NR341 EXAM 3 QUESTIONS WITH CORRECT
ANSWERS 2025
Types of transplants - CORRECT ANSWER -cornea
heart
trachea
lung
liver
bowel
kidney
pancreas
skin
vascular
Reason for increased liver transplants - CORRECT ANSWER -
Cure for hep C; recipients must accept and sign consent to receive organ infected with hep C
Types of patients high risk of hep C AND high risk of potential to donate organs -
CORRECT ANSWER -Drug users
Pathway to organ donation - CORRECT ANSWER -1. ABO compatibility
2. HLA compatibility
3. Sensitization to HLA antigens
4. Donor needs complete physical to look for HIV/AIDS, cancer, hepatitis, glucose intolerance, electr
olyte balances
5. Psychological testing to ensure medication compliance
Referral process - CORRECT ANSWER -
Potential organ donor identified, healthcare team member (nurse) will call 1-800-447-
9477 (Donor Network of Arizona Referral Hotline). Keeping in mind that timely referral of patients
who meet the criteria for donation is crucial to this process.
,The Center for Medicare and Medicaid Services requires facilities and Donor Network of Arizona (D
NA) to identify specific clinical trigger to determine when patients should be referred. Clinical trigg
ers to refer patients within one hour are:
-
When a patient with a severe neuro injury or insult who is ventilated and has a Glasgow Coma Sc
ore < 5.
-
When withdrawal of support being considered before there is a plan to discontinue mechanical or
pharmacological support.
- At time of cardiac death (regardless if the patient has already been referred).
Hospitals should also call DNA at 1-800-447-9477 to report any of the following:
- Brain death testing is being discussed or planned
- Discussion of withdrawal of support
- EOL/Comfort care measures being considered
- if the family inquires about donation.
Who pays for transplants - CORRECT ANSWER -medicare/medicaid
How many lives can be saved by one person? - CORRECT ANSWER -
8 lives with organ, 100 with tissue
Clinical triggers - CORRECT ANSWER -
All patients with a severe brain injury requiring mechanical ventilation
Call immediately if:
- brain death testing being discussed
-
discussion for withdrawal of ventilator or vasopressor support is is initiated by family or physician
(terminal weening)
- EOL/comfort care measures being considered
,Call within 1 hour if:
- GCS 5 or less and ventilated
- At time of cardiac death (always)
Complications of brain dead donor/pt - CORRECT ANSWER -- DI
- hyperglycemia
- reduced thyroid function
- hypotension
- acid base imbalances
Complications of transplant pt - CORRECT ANSWER -- infection
- rejection
- HTN
- hyperglycemia
- hyperlipidemia
- nephrotoxicity
AZ donor network - CORRECT ANSWER -OPO / UNOS
How to know if pt is donor candidate (ICU pt only) - CORRECT ANSWER -BRAIN DEATH
- absent cerebral & brain stem function with non-survivable head injury
- absent CN reflexes, GCS = 3 (minimum), flat line
-dilated unreactive pupils (beware of atropine)
- EEG: No electrical activity
- positive apnea test = no respiratory movement and increased CO2 level/respiratory acidosis
- cerebral angiography; no blood flow seen
- radionuclide CPP scan; all white
- do not feel pain so do not need analgesia
- do not need sedation
, CIRCULATORY DEATH
-
patients who have coded and die within minutes of life support removal (not COPD, not terminal
ween patients)
- circulatory collapse
-
Organs recovered after w/d life support: pt dies, limited family says goodbye and time of death is
clocked, then pt brought back in to OR and rehooked up to life support to oxygenate organs and
tissues
- Donor network assumes HCP role to determine how to preserve organs
Brain reflex tests - CORRECT ANSWER -
1. corneal: cotton swab across eyeball and normal response is to blink; brain dead will not blink
2. oculovestibular test: cold water in pt ear; normal response is eyes deviate to that ear
3. ear vs eye irrigations??? Look this up
4. Doll's eyes: turn patients head and normal response is eyes for deviate to opposite side. Brain d
ead eyes will follow direction.
5. swallow and gag reflex: must be absent for brain dead to be determined
6. babinski returns upon brain death, so positive babinski is very bad
7. apnea test: determine if pt has any spontaneous respirations. Hyperoxygenate for 30 minutes; N
OT extubating patient, just turning off vent. Keep off for 4 min
apnea test - CORRECT ANSWER --
RT stops ventilator but continues O2 therapy to look for respiratory movement or trigger to breat
he.
- Done for 8-10 minutes so there's time for CO2 level to rise and respiratory can do ABG
- Everyone required at bedside to watch for loss of hemodynamic stability
-
positive result if no respiratory movement and increasing CO2 = no ventilation happening within p
atient
ANSWERS 2025
Types of transplants - CORRECT ANSWER -cornea
heart
trachea
lung
liver
bowel
kidney
pancreas
skin
vascular
Reason for increased liver transplants - CORRECT ANSWER -
Cure for hep C; recipients must accept and sign consent to receive organ infected with hep C
Types of patients high risk of hep C AND high risk of potential to donate organs -
CORRECT ANSWER -Drug users
Pathway to organ donation - CORRECT ANSWER -1. ABO compatibility
2. HLA compatibility
3. Sensitization to HLA antigens
4. Donor needs complete physical to look for HIV/AIDS, cancer, hepatitis, glucose intolerance, electr
olyte balances
5. Psychological testing to ensure medication compliance
Referral process - CORRECT ANSWER -
Potential organ donor identified, healthcare team member (nurse) will call 1-800-447-
9477 (Donor Network of Arizona Referral Hotline). Keeping in mind that timely referral of patients
who meet the criteria for donation is crucial to this process.
,The Center for Medicare and Medicaid Services requires facilities and Donor Network of Arizona (D
NA) to identify specific clinical trigger to determine when patients should be referred. Clinical trigg
ers to refer patients within one hour are:
-
When a patient with a severe neuro injury or insult who is ventilated and has a Glasgow Coma Sc
ore < 5.
-
When withdrawal of support being considered before there is a plan to discontinue mechanical or
pharmacological support.
- At time of cardiac death (regardless if the patient has already been referred).
Hospitals should also call DNA at 1-800-447-9477 to report any of the following:
- Brain death testing is being discussed or planned
- Discussion of withdrawal of support
- EOL/Comfort care measures being considered
- if the family inquires about donation.
Who pays for transplants - CORRECT ANSWER -medicare/medicaid
How many lives can be saved by one person? - CORRECT ANSWER -
8 lives with organ, 100 with tissue
Clinical triggers - CORRECT ANSWER -
All patients with a severe brain injury requiring mechanical ventilation
Call immediately if:
- brain death testing being discussed
-
discussion for withdrawal of ventilator or vasopressor support is is initiated by family or physician
(terminal weening)
- EOL/comfort care measures being considered
,Call within 1 hour if:
- GCS 5 or less and ventilated
- At time of cardiac death (always)
Complications of brain dead donor/pt - CORRECT ANSWER -- DI
- hyperglycemia
- reduced thyroid function
- hypotension
- acid base imbalances
Complications of transplant pt - CORRECT ANSWER -- infection
- rejection
- HTN
- hyperglycemia
- hyperlipidemia
- nephrotoxicity
AZ donor network - CORRECT ANSWER -OPO / UNOS
How to know if pt is donor candidate (ICU pt only) - CORRECT ANSWER -BRAIN DEATH
- absent cerebral & brain stem function with non-survivable head injury
- absent CN reflexes, GCS = 3 (minimum), flat line
-dilated unreactive pupils (beware of atropine)
- EEG: No electrical activity
- positive apnea test = no respiratory movement and increased CO2 level/respiratory acidosis
- cerebral angiography; no blood flow seen
- radionuclide CPP scan; all white
- do not feel pain so do not need analgesia
- do not need sedation
, CIRCULATORY DEATH
-
patients who have coded and die within minutes of life support removal (not COPD, not terminal
ween patients)
- circulatory collapse
-
Organs recovered after w/d life support: pt dies, limited family says goodbye and time of death is
clocked, then pt brought back in to OR and rehooked up to life support to oxygenate organs and
tissues
- Donor network assumes HCP role to determine how to preserve organs
Brain reflex tests - CORRECT ANSWER -
1. corneal: cotton swab across eyeball and normal response is to blink; brain dead will not blink
2. oculovestibular test: cold water in pt ear; normal response is eyes deviate to that ear
3. ear vs eye irrigations??? Look this up
4. Doll's eyes: turn patients head and normal response is eyes for deviate to opposite side. Brain d
ead eyes will follow direction.
5. swallow and gag reflex: must be absent for brain dead to be determined
6. babinski returns upon brain death, so positive babinski is very bad
7. apnea test: determine if pt has any spontaneous respirations. Hyperoxygenate for 30 minutes; N
OT extubating patient, just turning off vent. Keep off for 4 min
apnea test - CORRECT ANSWER --
RT stops ventilator but continues O2 therapy to look for respiratory movement or trigger to breat
he.
- Done for 8-10 minutes so there's time for CO2 level to rise and respiratory can do ABG
- Everyone required at bedside to watch for loss of hemodynamic stability
-
positive result if no respiratory movement and increasing CO2 = no ventilation happening within p
atient
