Free CMSRN Transplant Questions and Answers — Questions and Answers
Question 1: When a patient receives a kidney transplant and is sent home on maintenance medication, which procedure or intervention should come first?
- Avoiding blood donation
- Avoiding the use of table salt
- Measuring abdominal girth daily
- Monitoring for bacterial and fungal infections (Correct answer)
Correct answer: Monitoring for bacterial and fungal infections
Patients who have received a kidney transplant are on lifelong immunosuppressive therapy to prevent organ rejection. This immunosuppression significantly compromises their immune system, making them highly susceptible to various bacterial, viral, and fungal infections. Therefore, monitoring for signs and symptoms of infection is the most critical and immediate post-discharge intervention to ensure patient safety and graft survival.
Question 2: A patient who had a kidney transplant two months prior experiences acute rejection and is admitted to the hospital. For this patient, which intervention is appropriate?
- Organ biopsy to diagnose impaired function (Correct answer)
- Immediate removal of the transplanted kidney
- Grief and loss counseling to prepare for loss of organ
- Magnetic resonance imaging of organ
Correct answer: Organ biopsy to diagnose impaired function
When acute rejection of a transplanted kidney is suspected, the definitive diagnostic procedure is an organ biopsy. This allows for histological examination of kidney tissue to confirm the presence of immune-mediated damage, differentiate rejection from other causes of graft dysfunction, and guide appropriate immunosuppressive treatment to reverse the rejection episode. Immediate organ removal is not the first step, and imaging alone is usually not definitive.
Question 3: The kidney transplant patient, who was recently moved from the recovery unit, is being attended to by the intensive care nurse. Which of the following findings during the first 12 hours following surgery is the most dangerous and has to be reported to the transplant surgeon right away?
- Abrupt decrease in urine (Correct answer)
- Small clots in bladder irrigation fluid
- Diuresis with increased output
- Pink or dark reddish urine
Correct answer: Abrupt decrease in urine
An abrupt decrease in urine output during the first 12 hours following a kidney transplant is a critical and dangerous finding. It can indicate serious complications such as acute tubular necrosis, vascular thrombosis (e.g., renal artery or vein thrombosis), or urinary obstruction, all of which can threaten the viability of the transplanted kidney. This requires immediate reporting to the transplant surgeon for urgent evaluation and intervention.
Question 4: When a transplant is rejected, how does the immune system react to a graft?
- Systemic tissue destruction occurs because of inability to differentiate self from nonself cells
- Collateral circulation develops and the transplanted organ becomes engorged
- Opportunistic infections develop because the body is immunosuppressed
- Host's immune system starts inflammation and immunologic actions to destroy nonself cells (Correct answer)
Correct answer: Host's immune system starts inflammation and immunologic actions to destroy nonself cells
Transplant rejection occurs when the recipient's (host's) immune system recognizes the transplanted organ (graft) as foreign, or 'non-self.' This triggers a complex and coordinated immune response involving various immune cells and antibodies, leading to inflammation and immunologic actions specifically aimed at destroying the foreign tissue. This is a normal function of the immune system, but it is detrimental in the context of transplantation.
Question 5: A patient receiving a heart transplant undergoes organ rejection during surgery. This is what kind of rejection?
- Hyperacute (Correct answer)
- Transplant
- Acute
- Chronic
Correct answer: Hyperacute
Hyperacute rejection is a severe and immediate form of transplant rejection that occurs within minutes to hours after transplantation, often while the patient is still in the operating room. It is caused by pre-existing antibodies in the recipient's blood that rapidly recognize and attack antigens on the donor organ, leading to widespread thrombosis within the graft and immediate organ destruction. This type of rejection makes the organ non-viable.
Question 6: Which test is the most crucial one for a nurse to perform to find out if a kidney transplant is working?
- Twenty-four hour urinary output
- White blood cell count
- Serum creatinine level (Correct answer)
- Renal ultrasound
Correct answer: Serum creatinine level
Serum creatinine is a waste product filtered by the kidneys, and its level directly reflects the glomerular filtration rate. After a kidney transplant, monitoring serum creatinine is crucial because an increase indicates that the new kidney may not be functioning effectively or could be experiencing rejection. It is the most sensitive and specific indicator of graft function, making it essential for assessing transplant success.
Question 7: The patient's creatinine level in the postoperative phase following kidney transplant surgery is 3.1 mg/dL. In light of this laboratory result, what action should the nurse take first?
- Obtain current blood test results
- Assess for decreased urine output (Correct answer)
- Check the intravenous infusion
- Notify the healthcare provider
Correct answer: Assess for decreased urine output
A creatinine level of 3.1 mg/dL post-kidney transplant is significantly elevated and indicates potential kidney dysfunction or rejection. Before notifying the healthcare provider, the nurse's priority is to gather more immediate assessment data. Assessing for decreased urine output directly reflects kidney perfusion and function, providing critical information to support the concern of graft dysfunction and guide subsequent interventions.
Question 8: Three days ago, the patient under the nurse's care underwent kidney transplant surgery. Urine levels drop suddenly and abruptly, as noted by the nurse. When thrombosis is detected, the nurse notifies the medical professional. Which priority idea is the foundation of this complexity?
- Perfusion (Correct answer)
- Cellular regulation
- Infection
- Elimination
Correct answer: Perfusion
A sudden and abrupt drop in urine output, especially when thrombosis is detected, points to a severe issue with blood flow to the transplanted kidney. Thrombosis obstructs the blood vessels, impairing the kidney's perfusion. Adequate perfusion is fundamental for the kidney to filter blood and produce urine, making it the underlying physiological concept affected by this complication.
Question 9: Immediately following surgery, the kidney transplant patient is under the nurse's care. How many hours will the nurse be monitoring the urine output at least every hour throughout this initial period?
- First 12 hours
- First 48 hours (Correct answer)
- First 8 hours
- First 24 hours
Correct answer: First 48 hours
In the immediate postoperative period following a kidney transplant, close monitoring of urine output is critical to assess graft function and detect complications. Hourly urine output monitoring for the first 48 hours allows for prompt identification of changes that could indicate poor perfusion, acute tubular necrosis, or vascular thrombosis. This intensive monitoring helps ensure the viability of the transplanted organ and enables timely intervention.
Question 10: A patient's kidney function has been gradually declining since receiving a kidney transplant five years ago. For this patient, which intervention is appropriate?
- Drug management may limit the damage and allow the graft to be maintained
- Patient should be admitted to intensive care for observation and possible dialysis
- Patient should be immediately prepped for surgical removal of the organ
- Patient should be educated about retransplantation; related living donor should be sought (Correct answer)
Correct answer: Patient should be educated about retransplantation; related living donor should be sought
When a transplanted kidney's function gradually declines over several years, it often indicates chronic rejection or graft failure. At this stage, medical management may no longer be sufficient to maintain the graft. The most appropriate long-term intervention is to prepare the patient for a second transplant, which includes educating them about the process and exploring options like finding a related living donor for better compatibility.
Question 11: Which patients are most likely to be turned away from transplantation? SATA
- Organ biopsy to diagnose impaired function
- Serum creatinine level
- Natural killer cells & Cytotoxic / cytolytic T-cells (Correct answer)
- Natural killer cells & Cytotoxic/cytolytic T-cells
Correct answer: Natural killer cells & Cytotoxic / cytolytic T-cells
Patients with a highly sensitized immune system, characterized by the presence of pre-formed antibodies or a strong cellular immune response involving natural killer cells and cytotoxic T-cells, are at a significantly increased risk for hyperacute or acute rejection. Such a robust immune profile makes finding a compatible donor extremely difficult and increases the likelihood of graft failure, leading to a patient being deemed unsuitable or 'turned away' from transplantation.
Free CMSRN Transplant Questions and Answers
When a patient receives a kidney transplant and is sent home on maintenance medication, which procedure or intervention should come first?