Unit 2

Question 1

Selecting the ideal candidate for transplantation is an intricate process. To evaluate a
patients suitability for transplantation, a comprehensive analysis on the patient is
performed that includes which of the following types of assessments? Select all that
apply.
A) Multisystem
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B) Physiological
C) Psychosocial
D) Single donor system

Answer 1

A B C

Question 2

Which of the following general assessment criteria guide the selection for
transplantation? Select all that apply.
A) Age
B) Presence of infection
C) Presence of malignancy
D) Health insurance

Answer 2

ABC

Question 3

Which of the following organ-specific criteria for transplantation are taken into
consideration?
A) ABO typing
B) Transfusion history
C) Gynecological examination
D) Eye examination

Answer 3

A B C

Question 4

The critical care nurse knows that determination of compatibility in transplantation
involves the evaluation of two major antigen systems. A mismatch in compatibility may
cause an immediate reaction leading to organ loss. The primary determinant for solid
organ transplantation is which of the following?
A) ABO grouping
B) HBO grouping
C) A and B antigen matching
D) HLA grouping

Answer 4

A

Question 5

Which of the following are paramount procedures that the critical care nurse ensures are
complete during the preoperative phase for the patient undergoing organ transplantation?
A) ECG
B) Complete dialysis within 48 hours
C) CT of the head without contrast
D) Venogram and arteriogram

Answer 5

A

Question 6

The nurse assesses a kidney transplant patient in the ICU immediately following surgery.
Which of the following assessments are paramount in the care of the patient? Select all
that apply.
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A) Vital signs
B) Central venous pressure
C) Patency of urinary catheters
D) Blood sugars

Answer 6

A B C

Question 7

During the immediate postoperative phase, the critical care nurse focuses on
hemodynamic stability. Blood products should be leukocyte reduced to avoid
introduction of CMV. CMV causes which of the following?
A) Death
B) Hyperkalemia
C) Shift of oxyhemoglobin curve to the right
D) Immunoadsorbent assays

Answer 7

A

Question 8

Some degree of postoperative renal dysfunction is common due either to hepatorenal
syndrome or hypotension during surgery. In addition, some immunosuppressive
medications are nephrotoxic. This can affect which of the following?
A) Fluid and electrolyte balance
B) Increased cardiac output
C) Amount of dialysis treatments
D) Retransplantation

Answer 8

A

Question 9

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

Answer 9

A

Question 10

Long-term care focuses on monitoring the patients progress and adherence to the health
care regimen. In solid organ transplant recipients, a major cause of graft loss in the long
term is failure of patients to adhere to which of the following?
A) Medication regimen
B) Dietary requirements
C) Follow-up appointments
D) Financial requirements

Answer 10

A

Question 11

A patient is being evaluated for a solid organ transplant. If the patient is found to be
eligible for a transplant, which of the following would the nurse expect to find?
A) Age less than 65 years
B) Presence of active inflammatory process
C) End-stage organ disease refractory to other treatments
D) Able to reach full life span without transplant

Answer 11

C

Question 12

A patient with end-stage organ failure is being evaluated for an organ transplant. What
factor is most likely to be a contraindication for transplant?
A) Age 30 to 55 years
B) Absence of acute or chronic infection
C) Cannot afford the cost of medications after transplant
D) Is receiving maximum doses of organ support medications

Answer 12

C

Question 13

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

Answer 13

C

Question 14

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

Answer 14

B

Question 15

A patient is awaiting a stem cell transplant. What donor is most likely to have the best
HLA and MLC matching?
A) Not related, with same ABO group
B) Sibling of same gender
C) Any blood relative
D) Nonrelated donor of either gender

Answer 15

B

Question 16

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

Answer 16

C

Question 17

The nurse is caring for a patient who has just received a kidney transplant. What nursing
assessment finding would be most indicative of development of urinary drainage
blockage?
A) Swelling over the graft site
B) Decrease in serum creatinine
C) Sudden drop in hourly urine drainage
D) Increase in serum sodium

Answer 17

C

Question 18

The nurse is caring for a patient who has received a liver transplant. The patients blood
pressure is dropping and there is increased bloody drainage from the Jackson-Pratt drains
at the abdominal incision. What is the most important nursing action?
A) Administer intravenous fluid bolus.
B) Continue close observation and monitoring.
C) Notify the surgeon.
D) Milk the Jackson-Pratt drainage tubes.

Answer 18

C

Question 19

A patient with end-stage liver failure has received a liver transplant. During the
postoperative care phase, the nurse monitors the patients oxygen status closely. What
condition may interfere with the use of peripheral pulse oximetry in this patient?
A) Metabolic acidosis
B) Severe jaundice
C) Normal body temperature
D) Clubbing of fingernails

Answer 19

B

Question 20

After a liver transplant, what nursing assessment best indicates that the transplanted liver
is functioning?
A) Increased INR ratio
B) Increased aminotransferase levels
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C) Unstable serum glucose levels
D) Increasing bile drainage

Answer 20

D

Question 21

A patient has had a heart transplant using the standard atrial cuff technique. Based on the
use of this surgical technique, what cardiac monitor reading does the nurse most expect?
A) Third-degree heart block with ventricular rate 80
B) Two P waves for each QRS complex with one in disassociation
C) Two independently rhythmic QRS complexes
D) Ventricular pacing stimulus followed by a QRS complex

Answer 21

B

Question 22

An adult patient with a heart transplant develops severe bradycardia. The patient also had
worsening hypotension and a deteriorating level of consciousness. What is the priority
nursing action?
A) Administer intravenous atropine.
B) Administer intravenous epinephrine.
C) Apply a transcutaneous pacemaker.
D) Place the patient in reverse Trendelenburg position.

Answer 22

C

Question 23

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

Answer 23

C

Question 24

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

Answer 24

B

Question 25

A patient who is immunosuppressed after organ transplant has acquired an infection.
What symptoms does the nurse most expect?
A) Fever above 101 F
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B) Increase in the percentage of WBC bands
C) Subnormal core body temperature
D) Decline in absolute neutrophil count

Answer 25

B

Question 26

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

Answer 26

B

Question 27

Why is it important for critical care nurses to be aware of antiretroviral therapy (ART) for
AIDS patients? Select all that apply.
A) To recognize life-threatening toxicities associated with this class of drugs
B) To keep the patient from taking these drugs
C) To avoid drug interactions between ARTs and other classes of drugs that are
common and potentially life-threatening
D) To avoid promoting ART drug resistance

Answer 27

A C D

Question 28

A patient is admitted to the critical care unit with pneumocystis pneumonia. Which of the
following will the nurse likely need to manage for this patient? Select all that apply.
A) Intravenous (IV) trimethoprim and sulfamethoxazole (Bactrim, Septra) and
corticosteroids
B) Dialysis
C) Bloodborne pathogen isolation
D) Ultrasound

Answer 28

A C

Question 29

A patient is admitted to the ICU to rule out necrotizing enterocolitis. Management of this
patient may include which of the following initial therapies?
A) Vasopressin
B) Prophylactic hematopoietic growth factors
C) Regular diet
D) NG feedings

Answer 29

B

Question 30

A patient is admitted to the ICU with the following symptoms: weak pulse, distant heart
sounds, pulsus paradoxis, and distended neck veins. What is the likely diagnosis for this
patient?
A) Cardiac tamponade
B) Pneumocystis pneumonia
C) Pleural effusion
D) Cardiac artery rupture

Answer 30

A

Question 31

A 48-year-old patient is admitted with hepatic veno-occlusive disease. Which of the
following are likely assessments and interventions for this patient? Select all that apply.
A) Observe and assess for dehydration.
B) Obtain serum bilirubin.
C) Prepare for a liver biopsy.
D) Prepare for a surgical intervention

Answer 31

B C

Question 32

Radiology results come back on a 44-year-old male cancer patient with a significant
pleural effusion. He is breathing at a rate of 60 breaths per minute and has already had
thoracentesis in the past to remove fluid. Current intervention should include which of the
following?
A) IV antibiotics
B) IV antiviral agents
C) Additional thoracentesis to reduce the fluid again.
D) Bag/mask ventilation

Answer 32

C

Question 33

A nurse is caring for a patient with spinal cord compression from a tumor. The family
asks the nurse why this happens. Which of the following is the nurses best response?
A) There is not enough data to answer that question.
B) Tumors arising within the epidural space through vertebral or lymphatic spread may
cause spinal cord compression.
C) More than 75% of cases are secondary to small cell or squamous cell lung cancers,
and 10% to 15% are secondary to mediastinal lymphomas.
D) This occurs because of a large amount of fluid in the spinal space.

Answer 33

B

Question 34

A nurse is caring for a patient with a tracheobronchial obstruction. The nurse should
assess the patient frequently and watch for which of the following major complications?
A) Pleural effusion and tachycardia
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B) Total airway occlusion and hemorrhage
C) Total airway occlusion and vomiting
D) Hemorrhage and decreased level of consciousness

Answer 34

B

Question 35

A nurse is caring for a patient with a diagnosis of hypocalcemia. This patient likely has a
corrected serum calcium level above which of the following?
A) 11 mg/dL
B) 5 mg/dL
C) 25 mg/dL
D) 2 mg/dL

Answer 35

A

Question 36

Which of the following are included in the management of a patient with hypocalcemia?
Select all that apply.
A) IV fluids for hydration
B) Medication to enhance renal excretion of calcium
C) Dialysis
D) Glucose

Answer 36

A B C

Question 37

A patient has been diagnosed with human immunodeficiency virus (HIV). HIV results in
dysfunction of what specific portion of the immune system?
A) T lymphocytes
B) B lymphocytes
C) T4 helper cells
D) IgG antibodies

Answer 37

C

Question 38

When caring for an HIV-positive patient, what isolation technique should the nurse
implement?
A) Droplet
B) Aerosol
C) Contact
D) Standard precautions D)

Answer 38

D

Question 39

The nurse is caring for a patient with active acquired immune deficiency syndrome
(AIDS) in an intensive care unit. What is the most important component of care for this
patient?
A) Psychological support
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B) Infection control measures
C) Prophylactic antibiotics
D) Neutropenic precautions

Answer 39

B

Question 40

An AIDS patient is to receive zidovudine (AZT, ZDV, Retrovir). What is the most
serious side effect that the nurse should include in teaching?
A) Nausea and vomiting
B) Bone marrow suppression
C) Bleeding disorders
D) General malaise

Answer 40

B

Question 41

The nurse is caring for an AIDS patient who is being offered therapy with potent
combination antiretroviral therapy (ART). The patient is concerned about the many
possible adverse effects of ART medications. What statement by the nurse most
accurately represents the rationale for the use of ART?
A) It suppresses and maintains the viral load at nondetectable levels.
B) It will ultimately cure AIDS.
C) Therapy is based on research study results.
D) Effects are similar in men, women, and children

Answer 41

A

Question 42

After receiving a bone marrow transplant, a cancer patient suffers a cardiopulmonary
arrest and needs mechanical ventilation. The family asks the nurse about the patients
chances of survival. What is the most accurate information for the nurse to base the
answer on?
A) Cardiopulmonary arrest and mechanical ventilation are associated with low survival
rates in patients with cancer.
B) The hospital has a generally low incidence of death after cardiopulmonary arrest
compared to national averages.
C) Every patient and every situation must be evaluated individually, and no prediction
of survival is possible at this time.
D) The family should be referred to the physician and the chaplain to discuss their
concerns about survival.

Answer 42

A

Question 43

A patient who has received a bone marrow transplant is suspected to have either
engraftment syndrome or sepsis and is undergoing evaluation. If the complication turns
out to be engraftment syndrome, what is the most likely differentiating criterion?
A) High fever, especially in the evening
B) Pruritic total body rash
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C) Leukocytes less than 2,500/mm3
D) Dyspnea with pulmonary infiltrates

Answer 43

C

Question 44

A patient with leukemia has been admitted with possible leukostasis. What sign or
symptom does the nurse most expect?
A) Critical neutropenia
B) High and persistent fever
C) SpO2 82% to 90%
D) Diffuse erythematous rash

Answer 44

C

Question 45

The patient has been diagnosed with leukostasis. What definitive medical treatment does
the nurse anticipate?
A) Supplemental oxygen
B) Magnetic resonance imaging (MRI)
C) Serial arterial blood gases
D) Therapeutic leukapheresis

Answer 45

D

Question 46

A patient with acute leukemia is also anemic and is to receive packed red blood cells.
What is the most important nursing action when giving the blood?
A) Give intravenous diuretics before the blood.
B) Administer the blood with normal saline volume.
C) Ensure administration of bronchodilators.
D) Prepare for continuous renal replacement therapy (CRRT)

Answer 46

B

Question 47

A patient with cancer has developed probable cardiac tamponade. The patient most likely
presents with which of the following symptoms?
A) Flat jugular veins when erect
B) Muffled or distant heart sounds
C) Bradycardia and heart block
D) Generalized erythematous rash

Answer 47

B

Question 48

A patient with thyroid cancer is at high risk for rupture of a carotid artery and has had a
carotid artery stent placed. The nurse notices a trickle of blood from the surgical site.
What is the first nursing action?
A) Application of a vascular clamp after digital pressure
B) Insertion of two large-bore intravenous lines
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C) Constant digital pressure until reaching the operating room
D) Immediate notification of the surgeon and oncologist

Answer 48

C

Question 49

The patient has developed a large pleural effusion as a complication from lung cancer.
The patients life expectancy is short. What medical treatment does the nurse anticipate?
A) Observation
B) Thoracentesis
C) Diuretic therapy
D) Pneumonectomy

Answer 49

B

Question 50

A critically ill cancer patient has severe hypercalcemia. What treatment should the nurse
initiate first?
A) Administer high doses of phosphorus.
B) Withhold antineoplastics.
C) Give high-volume intravenous saline.
D) Maintain complete bed rest.

Answer 50

C