NR 341 2025 Ultimate Study Set: Comprehensive Questions with Explanations - 2026

A brain-dead donor patient develops excessive urine output, rising sodium levels, and low urine specific gravity. Which complication is most likely? a. Diabetes insipidus (DI) b. Hyperglycemia c. Hypotension d. Infection Rationale: DI is common in brain-dead patients due to pituitary failure, leading to polyuria, hypernatremia, and dilute urine. Hyperglycemia, hypotension, and infection may occur but are less specific. During donor management, which intervention is essential for maintaining organ perfusion? a. Restrict fluids to prevent overload b. Give analgesics for pain c. Maintain blood pressure, serum glucose, temperature, and acid-base balance d. Withhold mechanical ventilation until donation Rationale: Optimal donor management ensures organ viability. Maintaining BP, glucose, temperature, and acid-base balance is crucial. Pain medications are unnecessary because braindead patients do not feel pain. Which hormone therapy is commonly administered to a brain-dead donor to support cardiovascular and metabolic function? a. Insulin only b. Levothyroxine only c. Vasopressin, insulin, and thyroid hormone d. Epinephrine only Rationale: Neurohormonal dysfunction after brain death requires vasopressin for DI, insulin for hyperglycemia, and thyroid hormone for cardiac support. Epinephrine alone is insufficient. A patient is being considered for donation after circulatory death (DCD). When should the donor network be contacted? a. 24 hours after life support withdrawal b. Only if organs fail c. Immediately after terminal weaning or cardiac death d. After family leaves the room Rationale: For DCD, the donor network must be notified immediately at the time of planned withdrawal of support or cardiac death to ensure organ preservation. Delays can compromise viability. Which brain reflex test confirms brainstem death? a. Babinski reflex b. Patellar reflex c. Gag and swallow reflex d. Plantar reflex Rationale: Absence of gag and swallow reflexes indicates loss of brainstem function, a key criterion for brain death. Babinski is a spinal reflex; patellar and plantar reflexes are not brainstem dependent. During an apnea test, the patient is removed from the ventilator but continues receiving oxygen. What indicates brain death? a. Spontaneous respirations resume b. Blood pressure rises c. No respiratory effort with rising PaCO2 d. Heart rate increases Rationale: A positive apnea test confirms brain death if no respiratory effort occurs while CO2 rises, showing the medullary respiratory center is nonfunctional. Radionuclide cerebral perfusion scan shows “all white” imaging. What does this indicate? a. Normal cerebral blood flow b. Partial brain activity c. Absence of cerebral blood flow d. Artifact from movement Rationale: All-white scan indicates no uptake of isotope, confirming absence of cerebral perfusion, consistent with brain death. Normal uptake would show normal brain activity. If a patient is homeless and has no family, who provides consent for organ donation? a. Treating physician b. Hospital ethics committee c. Coroner’s office d. ICU nurse Rationale: The coroner or medical examiner signs off on consent for donation if no next of kin or legal representative is available. Physicians or nurses cannot give consent. Which complication is most commonly seen in post-transplant patients and is the leading cause of morbidity? a. Infection b. Hyperglycemia c. Hyperlipidemia d. Hypertension Rationale: Immunosuppression increases infection risk, making it the most common and serious post-transplant complication. Metabolic issues and hypertension are secondary. Which of the following describes acute transplant rejection? a. Occurs within minutes after transplantation b. Develops over weeks to months and requires immunosuppressive therapy c. Gradual deterioration over years d. Irreversible and requires immediate organ removal Rationale: Acute rejection usually occurs within weeks to months post-transplant and is treated with high-dose immunosuppressive therapy. Hyperacute rejection is immediate; chronic rejection develops slowly over years. A potential organ donor is identified in the ICU. What is the nurse’s first action? a. Call (Donor Network of Arizona Referral Hotline) b. Begin donor organ preservation c. Notify the family immediately d. Administer immunosuppressive therapy Rationale: Timely referral to the organ procurement organization (OPO) is critical. The Donor Network coordinates evaluation and organ recovery. Other actions depend on OPO guidance. Which patients must be referred to the Donor Network within one hour? a. Any patient with hypotension b. Any patient with diabetes insipidus c. All patients with a severe brain injury requiring mechanical ventilation d. All ICU patients Rationale: Clinical triggers for referral include severe neuro injury with ventilation. Hypotension, diabetes insipidus, or general ICU status alone are not triggers for immediate referral. Who typically covers the cost of organ transplants in the United States? a. Medicare/Medicaid b. Private donor funds c. Hospital charity funds d. Patient out-of-pocket Rationale: Medicare and Medicaid cover the cost of organ transplants under federal guidelines. Private funds or charity may supplement care, but they are not primary payers. How many lives can potentially be saved by one organ donor? a. 2 lives with organ, 50 with tissue b. 4 lives with organ, 80 with tissue c. 8 lives with organ, 100 with tissue d. 10 lives with organ, 150 with tissue Rationale: A single donor can save up to eight lives through organ transplantation and improve many more through tissue donation. Other options underestimate or exaggerate these numbers. Which of the following is considered a complication in a brain-dead donor patient? a. Infection b. Rejection c. Diabetes insipidus (DI) d. Hyperlipidemia Rationale: Brain-dead patients often develop DI due to pituitary failure. Infection and rejection are transplant complications, not donor complications. Hyperlipidemia is unrelated. Which of the following is a common complication in a post-transplant patient? a. Infection b. Diabetes insipidus c. Hypotension d. Thyroid dysfunction Rationale: Immunosuppression increases susceptibility to infection. DI and thyroid dysfunction are donor complications. Hypotension may occur but is managed perioperatively. A patient meets criteria for brain death. Which of the following findings confirms brain death? a. Reactive pupils to light b. Spontaneous respirations c. Positive apnea test with no respiratory movements and rising CO2 d. Normal EEG activity Rationale: Brain death is confirmed by absent brainstem function, including a positive apnea test. Reactive pupils, spontaneous respirations, or normal EEG would indicate residual brain activity. A patient has absent corneal reflexes, no gag or swallow reflex, and doll’s eyes are absent. What does this indicate? a. Brain death b. Deep sedation c. Coma with preserved brainstem d. Spinal cord injury Rationale: Absent brainstem reflexes indicate brain death. Deep sedation or coma may suppress some reflexes but not all, and spinal cord injury does not eliminate cranial reflexes. During an apnea test, the respiratory therapist stops the ventilator but provides oxygen. What indicates a positive test? a. Patient coughs b. Patient begins to breathe spontaneously c. No respiratory movement and rising CO2 d. Blood pressure remains stable Rationale: A positive apnea test confirms brain death if the patient cannot initiate breaths and CO2 rises. Spontaneous breathing or cough indicates residual brainstem function. Which organ transplant complication develops within minutes to hours and requires immediate organ removal? a. Hyperacute rejection b. Acute rejection c. Chronic rejection d. Infection Rationale: Hyperacute rejection occurs immediately after transplantation and is irreversible. Acute and chronic rejection occur over weeks to years. Infection is unrelated to rejection timing. Which medication is commonly used post-transplant to prevent organ rejection but requires monitoring for nephrotoxicity? a. Tacrolimus (Prograf) or cyclosporine (Neoral) b. Prednisone only c. Insulin d. Levothyroxine Rationale: Calcineurin inhibitors like tacrolimus and cyclosporine prevent rejection but are nephrotoxic and require therapeutic monitoring. Prednisone is adjunct therapy; insulin and levothyroxine manage metabolic and thyroid issues, not rejection. A kidney transplant patient develops oliguria, edema, low-grade fever, and tenderness at the transplant site. What is the likely cause? a. Kidney rejection b. Infection c. Diabetes insipidus d. Hyperlipidemia Rationale: Signs such as oliguria and graft tenderness indicate kidney rejection. Infection may present differently; DI is a donor complication. Hyperlipidemia is a long-term medication effect, not acute rejection. After a kidney transplant, where is the new kidney typically placed? a. Original anatomical position b. Retroperitoneal space behind the old kidneys c. Iliac fossa d. Upper abdomen Rationale: The iliac fossa is used because of its proximity to major blood vessels and the bladder. Original kidney position is rarely used; retroperitoneal placement is uncommon. Which of the following nursing interventions is important for a kidney transplant patient postoperatively? a. Allowing contact sports immediately b. Withholding anti-rejection medications c. Monitoring for fluid/electrolyte imbalances, infection, and bleeding d. Encouraging raw produce consumption without washing Rationale: Post-transplant care focuses on monitoring complications and protecting the graft. Contact sports, withholding medications, or unwashed produce increase risk of ha A brain-dead donor patient has polyuria, hypernatremia, and hypotension. Which intervention is most appropriate? a. Administer vasopressin b. Administer insulin c. Administer levothyroxine d. Start antibiotics Rationale: Vasopressin treats diabetes insipidus caused by pituitary failure in brain-dead donors, helping maintain fluid balance and blood pressure. Insulin treats hyperglycemia; levothyroxine supports cardiac function. Antibiotics are not immediately indicated unless infection is suspected. Which of the following is a key goal in the management of a brain-dead donor? a. Withhold fluids to prevent edema b. Reduce oxygen delivery to organs c. Maintain hemodynamic stability and organ perfusion d. Avoid mechanical ventilation Rationale: Maintaining blood pressure, oxygenation, glucose, and acid-base balance ensures organs remain viable for transplantation. Withholding fluids or oxygen would compromise organ function. During brain death assessment, which reflex must be absent to confirm brainstem death? a. Patellar reflex b. Plantar reflex c. Corneal reflex d. Babinski reflex Rationale: The corneal reflex tests cranial nerve function and brainstem integrity. Its absence supports brain death diagnosis. Patellar and plantar reflexes are spinal; Babinski indicates upper motor neuron activity, not brainstem function. In the apnea test for brain death, oxygen is supplied but the ventilator is disconnected. What is a positive test? a. Patient initiates breathing b. Heart rate increases c. No respiratory effort and rising PaCO2 d. Blood pressure rises Rationale: A positive apnea test confirms the medullary respiratory center is nonfunctional if no spontaneous breaths occur while CO2 rises. Spontaneous breaths indicate residual brainstem activity. Radionuclide cerebral perfusion scan shows complete lack of isotope uptake. What does this indicate? a. Normal cerebral blood flow b. Partial brain activity c. Absence of cerebral perfusion (brain death) d. Technical error Rationale: No isotope uptake confirms absent cerebral blood flow, consistent with brain death. Normal flow would show uptake, and partial flow indicates residual activity. After a kidney transplant, which positioning is recommended post-biopsy to reduce bleeding risk? a. Supine for 1 hour b. Lie on the side of the biopsy to apply pressure c. Trendelenburg position d. Prone with head elevated Rationale: Positioning on the biopsy side helps compress the puncture site and prevent retroperitoneal bleeding. Supine or prone positions do not provide adequate compression. Which of the following is a sign of kidney transplant rejection? a. Oliguria and swelling over transplant site b. Polyuria and hypernatremia c. Bradycardia and hypotension d. Hyperglycemia and hyperlipidemia Rationale: Oliguria, edema, low-grade fever, and tenderness over the graft are classic signs of rejection. Polyuria may indicate DI in a donor. Bradycardia and hyperglycemia are unrelated. Which statement is true regarding a kidney transplant in the iliac fossa? a. Old kidneys are always removed b. The graft has poor vascular access c. The iliac fossa provides proximity to major blood vessels and bladder d. The location increases risk of infection Rationale: The iliac fossa is chosen for vascular and urinary tract access. Old kidneys usually remain unless complicated. Infection risk is managed but not location-dependent. Which of the following post-transplant medications requires monitoring due to nephrotoxicity? a. Tacrolimus or cyclosporine b. Prednisone c. Insulin d. Levothyroxine Rationale: Calcineurin inhibitors prevent rejection but are nephrotoxic and require regular lab monitoring. Prednisone is immunosuppressive but less nephrotoxic. Insulin and levothyroxine manage metabolic or endocrine issues. A transplant patient develops fever, graft tenderness, and oliguria two weeks post-surgery. What is the priority action? a. Notify the physician; acute rejection suspected b. Increase fluid intake c. Hold immunosuppressive drugs d. Administer vasopressin Rationale: Fever, graft tenderness, and oliguria indicate acute rejection. Immediate physician notification and adjustment of immunosuppressive therapy are required. Fluids, holding meds, or vasopressin are not first-line responses.