NURS5463 EXAM 4 FINAL PAPER 2026 SOLVED
QUESTIONS AND FULL SOLUTION UPDATED
◉ kidney: time to preserve the organe before retransplantation.
Answer: 48-72 hours.
◉ histocompatibility: immune consideration.
Answer: immunologic similarities between cells that allow body to
distinguish self from non-self. ID'd through Human leukocyte
antigens (HLA) of donor and recipient.
◉ crossmatching: immune consideration.
Answer: (tissue typing): tests potential recipients for antidonor
(preformed) antibodies. Increased from prior transplants, blood
transfusions or pregnancy.
◉ ABO tying: immune consideration.
Answer: same as blood typing.
◉ immunologcail consideration for transplantion.
Answer: histocompatibility. crossmatching. ABO tying
,◉ Determination of need/Who becomes the recipient?.
Answer: End stage organ failure. Short life expectancy...6 - 12
months. Severe functional disability. No additional serious health
problems. Psychological readiness.
◉ Potential Recipient Evaluation: assess.
Answer: Clinical status. Nutritional status. Psychological status.
Financial status.
◉ post transplant complications: technical complications.
Answer: Vascular thrombosis (early)-Treat with thrombectomy and
anticoagulation
Bleeding-Manage as any surgical patient
Anastomosis leak (1 -3 weeks after transplant)-Due to poor healing,
need surgical repair.
◉ Type III hypersensitivity response.
Answer: Minutes to hours post-transplant. B-lymphocytes are
activated to produce antibodies. Rare these days due to HLA and
ABO typing.
◉ Type IV hypersensitivity.
Answer: Sudden onset days or months post- transplant. Cell-
mediated immune response
,T-lymphocytes and macrophages of host (recipient) attack and
destroy the graft (donor) tissue
Graft HLA antigens are recognized as non-self. Requires early
recognition and treatment, for organ to be preserved!
◉ Chronic Graft Rejection. Humeral response.
Answer: Antibodies slowly attack graft. May occur any time and take
years to render graft
nonfunctional. Organ becomes ischemic and dies
◉ calcineurin inhibitors.
Answer: Suppresses cytotoxic T and B cells. They DO NOT suppress
bone marrow function! Considered most effective of the
immunosuppressants . Three major drugs in this group:
Cyclosporine (Sandimmune, Neoral). Highly incompatible with other
drugs!
Tacrolimus (Pro-graf, FK-506)
Sirolimus (Rapamune, Rapamycin) {kidney transplant rejection
only}. Adverse Effects:Infection, nephrotoxicity , cancer. Need to
closely monitor levels.
◉ glucocorticoid for immunosuppressant.
Answer: Prednisone (Deltasone); Methylprednisolone (Solu-
Medrol). Adverse effects: Delayed wound healing, increased chance
, of dehiscence, Cushing's, gastric ulcers. Nursing Implications: Pt
teaching: Do not stop abruptly, take w/ milk or food. Monitor BS, BP,
Wt, E-lytes.
◉ cytotoxic agents for immunosuppression.
Answer: Mycophenolate mofetil (MMF, CellCept). Adverse effects::
Bone marrow suppression, infection, N/V/D. Nursing Implications:
Monitor CBC, LFTs, GI sensitivity.
◉ monoclonal and polyclonal antibodies.
Answer: Muromonab-CD3 (Orthoclone OKT3); daclizumab
(Zenapax); basiliximab (Simulect). Muromonab-CD3 (Orthoclone
OKT3). "First-dose effect" aka cytokine-release syndrome (CRS).
N/V, chills, chest pain, dyspnea. Treat prophylactically w/ Tylenol,
Benadryl, IV steroids. Adverse effects of Monoclonal & Polyclonal.
Antibodies: Anaphylaxis, infection. Nursing Implications: OKT3-
administer prophylactic meds. Have EPI CPR equipment available.
Monitor for adverse effects.
◉ immunosppuressant related problems..
Answer: Infection...leading cause of M&M post transplant;
cytomegalovirus (CMV), aspergillus. Low grade fever (1005),
tachypnea, pain, fatigue, tachycardia. Organ
dysfunction...nephro/hepatotoxicity. Malignancy...lymphomas,
Kaposi's sarcoma, squamous cell (skin); much higher rates than
general population. Post-transplant diabetes (PTDM)...↓ insulin
QUESTIONS AND FULL SOLUTION UPDATED
◉ kidney: time to preserve the organe before retransplantation.
Answer: 48-72 hours.
◉ histocompatibility: immune consideration.
Answer: immunologic similarities between cells that allow body to
distinguish self from non-self. ID'd through Human leukocyte
antigens (HLA) of donor and recipient.
◉ crossmatching: immune consideration.
Answer: (tissue typing): tests potential recipients for antidonor
(preformed) antibodies. Increased from prior transplants, blood
transfusions or pregnancy.
◉ ABO tying: immune consideration.
Answer: same as blood typing.
◉ immunologcail consideration for transplantion.
Answer: histocompatibility. crossmatching. ABO tying
,◉ Determination of need/Who becomes the recipient?.
Answer: End stage organ failure. Short life expectancy...6 - 12
months. Severe functional disability. No additional serious health
problems. Psychological readiness.
◉ Potential Recipient Evaluation: assess.
Answer: Clinical status. Nutritional status. Psychological status.
Financial status.
◉ post transplant complications: technical complications.
Answer: Vascular thrombosis (early)-Treat with thrombectomy and
anticoagulation
Bleeding-Manage as any surgical patient
Anastomosis leak (1 -3 weeks after transplant)-Due to poor healing,
need surgical repair.
◉ Type III hypersensitivity response.
Answer: Minutes to hours post-transplant. B-lymphocytes are
activated to produce antibodies. Rare these days due to HLA and
ABO typing.
◉ Type IV hypersensitivity.
Answer: Sudden onset days or months post- transplant. Cell-
mediated immune response
,T-lymphocytes and macrophages of host (recipient) attack and
destroy the graft (donor) tissue
Graft HLA antigens are recognized as non-self. Requires early
recognition and treatment, for organ to be preserved!
◉ Chronic Graft Rejection. Humeral response.
Answer: Antibodies slowly attack graft. May occur any time and take
years to render graft
nonfunctional. Organ becomes ischemic and dies
◉ calcineurin inhibitors.
Answer: Suppresses cytotoxic T and B cells. They DO NOT suppress
bone marrow function! Considered most effective of the
immunosuppressants . Three major drugs in this group:
Cyclosporine (Sandimmune, Neoral). Highly incompatible with other
drugs!
Tacrolimus (Pro-graf, FK-506)
Sirolimus (Rapamune, Rapamycin) {kidney transplant rejection
only}. Adverse Effects:Infection, nephrotoxicity , cancer. Need to
closely monitor levels.
◉ glucocorticoid for immunosuppressant.
Answer: Prednisone (Deltasone); Methylprednisolone (Solu-
Medrol). Adverse effects: Delayed wound healing, increased chance
, of dehiscence, Cushing's, gastric ulcers. Nursing Implications: Pt
teaching: Do not stop abruptly, take w/ milk or food. Monitor BS, BP,
Wt, E-lytes.
◉ cytotoxic agents for immunosuppression.
Answer: Mycophenolate mofetil (MMF, CellCept). Adverse effects::
Bone marrow suppression, infection, N/V/D. Nursing Implications:
Monitor CBC, LFTs, GI sensitivity.
◉ monoclonal and polyclonal antibodies.
Answer: Muromonab-CD3 (Orthoclone OKT3); daclizumab
(Zenapax); basiliximab (Simulect). Muromonab-CD3 (Orthoclone
OKT3). "First-dose effect" aka cytokine-release syndrome (CRS).
N/V, chills, chest pain, dyspnea. Treat prophylactically w/ Tylenol,
Benadryl, IV steroids. Adverse effects of Monoclonal & Polyclonal.
Antibodies: Anaphylaxis, infection. Nursing Implications: OKT3-
administer prophylactic meds. Have EPI CPR equipment available.
Monitor for adverse effects.
◉ immunosppuressant related problems..
Answer: Infection...leading cause of M&M post transplant;
cytomegalovirus (CMV), aspergillus. Low grade fever (1005),
tachypnea, pain, fatigue, tachycardia. Organ
dysfunction...nephro/hepatotoxicity. Malignancy...lymphomas,
Kaposi's sarcoma, squamous cell (skin); much higher rates than
general population. Post-transplant diabetes (PTDM)...↓ insulin
