EVOLUTIONS OF PROFESSIONAL NURSING WAGNOR TESTBANK Chapter 39 PDF

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WAGNOR TEST BANK CHAPTER 39, CONTAINS ALL QUESTIONS AND DESCRIPTIONS FOR CHAPTER 39...

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High Acuity Nursing, 7e (Wagner) Chapter 39 Solid Organ and Hematopoietic Stem Cell Transplantation 1) A patient being prepared for a heart transplant is concerned that the transplanted organ will not be accepted in his body. What should the nurse consider when formulating a response to this concern? 1. Heart transplants are very successful because of immunosuppressant medication. 2. Today it is more common to do heart-lung transplants. 3. Hearts were the first organs to be transplanted so the technique has been perfected. 4. There are no guarantees since transplants are more successful between twins. Answer: 1 Explanation: 1. Cardiac transplantation is highly successful today, in part because of tissue typing and improved immunosuppressant therapy. 2. Both heart and heart-lung transplants are successful today. 3. The first transplants were done in the 1950s and were kidney transplants. Heart transplants were first successful in the mid-to-late 1960s. 4. Identical twin transplants are the most successful, but much success has also been demonstrated with non-twin transplants. Page Ref: 976 Cognitive Level: Applying Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO01: Discuss the history of organ transplantation.

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2) A patient tells the nurse that chronic kidney disease is "in his family" and his father died within a few months after having a kidney transplant in the late 1940s. What information should the nurse provide? 1. "Your chances of a successful transplant depend on finding a healthy family member who is a match and will agree to provide an organ." 2. "The most successful transplants have always been the heart and lungs." 3. "Many of the earlier failures of kidney transplants had to do with suturing technique." 4. "Medications to prevent problems associated with organ transplantation are now widely available." Answer: 4 Explanation: 1. Many nonfamily transplants are performed and are successful. 2. Transplanting the heart and lungs did not receive the focus of transplantable organs until the 1980s. There is no evidence that transplant of these organs is more successful than transplant of other organs. 3. The major problem associated with transplant has always been rejection. 4. Cyclosporine and other antirejection drugs are now available and have made transplant surgeries much more successful. Page Ref: 976 Cognitive Level: Applying Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO01: Explain the mechanisms of burn injury.

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3) The older brother of a patient in renal failure has agreed to donate a kidney. Testing reveals that the brothers are a good match for this procedure. How would the nurse describe this treatment plan? 1. Heterograft living donor 2. Histograft living donor 3. Allograft living donor 4. Isograft living donor Answer: 3 Explanation: 1. Heterograft is the transplantation of tissue between two different species. 2. Histograft is not a term used to describe status of the donor. Histocompatible refers to the compatibility between donor and recipient. 3. An allograft refers to tissue that is transplanted within the same species. A living donor is someone who agrees to have body parts transplanted into another person while alive. The patient's brother is an allograft living donor. 4. Isograft refers to tissue transplanted between twins. Page Ref: 977 Cognitive Level: Applying Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO02: Describe types of donors and transplant-related legal considerations.

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4) A patient is scheduled to receive a liver for transplantation from a person who has died. The nurse anticipates that the donor has which characteristic? 1. Died of natural causes 2. Experienced cardiac death 3. Died in an automobile accident 4. Experienced brain death Answer: 4 Explanation: 1. It is not possible for the nurse to know if the donor died from natural causes. 2. Cardiac death refers to death by cessation of cardiac and respiratory function. This type of death limits the kinds of tissues that can be donated and typically excludes organ donation. 3. The method of death is not predictable. 4. There are two types of cadaver donors. Organ donors from cadavers who have died from brain death comprise the largest number of implantable organs. Page Ref: 978 Cognitive Level: Applying Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessment of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment LO & MNL LO: LO02: Describe types of donors and transplant-related legal considerations.

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5) A patient, identified as a potential organ donor, has been diagnosed as brain dead and is being maintained on ventilator support. The nurse is reviewing the patient's hemodynamic parameters and is concerned about which findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Mean arterial pressure 50 mm Hg 2. Central venous pressure 5 mm Hg 3. Serum sodium 145 mEq/L 4. Serum glucose 140 mg/dL 5. Ejection fraction 30% Answer: 1, 5 Explanation: 1. There are specific hemodynamic parameters that an adult potential organ donor must meet. The mean arterial pressure should be between 60 and 110 mm Hg. 2. Acceptable CVP ranges are 4-12 mm Hg. 3. Acceptable serum sodiums are less than 155 mEq/L. 4. Acceptable serum glucose readings are less than 150 mg/dL. 5. The desirable range for ejection fraction is above 50%. Page Ref: 981 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessment of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment LO & MNL LO: LO04: Discuss organ donor management.

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6) A patient, identified as an organ donor, is diagnosed as being brain dead. The organ procurement organization (OPO) rules that the patient is not a candidate for transplant. The nurse would attribute this decision to which patient history? 1. Experimented with intravenous heroin 20 years prior 2. Being treated for hepatitis B 3. Treated for prostate cancer one year ago 4. Treated for shock Answer: 2 Explanation: 1. Drug abuse many years ago would be considered, but is not the most likely reason this patient's donor status was denied. 2. Transplantation from a donor with active hepatitis B causes risk for transmission to the recipient. This is the most likely reason that this patient's donor status was denied. 3. History of cancer, particularly if the cancer is in remission, is localized, and if not bloodborne does not eliminate a person from being a donor. 4. Treatment for shock may or may not result in the organs being unsuitable. The patient would likely be considered as a donor. Page Ref: 983 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessment of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment LO & MNL LO: LO05: Explain the general organ procurement process and organ preservation.

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7) The nurse is caring for a patient who will be an organ donor. Which nursing intervention is indicated to protect endocrine function? 1. Provide bolus of levothyroxine followed by continuous levothyroxine intravenous infusion. 2. Administer salt-poor intravenous fluid. 3. Administer blood transfusion. 4. Provide intravenous dopamine. Answer: 1 Explanation: 1. Management of the patient who is an identified organ donor includes maintaining endocrine stability. To do this, the thyroid protocol should be implemented, which is to provide a bolus of levothyroxine, methylprednisolone, insulin, and 50% dextrose followed by a continuous levothyroxine intravenous infusion. 2. Salt-poor intravenous fluids are used to manage the renal/fluid/electrolyte status. 3. Blood transfusions are used to manage the hematopoietic status. 4. Intravenous dopamine is used to manage the patient's hemodynamic status. Page Ref: 982 Cognitive Level: Applying Client Need/Sub: Physiological Integrity : Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO04: Discuss organ donor management.

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8) A patient awaiting a kidney transplant has O blood type. The nurse would explain that the patient's kidney can come from someone with which blood type? 1. Only O 2. B or O 3. A or O 4. A, B, or O Answer: 1 Explanation: 1. If an organ recipient's blood type is O, the only blood type of an organ donor that the recipient can receive must also be O. 2. If the organ recipient has the blood type of B, organs from donors with B or O can be received. 3. An organ recipient with the blood type A can receive an organ from a donor with the blood type of either A or O. 4. If the recipient has the blood type of AB, organs from donors with A, B, or O can be received. Page Ref: 986 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning LO & MNL LO: LO06: Discuss the immunologic considerations of organ transplantation.

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9) A patient who received a kidney transplant 2 years ago has been diagnosed with skin cancer. He tells the nurse that he cannot believe that he has cancer since he has already gone through "so much" with the kidney disease. How should the nurse respond to this patient's statement? 1. "It is unusual for malignancies to develop this long after transplant." 2. "Patients on long-term medications to prevent organ rejection are at risk for developing cancer." 3. "At least this cancer will not affect the transplanted kidney." 4. "Everyone can develop cancer at any time." Answer: 2 Explanation: 1. Cancers can develop as soon as 6 months after transplant surgery or may not develop for 10 to 15 years after surgery. 2. Patients on long-term immunosuppressant therapy are at increased risk for development of some form of malignancy. 3. It is unknown whether this cancer, which may be melanoma, will or will not affect the transplanted kidney. 4. This is a true statement but does not address this patient's concerns. Page Ref: 990 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO08: Discuss the major complications associated with organ transplantation.

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10) It has been determined that a patient who received hematopoietic stem cell transplantation is having poor functioning of the graft. The nurse would prepare the patient for which intervention? 1. Administration of high-dose corticosteroids 2. A second stem cell infusion 3. Administration of platelets 4. Surgery to remove the graft Answer: 2 Explanation: 1. Corticosteroids are included in the management of the patient experiencing graft versus host disease. 2. If the initial graft fails, a second stem cell infusion may be possible. 3. The administration of platelets or red blood cells would be indicated in the management of the patient experiencing severe pancytopenia. 4. Surgery to remove a stem cell graft is not possible. Page Ref: 996 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO10: Explain hematopoietic stem cell transplantation.

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11) A patient received allogeneic hematopoietic stem cell transplantation 2 days ago. Which information should the nurse provide? 1. "Your body is accepting the transplanted cells, so you should be feeling a lot better." 2. "Your body is making normal hematopoietic cells." 3. "You feel so bad because the transplanted cells are attacking your tissues, but that is normal and will pass." 4. "You may not feel well today, and we need to protect you from exposure to any infections." Answer: 4 Explanation: 1. This is a period in which the patient will not feel "much better." 2. It can take up to 5 weeks for the body to make normal hematopoietic cells and not 2 days. 3. If graft-versus-host disease (GVHD) is occurring, the patient will feel sick but GVHD does not "pass" nor is it normal. 4. Within 2 to 3 days after the transplant, the patient's bone marrow function drops to its lowest level, placing the patient at significant risk for infection. Page Ref: 996 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Physiological Adaptation Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation LO & MNL LO: LO10: Explain hematopoietic stem cell transplantation.

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12) During the posttransplantation period, a patient received tacrolimus (Prograf). The nurse would monitor this patient for the development of which adverse effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Congestive heart failure 2. Nausea and vomiting 3. Hyperglycemia 4. Hair loss 5. Infection Answer: 3, 5 Explanation: 1. Tacrolimus is not associated with the development of congestive heart failure. 2. Tacrolimus is not associated with the development of nausea and vomiting. 3. Tacrolimus, a macrolide antibody, has the development of hyperglycemia as a potential adverse reaction. 4. Tacrolimus is associated with hirsutism, not hair loss. 5. Tacrolimus increases risk for infection. Page Ref: 992 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity : Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.3 Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Competencies: IX.9 Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | NLN Competencies: Knowledge and Science: Knowledge: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment LO & MNL LO: LO09: Describe immunosuppressant therapy for prevention of graft rejection.