As the liver recovers, these levels will decrease within which of the following time periods?
A. Three to four weeks
B. three to four days
C. three to four hours
D. 7 to 14 days
D
492
Living lung donation requires 2 live donors. The most ideal lobes for living long donation are which of the following?
A. Left lower lobe and right middle lobe
B. apices on both left and right side due to the high oxygen content
C. right and left lower lobes
D. middle lobes of both lungs provide the greatest expansion in the recipient
C
493
You are providing teaching to the parents of a 3 year old undergoing a liver transplant. Dad will be the donor. You are explaining the surgical aspects of the case. For living liver donation in pediatric transplantation, which of the following lobes will be used?
A. Right lateral segment
B. right frontal segment
C. left lateral segment
D. left posterior segments
C
494
Your patient is 10 years post kidney transplant. Clinical systemic symptoms that may develop with chronic kidney disease include which of the following?
A. amenorrhea, impotence
B. hyperkalemia acidosis
C. muscle twitching and seizures
D. pallor and pruritus
1. 1, 3, 4,
2. 1, 2, 3
3. All of the above
4. 1 and 3 only
3
495
```
Bladder drainage of exocrine secretions may predispose the patient to which of the following complications?
A. Dehydration
B. metabolic acidosis
C. volume overload
D. cystitis
E. a, B, D
```
E
496
pancreas transplant Patients with anastomotic leak may present with which of the following symptoms?
```
A. sharp rise in blood glucose levels
B. increase in white blood cells
C. abdominal pain
D. elevated serum creatinine
E. A&C
F. BC and D
```
F
497
Clinical manifestations of renal insufficiency include:
1. increased serum potassium level
2. decrease serum potassium level
3. increase serum creatinine
4. decreased serum creatinine
5. increased sodium excretion
6. decreased sodium excretion
A. 2, 4 and 5
B. 1, 3, 6
C. 1, 3, 5
D. 1, 4, 5
B
498
An adult male received a kidney transplant six months ago. He is at risk for post transplant diabetes because he has the following risk factors:
1. history for steroid treated rejection
2. recipient less than 45 years of age
3. recipient greater than 45 years of age
4. recipient of Caucasian and Asian ethnicity
5. recipient of African American and Hispanic ethnicity
1. 1, 2, 5
2. 1, 2, 4
3. 1, 3, 5
4. 2, 4, 5
3
499
A 52 year old lung transplant recipient was just diagnosed with the most common malignancy in solid organ transplant recipients. She was diagnosed with which type of cancer?
A. Lung
B. skin
C. Colon
D. bladder
B
500
A 56 year old male transplant recipient is admitted to the hospital for first worsening heart failure period of the following types of antihypertensive medications, which is the most likely to affect cyclosporine or tacrolimus levels:
A. beta blockers
B. calcium channel blockers
C. angiotensin converting enzyme inhibitors
D. alpha adrenergic receptor blockers
B
501
Which of the following medications are typically associated with the development of gingival hyperplasia?
1. Cyclosporine
2. diuretics
3. anticonvulsants
4. antihyperlipidemic agents
5. calcium channel blockers
A. 1, 3, 5
B. 1, 4, 5
C. 2, 3, 5
D. 1, 2, 5
A
502
Signs of rejection following pediatric kidney transplantation may include which of the following symptoms?
A. Increased heart rate, jaundice, shortness of breath
B. hypertension, pain over graph site, hematuria
C. proteinuria, increase in weight
D. B&C
E. all of the above
D
503
You were assigned to care for a 12 year old recipient of a renal transplant that took place eight days ago. In evaluating your patients laboratory work results, you notice that the serum creatinine today is 3.4 but was recorded as 1.8, 2.0, and 2.1 on previous days. Which of the following tests would be most important today to evaluate for rejection?
```
A. Urine for electrolytes
B. renal ultrasound
C. spiral CT scan
D. renal biopsy
E. urine culture for BK vital inclusion cells
```
D
504
In evaluating heart transplant recipient for rejection, the most accurate way to determine rejection is:
A. an elevation in the amplitude of ECG tracings
B. an endomyocardial biopsy
C. An echocardiogram to assess left and right ventricular ejection fractions
D. a MUGA to assess left ventricular ejection fraction
B
505
Post transplant lymphoproliferative disorder is most commonly diagnosed in children following thoracic transplants. Risk factors for the development of PTLD include which of the following?
```
A. Young age at the time of transplant
B. higher doses of immuno suppression
C. recipient is ebv negative at the time of transplant
D. B&C
E. all of the above
```
E
506
Post lung transplantation, and inflammatory process of the small Airways that results in narrowing and scarring of the bronchioles is called:
A. hyper acute rejection
B. acute rejection
C. bronchiolitis obliterans or obliterative bronchiolitis
D. cellular rejection of the alveoli
C
507
Which of the following is a false statement about Blakemore tubes:
A. USED IN MANAGEMENT OF UPPER GI HEMORRHAGE
B. IS ALWAYS USED POSTTRANSPLANT
C. USE TO CONTROL OESOPHAGEAL VARICES
D. IS RARELY USED AT PRESENT
E. IS A DEVICE INSERTED THROUGH THE MOUTH OR THE NOSE
B
508
```
The metabolic abnormality associated with end stage liver disease in uremia is
A. metabolic acidosis
B. metabolic alkalosis
C. respiratory acidosis
D. respiratory alkalosis
```
A. metabolic abnormalities related to uremia include metabolic acidosis. Tubular cells are unable to regulate acid base metabolism, and phosphate, sulfuric, and lactic acids increase, leading to congestive heart failure and weakness. Decrease in red blood cell production: kidney is unable to produce adequate erythropoietin in peritubular cells resulting in anemia, usually normocytic and normochromic. Parathyroid hormone levels may increase causing bone marrow calcification, resulting in hyperproliferative anemia as RBC production is suppressed. Platelet abnormalities: decrease platelet count , increased turnover, and reduced adhesion leads to bleeding disorders. Hyperkalemia: the nephrons cannot excrete adequate amounts of potassium. Some drugs, such as potassium sparing diuretics, may aggravate the condition.
509
```
The type of insulin most commonly used to treat hyperglycemia post cardiac transplantation is
A. intermediate acting NPH insulin
B. short acting regular insulin
C. long acting lantis insulin
D. rapid acting Humalog or novolog
```
B. short acting regular insulin such as novolin R.
510
Prior to transplantation, a patient must undergo transplant specific lab work period which of the following screening tests are routinely performed pre transplant?
1. Abo blood typing, human leukocyte antigen, and panel reactive antibody
2. HIV, hepatitis, herpes, ebv, herpes simplex, and cytomegalovirus
3. anti citrullinated protein antibody
4. toxoplasma and tuberculosis
A. 1 and 2
B. 1 and 4
C. 1, 3, 4
D. 1, 2, 4
D
511
A kidney recipient presents with high fever, pain at surgical site, Leukocytosis, and renal graft dysfunction, and urinary sediment. Which diagnostic test is indicated?
A. Clean catch midstream urine specimen for culture
B. catheterize urine for culture
C. clean catch midstream urine specimen for urinalysis
D. catheterized urine specimen for culture and blood culture
A. High fever, pain at surgical site, Leukocytosis, renal allograft dysfunction, and urinary sentiment are consistent with urinary tract infection, such as pyelonephritis. A clean catch midstream urine specimen should be obtained for culture, bacterial and fungal. Treatment depends on the results of the culture and sensitivities although treatment may begin with septra and fluoroquinolones, which may also be used prophylactically to prevent infection. Routine urine cultures should be obtained after kidney transplant for surveillance purposes.
512
```
The age group that is most at risk for noncompliance with pre cardiac transplantation and post cardiac transplantation medical regimens and care is
A. 65 to 75
B. 50 to 65
C. 25 to 50
D. 18 to 25
```
D. those who are 18 to 25 have the lowest survival rates and are at most at risk for noncompliance become young adults are establishing their independence and identities and may have difficulty following through with medications and appointments it may be especially stressed by alterations in self image or peer approval. They may also have school or work related demands that interfere with treatment. Additionally following surgery, as patients begin to feel better, they may feel unrealistic that they are completely healthy and do not need treatment.
513
```
Following heart transplantation, a decrease in central venous pressure may be related to
A. increased intravascular volume
B. cardiac tamponade
C. low intravascular volume
D. thrombus obstruction
```
C. Decrease CVP is related to low intravascular volume, decreased preload, or vasodilation. Hemodynamic monitoring is the monitoring of blood flow pressures. In order for effective post surgical cardiac functioning, the correct relationship between high and low pressures must be maintained. Central venous pressures, the pressure in the right atrium or vena cava, is used to assess function of the right ventricles, preload, and flow of venous blood to the heart. Normal pressure ranges from 2 to 5 millimeters of mercury but may be elevated after surgery to 6 to 8 millimeters of mercury. Incorrect catheter placement or malfunctioning can affect readings.
514
```
The average length of stay in the hospital for kidney transplant patients is
A. 7 to 10 days
B. 12 to 14 days
C. 19 to 32 days
D. 55 to 72 days
```
A. length of stay varies according to the patient's condition and type of transplant, but the usual length of stay for kidney transplant patient is about 7 to 10 days. Liver transplant patients usually have a longer stay, averaging 12 to 14 days while the cardiac transplants patients links that stay has a wider range of 19 to 32 days. Patients receiving small intestine transplants may require about 55 days of hospitalization and up to 72 days of receiving multi visceral transplants.
515
When educating a patient about the post transplant complications, which of the following topics should be discussed
1. infections
2. rejections
3. malignancies
4. renal dysfunction
A. one and two
B. one, two and four
C. 1 , two and three
D. 1, 2, 3, 4
D. Infections, rejections, malignancy's, and renal dysfunction are common complications of transplantation and should be covered in patient education period infection is a high risk after surgery because of immunosuppressive drugs, and patients should be monitored carefully and taught signs of infection. Compliance with treatment regimens is critical to preventing organ dysfunction. Malignancies may occur as long term complications of immunosuppressants. Renal dysfunction often occurs as a result of hypokalemia , infection, or drugs that impair renal function, such as calcineurin inhibitors.
516
Following heart transplantation, increased central venous pressures, distended neck veins, muffled heart sounds, and hypo tension are indications of
A. compartment syndrome
B. cardiac tamponade
C. disseminated intravascular coagulation
D. myocardial infarction
B. Becks triad (distended neck veins, muffled heart sounds, and hypo tension) and increased CVP are indicative of cardiac tamponade. A sudden decrease in chest tube drainage can occur as fluid in clots accumulate in the pericardial SAC , preventing the blood from filling the ventricles and decreasing cardiac output and perfusion of the body, including the kidneys resulting in decreased urinary output. About 50ML of fluid normally circulates in the pericardial area to reduce friction. A sudden increase in volume can compress the heart, causing a number of cardiac responses. Low including increased end diastolic pressures in both ventricles , decreased venous return, decreased ventricular filling.
517
```
If a lung recipient exhibits stridor and intermittent hypoxia, which is resolved by coughing up sputum, the most likely diagnosis is
A. primary graft dysfunction.
B. Inadequate bronchial anastomosis.
C. Pneumothorax.
D. Tracheal bronchial stenosis.
```
D. Stridor and intermittent hypoxia , which are resolved by coughing up sputum, are characterized by tranquil bronchial stenosis. On palpation, a tracheal rumble may be noted for tracheal stenosis. Bronchial stenosis is most common and may occur at the site of anastomosis or distal to the site. The patient should have an emergent bronchoscopy to confirm diagnosis. CT may be done to show luminal diameter on inspiration and expiration. Treatment may include corticosteroids and balloon dilation or stenting.
518
Following a liver transplant, the initial laboratory indication of biliary obstruction is usually
A. increased gamma glutamyl transferase GGT
B. increase be UN and creatinine
C. increase serum alkaline phosphatase followed by increased bilirubin
D. increase bilirubin
C. The initial laboratory indication of biliary obstruction is increased serum alkaline phosphatase followed by increased bilirubin level. Obstruction is usually related to complications with anastomosis. Diagnostic procedures include an ultrasound, which may show biliary dilation but is not diagnostic if dilation is absent, and cholangiography to confirm. MRCP has a high sensitivity for diagnosis. Early obstruction usually occurs at the sight of duct to duct reconstruction.
519
```
A pancreas transplant recipient experience and arterial thrombosis may exhibit an abrupt
A. decrease in blood glucose
B. increase in blood glucose
C. decrease in serum amylase
D. increase in BUN
```
B. A pancreas transplant recipient experiencing an arterial thrombosis may exhibit an abrupt increase in blood glucose levels while serum amylase levels remain relatively stable period vascular thrombosis may be Venus or arterial and usually occur within the 1st 24 to 48 hours after transplantation. Patients usually receive some type of anticoagulation therapy or a combination of anticoagulants therapy and antiplatelet therapy as prophylaxis, such as Ivy heparin, in Knox apparent, and aspirin. Careful handling of the organ during the procurement procedures may help prevent this complication.
520
```
Indications of low cardiac output in the heart transplant recipient include
A. decrease BUN in serum creatinine
B. metabolic alkalosis
C. jugular vein distention
D. hypertension
```
C. Jugular vein distention is a sign of low cardiac output. Other signs and symptoms include dysrhythmias, cyanosis, pallor, cool clammy skin, impaired capillary refill, increased serum creatinine and BUN, oliguria and anuria, tachypnea , dyspnea, metabolic acidosis, basilar crackles , and mental status change period treatment may include atrial AV sequential pacing, volume and fusion, blood products, vasopressors, inotropes and antirejection agents. Circulatory support, such as with I AB P , may be required for graft failure. Causes may include decreased heart rate, hypovolemia, third space fluid shift, increase systemic vascular resistance, cardiac tamponade, dysrhythmias, graft failure, and rejection.
521
Indications of acute tubular necrosis in kidney transplant include
1. increased B UN and creatinine
2. decreased B UN and creatinine
3. hypokalemia, hypophosphatemia, and hypomagnesemia.
4. pulmonary and peripheral edema.
A. One and four
b. 1, 3 and 4
C. 2, three and four
D. two and four
A. Acute tubular necrosis occurs when a hypoxic condition causes renal ischemia that damages tubular cells of the glomeruli so they are unable to adequately filter the urine, leading to acute renal failure. Indications include increased B UN and creatinine, hyperkalemia, hyperphosphatemia, hypermagnesemia, and pulmonary and peripheral edema. Urinary sediment is tubular epithelial or granular. Patients may exhibit lethargy and nausea and vomiting. Atn can result in uremia, leading to destruction of platelets and bleeding, neurological deficits, and disseminated intravascular quaggy allopathy.
522
```
When evaluating postoperative mediastinal bleeding, chest tube drainage should not exceed
A. 200ML in two to six hours
B. 300ML in one to three hours
C. 400ML in six hours
D. 500ML in four hours
```
A. chest tube drainage should not exceed 200 mils in two to six hours. Acute onset of bleeding is characterized by bright red blood and continuous steady discharge. Dark red blood suggests older blood rather than active bleeding, especially if discharge slows after initial increase. Bleeding may be surgical or non-surgical.
523
```
A normal prothrombin time is
A. 21 to 35 seconds
B. 10 to 15 seconds
C. 30 to 45 seconds
D. 2 to 9.5 minutes
```
B.
524
Which of the following effects are characteristic of class two antidysrhythmic drugs, beta blockers?
1. reduce SA node activity
2. block beta adrenergic cardiac simulation
3. reduce ventricular contraction rate and cardiac output
4. block both alpha and beta agonistic cardiac stimulation
A. one, three and four
B. 2
C. one, two and three
D. three and four
C. Beta adrenergic blockers block sympathetic nervous stimulation of the heart, thereby reducing SA node activity and atrial ectopic focus stimulation. They reduce the ventricular contraction rate in cardiac output, reducing blood pressure. Beta adrenergic blockers are used primarily to control angina and hypertension and to treat supra ventricular and ventricular dysrhythmias. Beta blockers may interact with numerous other medications, with some reducing beta blocker activity including (antacids , NSAIDS, rifampicin ampicillin, phenothiazides), and others increasing activity (cimetidine loop diuretics and other antidysrhtymics)
525
```
The albumin level that indicates mild protein deficiency is
A. 3.5 to 5.5
B. 3 to 3. 5
C. 2.5 to 3
D. <2.5
```
B. albumin is a protein that is produced by the liver and is necessary component for cells and tissues. Albumin levels are most common screening to determine protein levels. Albumin has a half life of 18 to 20 days so it is sensitive to long term protein deficiencies more than short term . Normal values are 3.5 to 5.5 and mild deficiency is 3 to 3.5.
526
```
The pain management plan for a kidney recipient may include
A. fentanyl
B. ibuprofen
C. meperidine
D. Ketorolac
```
A. after kidney transplant, patient controlled anesthesia is commonly used with morphine or fentanyl for the first 24 to 48 hours, after which patients can usually be maintained with oxycodone . Meperidine should be avoided because it depends on the kidneys to excrete metabolites, which can be retained because the new kidney is limited in function, resulting in seizures. Ibuprofen and ketorolac, may impair renal perfusion as well as increase the risk of bleeding.
527
Signs of kidney rejection include
A. weight increase, Olivia, JVD, irregular heartbeat, hypertension, fever and dyspnea
B. dyspnea, productive cough, fever, tiredness, and hypoxemia
C. weight increase, increased B UN and creatinine, oliguria, peripheral edema and fever
D. abdominal pain or distention, nausea and vomiting, fever, change in stool output
```
The pain management plan for a kidney recipient may include
A. fentanyl
B. ibuprofen
C. meperidine
D. Ketorolac
```
528
A patient is scheduled for a liver biopsy. Which of the following should be verified prior to the procedure?
1. Coagulation test results
2. availability of donor blood
3. signed consent
4. protein study results
A. one and three
B. one, three and four
C. one, two and three
D. all of the above
C. Liver biopsy requires removal of a small amount of tissue, usually through needle aspiration. Coagulation studies should be obtained prior to the procedure and abnormalities treated as bleeding as a major complication. Additionally, donor blood should be available in the event of bleeding. Informed consent must always be obtained before invasive procedures . Protein studies are not required for liver biopsy. The patient's vital signs should be taken prior to the procedure to serve as a baseline to evaluate changes.
529
Following a liver biopsy, the correct positioning of the patient to prevent bleeding a bowel peritonitis is
A. supine with only pressure dressing over biopsy site.
B. Right sideline with pressure dressing over biopsy site and pillow under the costal margin
C. left sideline with the only pressure dressing in place over biopsy site
D. prone with only pressure dressing in place over the biopsy site
B. Following a liver biopsy, the patient should be positioned on the right side with a pressure dressing over the biopsy site and a pillow under the costal margin as this position compresses the liver capsule at the insertion site against the chest wall, preventing bleeding and escape of bile through the needle insertion site. Vital signs should be checked every 10 to 15 minutes for an hour and then every half hour for one to two hours or until the patient's condition is stable period the patient should be advised to restrict activities in lifting for a week
530
Initial signs of pancreas rejection in a patient who received a pancreas transplant with bladder drained graft include
A. pain in the right upper abdomen, increase serum amylase, and decrease urine amylase.
B. Diffuse abdominal pain, decreased serum amylase, and increased urine amylase.
C. Hyperglycemia, right upper abdominal pain, decrease serum amylase, and increase urine amylase.
D. Hypoglycaemia, diffuse abdominal pain, increased serum amylase, and decrease urine amylase.
A. Initial signs of pancreas rejection in a patient who received a pancreas transplant with a bladder drained graft include pain in the right upper abdomen, increased serum amylase, and decreased urine amylase. Symptoms are often very nonspecific although hyperglycemia is usually a late sign as glucose levels remain within normal limits initially. A biopsy is required to confirm rejection, after which patient should be kept on bed rest and observed for signs of bleeding on hematoma. Treatment for pancreas rejection may include Iv steroids and anti lymphocyte agents
531
```
Following heart transplant, infection of the deep soft tissues with purulent discharge and dehiscence along with fever, chills and local tenderness, chest pain and unstable sternum is classified as
A. superficial infection
B. sternal dehiscence
C. sepsis
D. mediastinitis
```
D. Infection of the deep soft tissue with purulent discharge and dehiscence along with fever chills local tenderness chest pain wall and unstable sternum Is mediastinitis. Superficial infection is characterized by Cellulitis with local tenderness erythema serous drainage. Small area of the wound breakdown may occur with some permanent discharge.
532
A cardiac recipient exhibits ventricular arrhythmias with increasing changes in ECG, weakness with ascending paralysis and hyper reflexes , confusion and diarrhea. Which of the following electrolyte imbalances do these symptoms suggest?
A. Hyperkalemia
B. hypokalemia
C. hypernatremia
D. hyponatremia
A. hyperkalemia. The primary symptoms relate to the effect on cardiac muscle: ventricular arrhythmias with increasing changes in ECG leading to cardiac and respiratory arrest , weakness with ascending paralysis and hyperreflexia, diarrhea, increasing confusion.
533
Adverse effects associated with calcineurin inhibitors include
A. acne, weight gain, hypertension, osteoporosis, and cataracts.
B. GI ulcerations and myelosuppression.
C. Hyperglycemia, neurotoxicity and nephrotoxicity.
D. Elevated cholesterol and triglyceride levels and proteinuria.
C. Adverse effects of calcineurin inhibitors include hyperglycemia, neurotoxicity, nephrotoxicity, diabetes mellitus, and hypertension. Neurotoxicity may result in headaches, tremor, and seizures. Cyclosporine may also cause hyperlipidemia and hirsutism with tacrolimus is associated with electrolyte imbalances, including hyperkalemia, hypophosphatemia, and hypomagnesemia. Calcineurin inhibitors must be used with care in combination with other drugs as some drugs such as antifungal agents, CC bees and macrolide antibiotics potentiate action by increasing drug concentration and others such as anti epileptic agents and some antibiotics decreased drug concentration.
534
Prior to administration of azathioprine to a renal transplant patient, which of the following must be assessed?
A. Chest X ray
B. platelet count and coagulation profile
C. vital signs, especially blood pressure and pulse
D. CBC and lipid profile
B. Because azathioprine is associated with thrombocytopenia, the platelet count and coagulation profiles should be assessed. Other adverse effects include leukopenia and hepatotoxicity. Azathioprine is an immunosuppressive agent that blocks purine metabolism, inhibiting the synthesis of T cell DNA, RNA and proteins which block the normal immune response. Azathioprine is used to prevent organ rejection in renal transplantation . Azathioprine may be administered orally or intravenously. Isaiah Prince should not be given with allopurinol, which interferes with azathioprine's metabolism, potentiating its effects. Giving azathioprine with ace inhibitors may cause severe leukopenia, and as a thiopurine may reduce effectiveness of anticoagulants.
535
```
Which of the following antifungal agents increases the risk of nephrotoxicity when combined with tacrolimus or cyclosporine?
A. Fluconazole
B. clotrimazole
C. amphotericin B
D. Voriconazole
```
C. Amphotericin B Increases risk of nephrotoxicity when combined with cyclosporine or tacrolimus. Amphotericin B is used to treat candidasis, blastomycosis, aspergillosis , coccidiomycosis, cryptococcosis. other adverse effects include hypokalemia and hypomagnesemia and elevated liver enzymes.
536
After teaching a patient incision care, the best technique to use to ensure the patient understands is
A. ask the patient to give a return demonstration
B. give the patient a brief quiz
C. ask the patient to explain the procedure
D. provide written directions for the patient to refer to
A. a return demonstration is given by patients to show mastery of the procedure.
537
```
The most critical skill for a clinical transplant nurse collaborating in a transplant team is
A. patience
B. assertiveness
C. empathy with others
D. willingness to compromise
```
D. while all these characteristics are important for team members, central to collaboration is a willingness to compromise.
538
A necessary component of informed consent prior to a procedure is
A. names of assisting staff members
B. beginning and ending times
C. risk and benefits of procedure
D. facility statistics regarding procedure
C. patients and families should be apprised of all reasonable risks and any complications that I might be life threatening or increase morbidity, as well as benefits.
539
```
Which of the following antiulcer agents may increase the risk of digoxin toxicity?
A. Omeprazole
B. sucralfate
C. cimetidine
D. ranitidine
```
A. omeprazole and other proton pump inhibitors may increase absorption of digoxin and increase risk of toxicity . PPI is also increase INR in those on warfarin in decrease the absorption and antifungals.
540
When preparing a patient for possible temporary hemodialysis after transplant, which of the following complications should the clinical transplant nurse review?
1. Hypotension and associated symptoms
2. exsanguination
3. muscle cramping
4. sleep disturbance
A. one, two and four
B. one, three and four
C. 1
D. one and threeD. no information can be provided without explicit permission of the patient.
B. The clinical transplant nurse should prepare the patient for complications that he or she may experience directly and help the person learn strategies to recognize these complications and deal with them . Exsanguination can occur of bloodlines separate and dialysis needles become dislodged during hemodialysis, but preventing these type of complications is a responsibility of the professional staff. If the patient is to have long term dialysis at home, then teaching about the possibility of examination becomes important
541
Under HIPAA guidelines, which of the following information can be communicated to a friend who is visiting a postoperative organ transplant recipient?
A. Report of general condition
B. detailed report of surgery
C. prognosis
D. no information
D. no information can be provided without explicit permission of the patient.
542
```
The vaccination that is contraindicated in the post transplant patient is
A. influenza
B. MMR
C. pneumococcal
D. tetanus
```
B. live attenuated vaccines such as MMR, oral polio, and varicella are contraindicated in organ recipients because viral replication may occur in those immunocompromised. Additionally, household members should also avoid this type of vaccination. Post transplant patients usually are advised to get yearly influenza vaccines, pneumococcal vaccinations every five to six years, and tetanus boosters every 10 years . However vaccines can be less effective. Pre transplants adults are usually advised to be vaccinated for hepatitis A and B , tetanus, influenza, varicella.
543
A patient in renal failure is hospitalized for transplant appears very upset after a physicians visit to discuss the transplantation. Which of the following is an example of therapeutic communication to encourage the patient to share feelings about the transplant slash donor?
A. Don't worry. Everything will be fine
B. you should trust your doctor
C. is there anything you would like to talk about
D. why are you so upset
C. is there anything you'd like to talk about? Is an open ended question that encourages the patient to share feelings.
544
```
The purpose of giving steroids (such as Prednisone or methyl Prednisolone ) in two divided doses, morning and afternoon, for pancreas recipients is to
A. control post steroid hyperglycemia
B. prevent GI symptoms
C. reduce sodium and fluid retention
D. reduce risk of fungal infections
```
A. because corticosteroids can cause hyperglycemia, pancreas recipients who are prescribed steroids may receive the drug in two divided doses , morning and afternoon. Other adverse effects include hypokalemia and hypernatremia, mood changes, headaches, Vertigo, Cushing syndrome, GI upset and ulcers, skin fragility , muscle weakness, osteoporosis, glaucoma, cataracts, and weight gain. Steroids may mask symptoms of bacterial or fungal infections. Concurrent use with non potassium sparing diuretics may lead to hypocalcemia and hypokalemia.
545
```
The therapeutic trough level of sirolimus drug during and following withdrawl from cyclosporine is
A. 4 to 12
B. 12 to 24
C. 5 to 20
D. 3 to 8
```
B. the therapeutic trough level for sirolimus drug during and following withdrawal from cyclosporin is 12 to 24 in whole blood. This is higher than normal therapeutic target of four to 12 . Trough levels should be elevated about four to five days after change in dosage. Trough levels refer to the lowest concentration of the agent in the body after levels fall from the peak level. Trough levels should be monitored carefully in doses adjusted to obtain optimal levels
546
```
. The primary target for transplant patients receiving statins such as pravastatin for hyperlipidemia is
A. HDL level
B. triglyceride level
C. total cholesterol level
D. LDL level
```
D. the primary target for transplant recipients receiving statins is the LDL level
547
```
A patient with end stage liver disease has a paracentesis to relieve massive ascites causing severe shortness of breath. Which of the following is used to reduce hyponatremia and renal dysfunction resulting from decreased effective arterial volume?
A. Packed red blood cells
B. spironolactone
C. acetazolamide
D. albumin infusion
```
D. albumin infusions are used to reduce hyponatremia and renal dysfunction resulting from decreased effective arterial volume after paracentesis. Paracentesis is usually done only to relieve severe symptoms, such as shortness of breath after sodium restrictions and use of diuretics have proven ineffective. Spironolactone helps her prevent potassium loss period other diuretics such as furosemide may be added but must be carefully monitored as severe hyponatremia may result. acetazolamide is contraindicated because it increases risk of hepatic coma
548
A patient with lung failure and severe shortness of breath is evaluated for lung transplantation. Which is the following is an absolute contraindication for lugg transplant?
A. Age greater than 55 for single lung
B. history of smoking within 12 months
C. corticosteroid dependency equivalent to greater than 20 milligrams of Prednisone a day
D. history of alcohol abuse
C. corticoid steroid dependency is an absolute contrindication for lug transplantation other contraindications include greater than 65 for single lung , greater than 55 for bilateral lung, and greater than 45 for heart lung transplants. Patient should have no history of smoking for six months and no current alcohol, drug or tobacco use. Patients must be emotionally stable and able to understand and comply with medical regimens and have psychosocial support system. Body weight should not exceed 140% of predicted or be less than 80% of predicted
549
```
Following heart transplant, in the rewarming stage after hypothermia, a patient becomes hypotensive with decreased cardiac output because of vasodilation and hypovolemia. The usual initial treatment is
A. bolus of 500ML of LR or NS
B. bolus of 500ML of colloids
C. blood transfusion
D. platelets
```
A. the usual initial bolus of fluid is 500 mils of LR or NS. Colloids should be avoided with capillary leak syndrome but are indicated for hypo tension primarily related to peripheral vasodilation. Volume resuscitation must be adequate to maintain filling pressures, especially for the first six postoperative hours. But overloading the patient with fluid may result in haemo dilution, requiring blood transfusions and played plasma or platelets to increase clotting factors and prevent bleeding
550
Following a renal transplant, the patient's kidney is not yet functioning adequately but the patient is constipated. Which of the following laxatives slash bowel control agents is contraindicated?
A. Stool softener
B. saline laxative
C. bulk former
D. lubricant
B. people with impaired kidney function should avoid products containing magnesium or phosphates, which can cause acute phosphate nephropathy. Saline laxatives, such as milk of magnesia and Epsom salt, contained ions, such as magnesium phosphate, magnesium hydroxide, and citrate, which are not absorbed through the intestines and draw more fluid into the stool. The magnesium in the preparations also stimulate the bowel. Stool softeners, bulk formers and lubricants are usually well tolerated but bulk formers may result in Constipation if fluid intake is inadequate.
551
```
In the post transplantation. The patient's white blood cell count is 5300, but the at salute neutrophil count is 526. The patient is at risk for
A. bleeding
B. thrombo embolia
C. no risk as wbc and anc are normal
D. infection
```
D. while the patient's white blood cell count is within normal parameters, the normal ANC for adults is 1800 to 7700. The risk of infection increases market Lee if the ANC falls below 1000 and is severe at less than 500
552
The transplant recipient is most at risk for CMV infection when
A. donor and recipient both test positive for CMV
B. donor test negative and recipient test positive
C. donor and recipient both test negative
D. donor test positive and recipient negative
D. highest risk occurs when the donor test positive for CMV and the recipient test negative. When both the donor and recipient test positive or the donor test negative and the recipient positive, the risk is moderate. The lowest risk occurs when both the donor and recipient test negative, but the recipient may develop primary CMV from community exposure or contaminated blood. Lung and bowel recipients have the highest risk for development of CMV with moderate risk to those receiving liver, pancreas, and heart and low risk to kidney recipients.
553
```
A patient receiving tacrolimus complains of pain in the mouth along with slight bleeding and loss of taste sensation . White lesions are evident on the mucosa. The most likely diagnosis is
A. herpes simplex
B. gingivitis
C. oral pharyngeal Candidiasis
D. periodontitis
```
C. pain in the mouth, slight bleeding, loss of taste sensation, and white lesions on the mucosa are consistent with oral pharyngeal Candidiasis , caused by fungus. Treatment can include nystatin oral suspension and clotrimazole although clotrimazole may cause hepatotoxicity. And filters in B should be avoided with nephrotoxic drugs such as tacrolimus. Transplant recipients may be treated with prophylactic antifungals to prevent Candidiasis. Candidiasis may treat be treated as it can spread systemically in those who are immunocompromised.
554
```
The type of precautions indicated for a patient with surgical site infection and purulent discharge is
A. droplet
B. airborne
C. contact and droplet
D. contact
```
D. contact
555
```
A liver recipient is experiencing organ rejection. Which of the following agents is indicated for rejection that is already in progress?
A. Mycophenolate mofetil
B. sirolimus
C. tacrolimus
D. Muromanab
```
D. While a number of drugs are used to prevent rejection, Muromanab is indicated to treat acute organ rejection that is already in progress.
556
Leukopenia and GI disturbances are seen commonly with which antiproliferative agent?
A. Azathioprine
B. Rapamycin
C. Mycophenolate mofetil
D. Alemtuzemab
C
