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pH range Answer - 7.35 - 7. PaCO2 range Answer - 35 - 45 mmHg HCO2 range Answer - 22-26 mmHg SaO2 range Answer - 95- Low pH, low HCO2, low PaCO2 Answer - Metabolic acidosis (loss of HCO2) High pH, high HCO2, high PaCO2 Answer - Metabolic Alkalosis (gain of HCO2) Low pH, high HCO2, high PaCO2 Answer - Respiratory Acidosis (hypoventilation) High pH, low HCO2, low PaCO2 Answer - Respiratory alkalosis (hyperventilation) A nurse reports the following donor information to the Procurement Coordinator: SBP 80 mmHg HR-150 CVP-2 U/O-1200 cc/hr Dopamine@ 10 meg What should the Coordinator do first? A. T4 protocol B. Fluid bolus C. DDAVP D. Dobutrex Answer - Fluid bolus Evaluation of a potential donor reveals the following vent settings and ABG result - Mode - IMV Ph-7.51 Rate 14/min Расо2 30 FIO2-50 % PaO2 127 PEEP Ocm H НСОЗ- 28 Vt- 700 ml SaO2-99.9 Which of the following should the coordinator FIRST recommend to normalize the АBG? A. Add 5cm H2O PEEP B. Increase IMV rate to 10 C. Decrease IMV rate to 10 D. Admin NaBicarb IV Answer - Decrease the IMV rate to 10 The Procurement Coordinator is managing a 26 year old male donor ABG results are: Ph-7.
PaCo2- PaO2- HC03- Which of the following is most appropriate? A. Add 5cm of PEEP B. Increase FIO C. Give Bicarbonate D. Increase vent rate Answer - Increase vent rate During the physical exam of a male donor who is 72 inches tall (183cm) and weighs 198 lbs (90kg) coordinator is unable to verify bilateral and equal breath sounds. A chest x-ray reveals end of the ET tube lying just below the carina. The procurement coordinator should be suspicious of which of the following: A. An ETT cuff link B. Airway obstruction C. Low lung compliance D. Improper intubation Answer - Improper ventilation UNOS requires that the host OPO documentation sent with each organ must include which of the following: A. Infectious disease testing B. Donor HLA report C. ABO confirmation D. Original concent form Answer - C. ABO confirmation, A. Infectious disease testing In addition to the consent form which of the following documentation should be included with every organ: A. Consults, progress notes, OPO donor chart B. OP reports, donor chart, ABO confirmation C. Death declaration, consults, OP report D. ABO confirmation, death declaration, and OPO donor chart Answer - ABO confirmation, death declaration, and OPO donor chart Which of the following must be submitted to UNOS following each organ recovery case: A. Family consent form B. Organ sharing documentation C. ME permission D. Credentials of recovery teams Answer - organ sharing documentation All of the following demographic data are necessary for obtaining a UNOS number on a potential multiorgan donor except: A. Name B. Weight C. Blood type D. SSN Answer - Social security number It is mandatory for the host OPO to provide documentation of which of the following to the visiting procurement team:
C. Offer to a status one pt on the national list D. Skip center C and find a backup for Center A on the regional list Answer - Contact CenterC to back up Center A's first patient Prior to making liver allocation calls, a coordinator learns that the donor serology results include a reactive hepatitis C virus (HCV) the coordinator should: A. Caution the ICU staff to adherent universal precautions B. Obtain PCR testing to confirm results C. Offer only to HCV reactive liver pts D. Run a match list with the proper HCV status Answer - Run a match list with the proper HCV status A procurement coordinator is allocating a liver from a donor with blood type A, subtype A2, the first liver candidate on the match run list is blood type O. Which of the following should the coordinator do? A. Request new match run from UNOS B. Call the OPO administrator on call C. Offer it to the first blood type A candidate D. Proceed with the offer for the first candidate Answer - Proceed with the offer for the first candidate When contacting UNOS to arrange commercial transportation for a pancreas, the procurement coordinator should provide which of the following.p?
- Donor HLA
- Receiving centers Name
- Delivery address
- Recovery surgeons name Answer - 2 & 3 Warm Ischemia is defined as the time from Answer - Cessation of effective circulation until core cooling The vessel most commonly cannulated for insitu perfusion of cadaver donor kidneys is Answer - Distal aorta According JCAHO standards, in addition to brain death and consent documentation, what must be included in a donor's hospital chart? Answer - Operative note Which of the following is true about the recovery of tissue typing material after removal of the organs for transplant? A. Tissue typing material is not needed if a complete type has been rendered by the pre typing material B. Inguinal lymph nodes should be obtained C. The spleen and as many lymph nodes as possible should be recovered D. The spleen must be removed and left whole Answer - The spleen and as many lymph nodes as possible should be recovered Which of the following documentations are necessary to facilitate tissue from an organ donor
- Input & Output records
- Time of brain death
- Cross clamp time
- Donor body weight Answer - 1,3 & 4 While performing in situ perfusion, what solution is most often used for liver pre- cooling? Answer - Ringers Lactate When transporting a potential multi-organ donor from ICU to OR what is important to monitor? Answer - Arterial B/P If a cannula is used for drainage during in situ flushing, it is placed in the? Answer - Vena cava The storage solution of choice for tissue typing specimens removed in the OR is what? Answer - A nutritive tissue culture medium A 35 year old drowning victim is now a potential organ donor adequate pulmonary function has been difficult to maintain, requiring frequent suctioning, FI02 and PEEP 10cm. While en route to the OR which of the following is needed to maintain donor stability:
- Warming blanket
- PEEP valve
- 02 source
- Cardiac monitor Answer - 2,3 & 4 The cold temperature, increase potassium content of cardioplegia solution has which of the following effects on the myocardium:
- Reduction of metabolic rate
- Interruption of the electrical conduction system
- Maintenance of the sodium/potassium pump function
- Preservation of high oxygen tension Answer - 1& All essential components when reporting results of a death record review to key hospital personnel except: A. Nursing notes B. COD C. Patient's name D. Physician specialty Answer - Patient's name A hospital has not been complaint with referrals for 18 months. In order to assess donor potential, the Procurement Coordinator should first: A. Conduct a death record review B. Preform a medical staff survey C. Develop educational programs D. Review hospital policy Answer - Conduct a death record review Reviewing a hospital's past referral activity it is helpful when making a Hospital Development (HD) plan because it Answer - Identifies obstacles to the donation process
- Myers-Briggs profile Answer - 1,2 and 3 only When educating medical professionals about organ and tissue donation, presentations which of the following:
- Number of staff and time constraints of the target audience
- Performance criteria for OPO's
- Organ acquisition fee
- Hospital specific donation policies Answer - 1 and 4 only In performing the monthly medical record review in an assigned hospital, the Procurement Coordinator discovers a medically suitable potential donor that was not referred to the OPO. The most appropriate initial action to address the failure to make the referral would be to: Answer - Contact hospital staff involved with the case. Hospital #1 Potential Donors 9, Organ Refferals 11, Donors 6 Hospital #2 Potential Donors 15, Organ Refferals 8, Donors 6 Hospital #3 Potential Donors 12, Organ Refferals 11, Donors 4 Baised om the information above, how should hospital development activity be prioritized? Answer - 2,3, When educating pastoral care staff, all of the following should be addressed except: A. Donor management principles B. Family grief assistance C. The referral process D. Consent strategies Answer - Donor management principles Which of the following HD activites should be done prior to setting up an appointment with hospital administrators?
- Develop educational tools and methodologies for the hospital
- Interview key hospital staff to learn about the hospital
- Review the hospital's policies related to organ and tissue donation
- Review the OPO records related to the hospital's donation history Answer - 234 The unit has a good tissue donor referral rate, but has only fair potential organ donor referral rates. The relationship between the OPO and Tissue always been strained. What is the most appropriate action? Answer - Call the Tissue Bank Coordinator and ask if you can also participate in the in-services. ICU nursing staff ahs been in-serviced of the referral and consent process. To determine the outcomes of their efforts, the OPO compares the following Death Record Review data obtained 6 months before and after in-service BEFORE: Potential donors 10, Medically suitable refferals 2, Families approached 8,
of donors 2
AFTER: BEFORE: Potential donors 10, Medically suitable refferals 8, Families approached 8, # of donors 2 The coordinator should conduct further in-servicing on: Answer - Consent process
The "80/20" rule as it relates to organ donation suggests Answer - 80% of an OPO's donors come from 20% of its hospitals According to public opinion polls, which of the following frequently identified reason people do not discuss donation is the most with their families? Answer - They do not like to think about death Follow-up communication with consulting and referring physicians involved in the donation process should include all of the following except: Answer - Recipient name All of the following are acceptable for documenting death notification in compliance with CMS conditions of Participation except the Answer - Autopsy report When assessing a new donor hospital assigned to a Procurement Coordinator, the ICU staff complains that although 12 potential donors were identified last year, consent was obtained in only 4 cases. What course of action would be most appropriate for the Coordinator? Answer - Determine how families are being approached The primary objective in monitoring referrals from a hospital unit is to: Answer - Measure effectiveness of professional educational programs When outlining objectives for a hospital's organ donation strategic plan, which of the following the most important elements to consider?
- OPO resources required to carry out the plan
- Time frames expected for each planned step
- Essential events to be carried out by the OPO staff
- Hospital administration support of the plan Answer - 1 23 A Procurement Coordinator has implemented a strategic plan in a donor hospital. Part of that plan includes scheduled in-services every 6 months for ICU staff. The Coordinator has reached 25 % of the intended audience hospital through these in- services over the past 18 months. The Coordinator decides to: Answer - Modify a strategic plan to reach the remainder of the staff Inform hospital personnel that JCAHO surveyor will be looking for:
- OPO affiliation
- Operative reports
- Donation policies
- Donation records Answer - 1, 2, 3, and 4 All of the following reasons for documenting professional education activities except: A. Relating educational programs to donor activity B. Tracking coordinator activities C. Complying with UNOS regulations D. Tracking total number of people attending in-services Answer - Complying with UNOS regulations
Good indicators of adequate hydration in a renal donor with DI and normal serum creatinine: 1. Sodium less than 150 mEq/L
- CVP of 10cm H
- U/O of 700cc/hr
- Urine specific gravity greater than 1.040 Answer - 1& 23 y/o potential donor with a history of injectable drug is referred. Pre- transfusion serology screening-Anti-HCV (reactive) the rest is non-reactive. The Coordinator should: Answer - Offer all consented organs Blood culture, arterial-line, 72 hours. Sensitivity to Cephalosporin, Penicillin and Vancomycin. Select the proper antibiotic, Answer - Cefazolin (Ancef) Hetastarch (Hespan) is contraindicated in which of the following: Answer - Coagulopathy Preoperative lymph nodes for HLA typing are surgically obtained from: Answer - Inguinal region A potential organ donor has an elevated WBC. What hematology studies would help determine the source of this result? Answer - Differential What antibiotics is nephrotoxic and should be discontinued on a potential renal donor? Answer - Vancomycin A cadaveric donor has received multiple blood transfusions and steroid drug therapy. Under these circumstances, what is the preferred preoperative source of T and B lymphocyte isolation? Answer - Inguinal nodes The Procurement Coordinator is managing a donor with the following ventilators settings and blood gas results: FI02-0. Ph-7. PC02-35 tor PO2 100 torr. Answer - Maintain the current settings. Which of the following are indicators for transfusion of PRBC's? Answer - Hgb 8 Hct 25 What fluids is most appropriate to treat hypernatremia? Answer - D5 1/4 NS An adult donor has a heart rate of 140, a BP 90/60 and a Na+ 168. The Procurement Coordinator should administer: A. Dopamine B. LR C. 0.45% NS D. Hespan Answer - 0.45% NS 25 y/o multi-organ donors, HR 104/min, mean arterial pressure 70 mmHg and CVP 9 cm H20. The Procurement Coordinator should?
A. Start vasopressin B. Continue the present treatment C. Initiate T4 protocol D. Give 1L crystalloid bolus over 1 hr Answer - Continue the present treatment Which of the following would be effective in resuscitating an organ donor during cardiac arrest?
- Atropine
- Epinephrine
- Lidocaine (Xylocaine)
- Isoproterenol (Isuprel) Answer - 2,3& During management of a multi-organ donor PaO2 decreased from 150 torr to 82 torr. Present ventilator settings are as follows:, FIO2-0.75 Resp. Rates 15/min Vt-750 ml PEEP 5cm H The coordinator should A. Repeat ABG B. Obtain CXR C. Auscultate the chest D. Increase TV Answer - Auscultate the chest ABG result are obtained on a donor: Ph-7. PaCO2- PAO2- HCO3- SaO2- This ABG shows what? Answer - Metabolic Acidosis A donor's chest X-ray reveals a 25% pneumothorax following the insertion of a CVP. The Coordinator should: A. Increase TV B. Draw ABG C. Arrange for chest tube placement D. Monitor for pneumo progression Answer - Arrange for chest tube placement What medication is most effective in treating bradycardia in a donor? Answer - Isuprel A 2 y/o donor is being maintained on pressure-controlled ventilation and has a SaO2-88%. What should the Procurement Coordinator do FIRST? Answer - Assess the patient's pulmonary status A 23 y/o male -MVA, evaluation for donor. The donor is oliguria with a current serum creatinine-2.5 mg/dl. Donor is normotensive and has no inotropic support. I.V. fluids- 120 cc/hr, Wedge is 18mmHg. Following a fluid bolus and the administration of 20mg furosemmide (Lasix), the donor remains with oliguria and a repeate Serumn creatinine is 2.9. The coordinator should administer Answer - 40 mg Lasixs
During the in situ flushing of a kidney only recovery, a poor flow rate is noted. The most common cause is: Answer - Vascular resistance Unexpected delays occur in starting the tissue recovery after organ donation. To foster a relationship with the Funeral Director, the Coordinator should: Answer - Call and explain the delay, then follow with a letter Which of the following methods of packaging kidney recovered for transplantation is allowed by UNOS policy? Answer - The kidney has 3 sterile barriers and is placed in a rigid containor. After transporting a donor from ICU to the OR, the 02 saturation dropped significantly. Despite an FIO2 setting of 100 % in the OR, the 02 saturation remains low. The Procurement Coordinator should first asses for Answer - A displaced ET tube Just prior to leaving the ICU, 40 y/o female donor, with BP 110/70, HR 100 bmp, and she is on 5mcg/kg/min of Dopamine. During transport to the Operating room the Procurement Coordinator notices that the BP has fallen to 80/40, HR 150 bpm. Which of the following is the best action for that Coordinator? A. Return to ICU for evaluation B. Increase dopamine to 15mck/kg/min C. Administer 1mg of Epi D. Check all IV lines to ensure patency Answer - Check all IV lines to ensure patency All of the following are acceptable for proper packaging of a kidney except: A.3 sterile plastic bags B. 2 sterile plastic bags inside a rigid sterile container C. 3 sterile plastic bags inside a non-sterile rigid container D. A small, sterile rigid container inside a sterile plastic bag, inside another sterile plastic container Answer - A.3 sterile plastic bags Collins, Via Span and cardioplegia should not be used for volume expansion because they are: A. Expensive B. Hypotonic solutions C. Hyperkalemic solutions D. Only effective at 4 degrees centigrade Answer - C. Hyperkalemic solutions A donor with ventricular tachycardia systolic pressure of 50mmHg when transferred to OR bed. Attempts to resuscitate fall and the donor becomes asystolic. As the liver recovery surgeon preps and drapes for an emergent organ recovery, the Coordinator should facilitate which of the following?
- External cardiac massage
- Notation of cardiac arrest time
- Systemic heparinization
- Notification of OPO Administrator Answer - 1,2&
A donor becomes asystolic while on the OR table and is not responding to ACLS protocol. Which of the following should be administered quickly to increase the likelihood that the kidneys will be suitable for transplantation? A. Heparin B. Verapamil (Calan) C. Epinephrine D. Phentolamine (Regitine) Answer - А. Нераrin A 2 y/o donor arrives in the OR with a single 20 gauge peripheral IV. BP 85/59 and serum potassium of 3.2 mEq/L. The Procurement Coordinator should recommend which of the following first? A. Administer KCL B. Obtain additional IV Access C. Repeate serum K D. Admin vasopressors Answer - B. Obtain additional IV Access Rate Formula Answer - New RR= (current rate X current CO2)/ TV Formula Male Answer - 50 + 2.3 (height" - 60) TV Formula Female Answer - 45.5 (height" - 60) HBsAg: neg Anti-HBc: neg Anti-HBs: neg Answer - Suseptible HBsAg: neg Anti-HBc: pos Anti-HBs: pos Answer - Immune due to natural infection HBsAg: neg Anti-HBc: neg Anti-HBs: pos Answer - Immune due to hep B vax HBsAg: pos Anti-HBc: pos IgM anti-HBc: pos Anti-HBs: neg Answer - Acutely infected HBsAg: pos Anti-HBc: pos IgM anti-HBc: neg Anti-HBs: neg Answer - Chronically infected HBsAg: neg Anti-HBc: pos Anti-HBs: neg Answer - Interpretation unclear This legislation was passed to improve the and tissue allocation after successful heart and kidney system for organ, eye, transplants:
Hospital and OPO brain death policies are created following guidelines set forth by these entities: (select all that apply) a. The American Association of Critical Care Nurses (AACN) b. The Uniform Anatomical Gift Act (UAGA) c. The American Medical Association (AMA) d. The American Association of Pediatrics (AAP) Answer - The Uniform Anatomical Gift Act (UAGA) The American Medical Association (AMA) The American Association of Pediatrics (AAP) This legislation provides reimbursement for organ transplantation and costs associated with donation: a. The Uniform Anatomical Gift Act (UAGA) b. The End Stage Renal Disease Act (ESRD) c. The Uniform Determination of Death Act (UDDA) d. The National Organ Transplant Act (NOTA) Answer - The End Stage Renal Disease Act (ESRD) The OPO is paid directly for costs associated with transplantation, except brain death testing, by: a. The Centers for Medicare and Medicaid Services (CMS) b. The transplant center recovering and accepting an organ c. The recipient's insurance carrier d. The donor's insurance carrier Answer - The transplant center recovering and accepting an organ This legislation requires hospitals who participate with Medicare or Medicaid to call the OPO to refer a patient who meets clinical triggers: a. The Uniform Anatomical Gift Act (UAGA) b. The End-Stage Renal Disease Act (ESRD) c. The Omnibus Reconciliation Act of 1986 d. The National Organ Transplant Act (NOTA) Answer - The Omnibus Reconciliation Act of 1986 This legislation provides a medically sound base for determining death: a. The Uniform Anatomical Gift Act (UAGA) b. The End-Stage Renal Disease Act (ESRD) c. The Uniform Determination of Death Act (UDDA) d. The National Organ Transplant Act (NOTA) Answer - The Uniform Determination of Death Act (UDDA) _________________ are key contacts within hospitals who are especially passionate about and support organ donation and want to advocate on its behalf. Answer - Donor Champions Referral/clinical triggers include: (select all that apply) a. Family decision to withdraw care b. Absence of 2 or more brainstem reflexes c. GCS 5T or less d. Neurological injury or insult Answer - Family decision to withdraw care
Absence of 2 or more brainstem reflexes GCS 5T or less Neurological injury or insult The first non-steroidal immunosuppressive drug which promoted an unprecedented number of successful heart transplants and helped donation and transplantation rates to soar. a. Penicillin b. Cyclosporine c. Tacrolimus d. Azathioprine Answer - Cyclosporine This legislation provided federal grants to OPOS which helped them become reputable and established in every State. a. National Organ Transplant Act (NOTA) b. The Omnibus Reconciliation Act of 1986 c. The End Stage Renal Disease Act (ESRD) d. Anatomical Gift Act (UAGA) The Uniform Answer - National Organ Transplant Act (NOTA) This legislation called for a national network to coordinate clinical data about donors, the allocation of organs and collect candidates, and recipients. a. National Organ Transplant Act (NOTA) b. The Omnibus Reconciliation Act of 1986 c. The End Stage Renal Disease Act (ESRD) d. The Uniform Anatomical Gift Act (UAGA) Answer - National Organ Transplant Act (NOTA) The United Network for Organ Sharing (UNOS) was established to: (select all that apply) a. Coordinate the allocation of organs b. Collect clinical data about donors, candidates, and recipients c. Manage disagreements between OPOS and transplant centers d. Outlaw the sale of organs Answer - Coordinate the allocation of organs Collect clinical data about donors, candidates, and recipients Outlaw the sale of organs UNOS was awarded the federal contract which holds them responsible for allocation policy, organ placement, data collection and analysis, and public and professional education regarding organ transplantation. This contract is called: a. The Allocation and Recovery Contract (ARC) Agreement (DAEA) b. The Data Analysis and Education c. The Organ Procurement Transplant Network (OPTN) d. The Education and Allocation Agreement (EAA) Answer - The Organ Procurement Transplant Network (OPTN) The Omnibus Reconciliation Act of 1986 was passed to: (select all that apply) a. Ensure no more than one OPO operates per service area (DSA) b. Hospitals who comply with CMS have policies for organ donation and that referrals are made when clinical triggers are met within a specified timeframe
c. The Brain Death Act (BDA) d The Uniform Determination of Death Act (UDDA) Answer - The Centers for Medicare and Medicaid Conditions of Participation (CMS) A 75-year-old male who is declared brain dead per hospital policy is classified as: a. Eligible b. Neither c. Imminent Answer - Neither A 60-year-old female with overwhelming sepsis and multi-system organ failure is classified as: a. Eligible b. Neither c. Imminent Answer - Neither A 28-week-old infant who is declared brain dead is classified as: a. Eligible b. Neither c. Imminent Answer - Neither A 30-year-old male with no cough/gag, pupils are fixed/dilated, and is not overbreathing the ventilator, but is not formally declared is classified as: a. Eligible b. Neither c. Imminent Answer - Imminent A 40-year-old female who is declared brain dead but the family declines donation is classified as: a. Eligible b. Neither c. Imminent Answer - Eligible The percentage of referred patients divided by all missed and referred patients: a. Referral rate b. Timely referral с. Consent rate d. Conversion rate e. Organs transplanted per donor Answer - Referral rate Amount of organs transplanted per single donor: a. Referral rate b. Timely referral c. Consent rate d. Conversion rate e. Organs transplanted per donor Answer - Organs transplanted per donor There are five main classifications of immunoglobulins, what are they and what do they mean? Answer - IgM - Recent Infection IgG - Old Infection IgE - Allergies IgA - saliva, beast milk, or other secretions
IgD - Antigen receptor or lymphocyte membranes Serologies required in Tissue and Organ donors Answer - HIV 1&2 ELIZA HIV Western Blot HTLV 1& RPR/VDRL CMV EBV HbsAG HBcAB HBsAB HCV HIV NAT HCV NAT HBV NAT
