Nursing Critical Care Questions Chapter 5

Chapter 05: Organ Donation MULTIPLE CHOICE 1. The patient has a Glasgow Coma Scale (GCS) score of 3 and discussions have been held with the family about withdrawing life support. Which statement by the nurse best describes requirements that must be met to sustain Centers for Medicare and Medicaid Services (CMS) Conditions of Participation? a. “I need to notify the organ procurement organization OPO of my patient’s impending death.” b. “I will contact the physician to obtain informed consent for organ donation.” c. “The charge nurse will notify organ procurement organization OPO once the patient has been pronounced brain dead.” d. “I need the physician to evaluate my patient’s suitability for organ donation.” ANS: Hospi cases the ph poten prior s that receive Medicare or Medicaid reimbursement must notify the local OPO in impending death. It is the responsibility of the organ procurement organization, not ician, to obtain family consent for organ donation and to evaluate the patient for suitability as a donor. Notification of the organ procurement organization must occur death, not after the patient has been pronounced dead. DIF: TOP: MSC: ognitive Level: Comprehension OBJ: Discuss processes associated with organ donation. ursing Process Step: Implementation CLEX: Safe and Effective Care Environment: Management of Care 2. The n patien a. M b. pH c. Pu d. C e is managing a donor patient six hours prior to the scheduled harvesting of the organs. Which assessment finding requires immediate action by the nurse? ning serum blood glucose of 128 mg/dL .30; PaCO2 38 mm Hg; HCO3 16 mEq/L onary artery temperature of 97.8° F ral venous pressure of 8 mm Hg ANS: Donor management focuses on maintaining hemodynamic stability and normal laboratory parameters. Standardized order sets are usually used, and they focus on preserving organ function and viability. Immediate action is required for an arterial blood gas value of pH 7.30; PaCO2 38 mmHg; HCO3 16 mEq/L which indicates metabolic acidosis. All other values are within normal limits. DIF: OBJ: TOP: MSC: Cognitive Level: Analysis Describe clinical triggers associated with brain death. Nursing Process Step: Implementation NCLEX: Safe and Effective Care Environment: Management of Care 3. Which patient should the nurse notify the organ procurement organization (OPO) to evaluate for possible organ donation? a. A 36-year-old patient with a Glasgow Coma Scale score of 3 with no activity on electroencephalogram b. A 68-year-old male admitted with unstable atrial fibrillation who has suffered a stroke c. A 40-year-old brain-injured female with a history of ovarian cancer and a Glasgow Coma Scale score of 7 d. A 53-year-old diabetic male with a history of unstable angina status post resuscitation ANS: A pati with a GCS score of 3 and no activity on EEG is facing impending death. The OPO should e notified. There are no indications of impending death in any of the other patient scenar . DIF: TOP: MSC: gnitive Level: Application OBJ: Discuss processes associated with organ donation. rsing Process Step: Implementation CLEX: Safe and Effective Care Environment: Management of Care 4. The tr plant clinic coordinator is evaluating relatives of a patient with end-stage renal whose blood type is A positive, for suitability as a living donor for kidney tation. Which family member best qualifies for evaluation? -year-old brother with a history of hypertension; blood type A positive -year-old female with a history of food allergies; blood type O negative -year-old son, otherwise healthy with no history; blood type B negative -year-old mother, with a history of sinus infections; blood type A positive diseas transp a. A b. A c. A d. A ANS: To qua kidney female for eva accept type. y as a living donor, an individual must be free from hypertension, diabetes, cancer, sease, and heart disease and generally between 18 and 60 years of age. A 35-year-old ith a history of food allergies; blood type O negative (universal donor) best qualifies ation. The brother and mother, although blood-type compatible, are outside of e age ranges for living donation. The minor son does not qualify based on blood DIF: TOP: gnitive Level: Application rsing Process Step: Assessment OBJ: Discuss processes associated with organ donation. MSC: NCLEX: Physiological Adaptation 5. The nu e is caring for a patient who is being evaluated clinically for brain death by a primary care p a. Ab b. Un c. W d. Co ider. Which assessment findings by the nurse support brain death? nce of a corneal reflex ual, reactive pupils drawal from painful stimuli temperature of 100.8° F ANS: Absence of a corneal reflex indicates altered brainstem activity and is a component used in the clinical evaluation of brain death. Reactive pupils, withdrawal reaction to painful stimuli, and the ability to maintain core temperature indicate brainstem activity. DIF: OBJ: TOP: MSC: Cognitive Level: Comprehension Describe clinical triggers associated with brain death. Nursing Process Step: Assessment NCLEX: Physiological Integrity: Physiological Adaptation 6. The nurse is caring for a mechanically ventilated patient following bilateral lung transplantation. When planning the care of this patient, what is the priority nursing intervention? a. Thirty-degree elevation of head of bed b. Endotracheal suctioning as needed c. Frequent side to side repositioning d. Sequential compression stockings ANS: Dener produc preven in the and ap they a ion of the lung that occurs during lung transplantation causes changes in mucus on and ciliary movement. As a result, to promote the drainage of secretions and mucus plugging, endotracheal and oral suctioning should be a priority of nursing care stoperative lung transplant patient. Head of bed elevation, side to side repositioning, cation of sequential compression stockings are appropriate nursing interventions, but not the priority intervention. DIF: ognitive Level: Application OBJ: escribe the postsurgical nursing and medical management of solid organ transplant proced s. TOP: Nursing Process Step: Planning MSC: CLEX: Physiological Integrity 7. A fam donate a. Ar b. Co c. No d. Ob member approaches the nurse caring for their gravely ill son and states, “We want to ur son’s organs.” What is the best action by the nurse? nge a multidisciplinary meeting with physicians. ult the hospital’s ethics committee for a ruling. y the organ procurement organization (OPO). in family consent to withdraw life support. ANS: It is th and ob Arrang comm suppo ultimate responsibility of the organ procurement organization to approach the family n consent for organ donation. The best action by the nurse is to notify the OPO. g a multidisciplinary meeting with physicians and consulting the hospital’s ethics ee are not appropriate actions in this scenario. Informed consent to withdraw life s provided by the physician. DIF: TOP: MSC: ognitive Level: Application OBJ: Discuss processes associated with organ donation. ursing Process Step: Implementation CLEX: Safe and Effective Care Environment 8. The nu e is caring for a patient in the critical care unit who, after being declared brain dead, is bein by the rate 12 core te first? a. Ap b. Ob c. Be d. Dr ANS: managed by the OPO transplant coordinator. Thirty minutes into the shift, assessment urse includes a blood pressure 75/50 mm Hg, heart rate 85 beats/min, and respiratory reaths/min via assist/control ventilation. The oxygen saturation (SpO2) is 99% and perature 93.8° F. Which primary care provider order should the nurse implement y forced air warming device to keep temperature > 96.8° F in basic metabolic panel every 4 hours until surgery n phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg arterial blood gas every 4 hours until surgery Hemodynamic stability is a priority in donor management. Following brain death, loss of autoregulation results in intense vasodilation. To maintain perfusion to the vital organs, the priority action is to begin a phenylephrine (Neo-Synephrine) infusion to get systolic BP > 90 mm Hg. Maintaining normothermia is the next priority. Obtaining laboratory tests and arterial blood gasses is a part of donor management but not the priority in this scenario. DIF: Cognitive Level: Application OBJ: Describe the postsurgical nursing and medical management of solid organ transplant procedures. TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The family of a critically ill patient has asked to discuss organ donation with the patient’s nurse. When preparing to answer the family’s questions, the nurse understands which concern(s) most often influence a family’s decision to donate? (Select all that apply.) a. Donor disfigurement influences on funeral care b. Fear of inferior medical care provided to donor c. Age and location of all possible organ recipients d. Concern that donated organs will not be used e. Fear that the potential donor may not be deceased f. Concern over financial costs associated with donation ANS: Common fears and concerns that can influence a family’s decision to donate include fear of disfigurement of the donor, fear of inferior medical care being provided to the donor in order to hasten the process, fear that the donor may not really be deceased, and concern that the family of the donor will assume the financial burden associated with the donation. The number of individuals awaiting transplant along with the current UNOS registry system ensures all procured organs will be transplanted. The age and location of recipients are not disclosed by the OPO. DIF: Cognitive Level: Comprehension OBJ: Discuss processes associated with organ donation. TOP: Nursing Process Step: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care