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Critical Care Unit 2

Terms in this set (50)

Selecting the ideal candidate for transplantation is an intricate process. To evaluate a patient's 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
B) Physiological
C) Psychosocial
D) Single donor system
A) Multisystem
B) Physiological
C) Psychosocial
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
A) Age
B) Presence of infection
C) Presence of malignancy
Which of the following organ-specific criteria for transplantation are taken into consideration? Select all that apply.

A) ABO typing
B) Transfusion history
C) Gynecological examination
D) Eye examination
A) ABO typing
B) Transfusion history
C) Gynecological examination
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
A) ABO grouping
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
A) ECG
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.

A) Vital signs
B) Central venous pressure
C) Patency of urinary catheters
D) Blood sugars
A) Vital signs
B) Central venous pressure
C) Patency of urinary catheters
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
A) Death
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
A) Fluid and electrolyte balance
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
A) Acute graft-versus-host disease
Long-term care focuses on monitoring the patient's 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
A) Medication regimen
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
C) End-stage organ disease refractory to other treatments
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
C) Cannot afford the cost of medications after transplant
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
C) ABO blood grouping
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.
B) The higher the number of matching antigens, the lower the risk of rejection.
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
B) Sibling of same gender
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 examiner's office
C) Registered nurse from organ procurement organization
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
C) Sudden drop in hourly urine drainage
The nurse is caring for a patient who has received a liver transplant. The patient's 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.
C) Notify the surgeon.
A patient with end-stage liver failure has received a liver transplant. During the postoperative care phase, the nurse monitors the patient's 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
B) Severe jaundice
After a liver transplant, what nursing assessment best indicates that the transplanted liver is functioning?

A) Increased INR ratio
B) Increased aminotransferase levels
C) Unstable serum glucose levels
D) Increasing bile drainage
D) Increasing bile drainage
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
B) Two P waves for each QRS complex with one in disassociation
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.
C) Apply a transcutaneous pacemaker.
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 nurse's 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.
C) Acute rejection is the type most likely to respond to immune suppression.
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 antigen antibody reactions
B) Evidence of deteriorating organ function
A patient who is immunosuppressed after organ transplant has acquired an infection. What symptoms does the nurse most expect?

A) Fever above 101° F
B) Increase in the percentage of WBC bands
C) Subnormal core body temperature
D) Decline in absolute neutrophil count
B) Increase in the percentage of WBC bands
A patient who has received an allogenic stem cell transplant has developed graft-versus-host 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
B) Elevated liver function tests
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
A) To recognize life-threatening toxicities associated with this class of 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
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
A) Intravenous (IV) trimethoprim and sulfamethoxazole (Bactrim, Septra) and corticosteroids
C) Bloodborne pathogen isolation
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
B) Prophylactic hematopoietic growth factors
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
A) Cardiac tamponade
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.
B) Obtain serum bilirubin.
C) Prepare for a liver biopsy.
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
C) Additional thoracentesis to reduce the fluid again.
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 nurse's 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.
B) Tumors arising within the epidural space through vertebral or lymphatic spread may cause spinal cord compression.
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
B) Total airway occlusion and hemorrhage
C) Total airway occlusion and vomiting
D) Hemorrhage and decreased level of consciousness
B) Total airway occlusion and hemorrhage
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
A) 11 mg/dL
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
A) IV fluids for hydration
B) Medication to enhance renal excretion of calcium
C) Dialysis
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
C) T4 helper cells
When caring for an HIV-positive patient, what isolation technique should the nurse implement?

A) Droplet
B) Aerosol
C) Contact
D) Standard
D) Standard
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
B) Infection control measures
C) Prophylactic antibiotics
D) Neutropenic precautions
B) Infection control measures
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
B) Bone marrow suppression
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.
A) It suppresses and maintains the viral load at nondetectable levels.
After receiving a bone marrow transplant, a cancer patient suffers a cardiopulmonary arrest and needs mechanical ventilation. The family asks the nurse about the patient's 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.
A) Cardiopulmonary arrest and mechanical ventilation are associated with low survival rates in patients with cancer.
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
C) Leukocytes less than 2,500/mm3
D) Dyspnea with pulmonary infiltrates
C) Leukocytes less than 2,500/mm3
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
C) SpO2 82% to 90%
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
D) Therapeutic leukapheresis
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).
B) Administer the blood with normal saline volume.
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
B) Muffled or distant heart sounds
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
C) Constant digital pressure until reaching the operating room
D) Immediate notification of the surgeon and oncologist
C) Constant digital pressure until reaching the operating room
The patient has developed a large pleural effusion as a complication from lung cancer. The patient's life expectancy is short. What medical treatment does the nurse anticipate?

A) Observation
B) Thoracentesis
C) Diuretic therapy
D) Pneumonectomy
B) Thoracentesis
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.
C) Give high-volume intravenous saline.
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