- Email: [email protected]
Examination: What is New with Renal Transplantation?
MAY 2003, VOL 77, NO 5
Examination WHAT IS NEW WITH RENAL TRANSPLANTATION?
1.Transplantation success rates vary depending on the cause of renal failure. The highest success rate for renal transplantation is found in patients with a. cystic kidney disease. b. diabetes. c. hypertension. d. obstructive nephropathy. 2.All of the following issues describe using a cadaveric donor for renal transplantation except a. there is a possible long waiting period for a suitable donor. b. one year graft survival rate is 88%. c. the surgical procedure is planned. d. postoperative complications are greater. 3.The term required request legislation describes federal and state laws that make it optional for hospitals to establish protocols ensuring that family members of potential donors are offered the option of donation. a. true b. false
4.
immune response occurs when antibodies are produced that can destroy a transplanted graft rapidly and result in hyperacute rejection. a. Celosomic b. Cellular c. Human prion d. Humoral
5.Mixed lymphocyte culture testing a. identifies preformed, circulating cytotoxic antibodies in the recipient that can form after blood transfusions, pregnancies, infections, or previous transplantations. b. determines the degree of compatibility between the donor and recipient without defining the exact antigens responsible. c. identifies the donor’s and recipient’s specific human leukocyte antigens. d. ensures red blood cell compatibility between
donor and recipient. 6.Chronic renal failure (CRF) is a progressive deterioration of renal hnction that ends in uremia, which is defined as a. an excess of urea and other nitrogenous wastes in the blood. b. an inflammation of the glomerulus of the kidney, characterized by proteinuria and edema. c. the abnormal presence of fluid in the peritoneal cavity of patients undergoing hemodialysis. d. a diffuse pyogenic infection of the pelvis and parenchyma of the kidneys. 7.All of the following are appropriate interventions for the nursing diagnosis “risk of fluid volume deficit or excess related to chronic renal failure” except a. auscultate lung fields for rales. b. administer analgesics and provide massage for muscle cramps. c. evaluate for signs and symptoms of hyperkalemia and monitor serum potassium levels. d. inspect neck veins for engorgement and extremities for edema. 8.According to the clinical pathway for the patient undergoing renal transplantation, providing patient and family member teaching regarding the procedure, potential for rejection, and postoperative commitments and requirements begins during the phase. a. preoperative b. intraoperative c. closure d. discharge
9.
is a condition usually associated with prolonged cold ischemia of the graft. This condition is reversible if diagnosed and treated before severe damage has occurred. a. Chronic tubular necrosis b. Chronic glomerulonephritis c. Acute tubular necrosis
967 AORN JOURNAL
MAY 2003, VOL 77, NO 5
d. Postinfectious glomerulonephritis
rejection by blocking T cell function. a. acyclovir b. clotrimazole c. famotidine d. muromonab-CD3
1Qlf acute tubular necrosis occurs postoperatively, a series of IV injections of the immunosuppressant is initiated to reverse graft AORN is occredited 0s o provider of continuing nursing educotion by the American Nurses Credentioling Center's Commission on Accreditotion.AORN recognizes these activities 0s continuing education for RNs. This recognition does not imply thut AORN or the
American Nurses Credentiuling Center opproves or endorses products mentioned in the activiiy. AORN is provider-approved by the Colifornio Board of Registered Nursing, Provider Number CEP 13019.
US Food and Drug Administration Begins New Initiative The US Food and Drug Administration (FDA) has begun an initiative to make innovative medical technologies available sooner, according to a Jan 3 I , 2003, news release from the agency. Another aim of the initiative is to reduce the costs of developing safe, effective medical products; however, the FDA does plan to maintain its high standard of consumer protection. All of the FDA's medical product review centers (ie, medications, biologics, devices, veterinary medicine) will be involved in the initiative. The initiative will be developed collaboratively with other government agencies, including the National Institutes of Health. The FDA plans to achieve its goals by reducing delays and avoidable product development costs by avoiding multiple cycles of FDA review through early communication and other efforts to improve the quality of new product applications, improving the quality and efficiency of the review process through adoption of a quality systems approach to medical product reviews, and facilitating new product development through provision of clear, up-to-date guidance for specific diseases and emerging technology. To meet its first objective, the FDA will examine the reasons why some product approvals require more than one review cycle. A savings of $100 million in development costs per approved medication could be realized by cutting total clinical development and regulatory review time by 25%. Possible solutions include improving the quality and frequency of communication between the FDA and sponsors of medications, biological products, and medical devices and implementing a continuous marketing application pilot project.
To meet its second objective, the FDA will establish a continuous improvement/quality systems approach to medical product reviews. This system will enhance reviewer training on review practices, institute peer review, and further develop review standards. A system such as this should result in a more efficient review process, a better scientific and professional environment for reviewers, and stronger, well-integrated review divisions. To meet its third objective, the FDA will publish clearer guidance for product approvals designed to help innovators develop new products and marketing applications for particular diseases. Guidance also will be directed at improving the review process for emerging technologies. The FDA expects to create work groups of experts from across the country to create guidance for dealing with specific diseases. The agency's proposed actions can be found in the report titled Improving Innovation in Medical Technology: Beyond 2002 (ie, http://www.fda.gov /bbs/topics/NEWS/2003/beyond2002/report.html). The report also summarizes the FDA's product review performance for 2002. Results for the past year are mixed, with an increased number of total products approved but a decrease in the number of marketing applications and longer total approval times in some significant product areas (eg, new molecular entities for medications, class I11 medical devices). FDA Launches Initiative to Improve the Development and Availability of Innovative Medical Products (news release, Rockville, Md: US Food and Drug Administration, Jan 3 I , 2003) h i @ : / , .fda.gov/bbs/topic~EWS/2003 flEW00867.him1 (accessed 10 Feb 2003).
968 AORN JOURNAL
MAY 2003, VOL 77, NO 5
Answer Sheet WHAT IS NEW WITH RENAL TRANSPLANTATION?
lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2 170 S Parker Rd, Suite 300 Denver, CO 8023 1-571 1 or fax with credit card information to (303) 750-3212.
ID Number
c]oO00000000
A score of 70% correct on the examination is required for credit. Additionally, please verify by signature that you have reviewed the objectives and read the article, or you will not receive credit.
Session Number
i
0000000000 0000000000 0000000000 0000000000
Event # 03084 Session #7467 Contact hours: 5.5 Fee: Members $27.50; Nonmembers $55
Mark only one answer per question. 1 @ @ @ @ @ 11 @ @ @ @ @ 2 @ @ @ @ @12@@@@@ 3@@@@@ 13@@@@@ 4 @ @ @ @ @ 14@@@@@ 5@@@@@ 15@@@@@ 6@@@@@l6@@@@@ 7 @ @ @ @ @17@@@@@ 8 @ @ @ @ @ 18@@@@@ 9 @ @ @ @ @ 19@@@@@ l o @ @ @ @ @ 20@@@@@
Program offered May 2003. The deadline for this program is May 3 I , 2006. 1. Record your AORN member identification number in the appropriate section below. (See your member card.) 2. Completely darken the spaces that indicate your answers to examination questions one through 10. Use blue or black ink only. 3. Our accrediting body requires that we verify the amount of time you required to complete this 5.5 contact hour (275 minutes) program. 4. Enclose fee if information is mailed. AORN (ID) # Name Address City State RN license # State Phone number (
Fee enclosed or bill the credit card indicated MC 0Visa American Express Card # Expiration date Signature
Zip
)
(for credit card authnr17altion)
969 AORN JOURNAL
0Discover
MAY 2003, VOL 77, NO 5
Learner Evaluation WHAT IS NEW WITH RENAL TRANSPLANTATION?
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5 . OBJECTIVES
To what extent were the following-objectives of this . Study Program achieved? Describe the history of renal transplantation based on end-stage renal disease. Describe the history of renal organ donation. Explain how compatibility testing helps minimize the risk of organ rejection. Describe chronic renal failure. Differentiate between the procedure to harvest a cadaveric versus living-related donor kidney. Describe the procedure to transplant a donated kidney into a recipient. Describe the postoperative course of a patient after having undergone renal transplantation.
w
Session Number
-
0000000000~ 0000000000 0000000000 0000000000
(Lorvj (High) (Low) L
PURPOSEIGOAL
To educate the perioperative nurse about advances in renal transplantation. CONTENT
(8) Did this article increase your knowledge of the subject matter? (9)Was the content clear and organized? (10) Did this article facilitate learning? (1 1) Were your individual objectives met? (12) How well did the objectives relate to the overall purpose/goal? TEST OUESTIONS/ANSWERS
(1 3) Were they reflective of the content? (14) Were they easy to understand? (1 5) Did they address important points? LEARNER INPUT
( 1 6) Will you be able to use the information from
this Home Study in your work setting? a. yes b. no (1 7) I learned of this Home Study via a. the Journal I receive as an AORN member. b. the Journal that I obtained elsewhere. c. the AORN web site.
d. SSM Online. (1 8) What factor most affects whether you take an
AORN Journal Home Study? a. need for contact hours b. price c. subject matter relevant to current position d. number of contact hours offered What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s): Author name(s) and address(es):
970 AORN JOURNAL
Examination WHAT IS NEW WITH RENAL TRANSPLANTATION?
1.Transplantation success rates vary depending on the cause of renal failure. The highest success rate for renal transplantation is found in patients with a. cystic kidney disease. b. diabetes. c. hypertension. d. obstructive nephropathy. 2.All of the following issues describe using a cadaveric donor for renal transplantation except a. there is a possible long waiting period for a suitable donor. b. one year graft survival rate is 88%. c. the surgical procedure is planned. d. postoperative complications are greater. 3.The term required request legislation describes federal and state laws that make it optional for hospitals to establish protocols ensuring that family members of potential donors are offered the option of donation. a. true b. false
4.
immune response occurs when antibodies are produced that can destroy a transplanted graft rapidly and result in hyperacute rejection. a. Celosomic b. Cellular c. Human prion d. Humoral
5.Mixed lymphocyte culture testing a. identifies preformed, circulating cytotoxic antibodies in the recipient that can form after blood transfusions, pregnancies, infections, or previous transplantations. b. determines the degree of compatibility between the donor and recipient without defining the exact antigens responsible. c. identifies the donor’s and recipient’s specific human leukocyte antigens. d. ensures red blood cell compatibility between
donor and recipient. 6.Chronic renal failure (CRF) is a progressive deterioration of renal hnction that ends in uremia, which is defined as a. an excess of urea and other nitrogenous wastes in the blood. b. an inflammation of the glomerulus of the kidney, characterized by proteinuria and edema. c. the abnormal presence of fluid in the peritoneal cavity of patients undergoing hemodialysis. d. a diffuse pyogenic infection of the pelvis and parenchyma of the kidneys. 7.All of the following are appropriate interventions for the nursing diagnosis “risk of fluid volume deficit or excess related to chronic renal failure” except a. auscultate lung fields for rales. b. administer analgesics and provide massage for muscle cramps. c. evaluate for signs and symptoms of hyperkalemia and monitor serum potassium levels. d. inspect neck veins for engorgement and extremities for edema. 8.According to the clinical pathway for the patient undergoing renal transplantation, providing patient and family member teaching regarding the procedure, potential for rejection, and postoperative commitments and requirements begins during the phase. a. preoperative b. intraoperative c. closure d. discharge
9.
is a condition usually associated with prolonged cold ischemia of the graft. This condition is reversible if diagnosed and treated before severe damage has occurred. a. Chronic tubular necrosis b. Chronic glomerulonephritis c. Acute tubular necrosis
967 AORN JOURNAL
MAY 2003, VOL 77, NO 5
d. Postinfectious glomerulonephritis
rejection by blocking T cell function. a. acyclovir b. clotrimazole c. famotidine d. muromonab-CD3
1Qlf acute tubular necrosis occurs postoperatively, a series of IV injections of the immunosuppressant is initiated to reverse graft AORN is occredited 0s o provider of continuing nursing educotion by the American Nurses Credentioling Center's Commission on Accreditotion.AORN recognizes these activities 0s continuing education for RNs. This recognition does not imply thut AORN or the
American Nurses Credentiuling Center opproves or endorses products mentioned in the activiiy. AORN is provider-approved by the Colifornio Board of Registered Nursing, Provider Number CEP 13019.
US Food and Drug Administration Begins New Initiative The US Food and Drug Administration (FDA) has begun an initiative to make innovative medical technologies available sooner, according to a Jan 3 I , 2003, news release from the agency. Another aim of the initiative is to reduce the costs of developing safe, effective medical products; however, the FDA does plan to maintain its high standard of consumer protection. All of the FDA's medical product review centers (ie, medications, biologics, devices, veterinary medicine) will be involved in the initiative. The initiative will be developed collaboratively with other government agencies, including the National Institutes of Health. The FDA plans to achieve its goals by reducing delays and avoidable product development costs by avoiding multiple cycles of FDA review through early communication and other efforts to improve the quality of new product applications, improving the quality and efficiency of the review process through adoption of a quality systems approach to medical product reviews, and facilitating new product development through provision of clear, up-to-date guidance for specific diseases and emerging technology. To meet its first objective, the FDA will examine the reasons why some product approvals require more than one review cycle. A savings of $100 million in development costs per approved medication could be realized by cutting total clinical development and regulatory review time by 25%. Possible solutions include improving the quality and frequency of communication between the FDA and sponsors of medications, biological products, and medical devices and implementing a continuous marketing application pilot project.
To meet its second objective, the FDA will establish a continuous improvement/quality systems approach to medical product reviews. This system will enhance reviewer training on review practices, institute peer review, and further develop review standards. A system such as this should result in a more efficient review process, a better scientific and professional environment for reviewers, and stronger, well-integrated review divisions. To meet its third objective, the FDA will publish clearer guidance for product approvals designed to help innovators develop new products and marketing applications for particular diseases. Guidance also will be directed at improving the review process for emerging technologies. The FDA expects to create work groups of experts from across the country to create guidance for dealing with specific diseases. The agency's proposed actions can be found in the report titled Improving Innovation in Medical Technology: Beyond 2002 (ie, http://www.fda.gov /bbs/topics/NEWS/2003/beyond2002/report.html). The report also summarizes the FDA's product review performance for 2002. Results for the past year are mixed, with an increased number of total products approved but a decrease in the number of marketing applications and longer total approval times in some significant product areas (eg, new molecular entities for medications, class I11 medical devices). FDA Launches Initiative to Improve the Development and Availability of Innovative Medical Products (news release, Rockville, Md: US Food and Drug Administration, Jan 3 I , 2003) h i @ : / , .fda.gov/bbs/topic~EWS/2003 flEW00867.him1 (accessed 10 Feb 2003).
968 AORN JOURNAL
MAY 2003, VOL 77, NO 5
Answer Sheet WHAT IS NEW WITH RENAL TRANSPLANTATION?
lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2 170 S Parker Rd, Suite 300 Denver, CO 8023 1-571 1 or fax with credit card information to (303) 750-3212.
ID Number
c]oO00000000
A score of 70% correct on the examination is required for credit. Additionally, please verify by signature that you have reviewed the objectives and read the article, or you will not receive credit.
Session Number
i
0000000000 0000000000 0000000000 0000000000
Event # 03084 Session #7467 Contact hours: 5.5 Fee: Members $27.50; Nonmembers $55
Mark only one answer per question. 1 @ @ @ @ @ 11 @ @ @ @ @ 2 @ @ @ @ @12@@@@@ 3@@@@@ 13@@@@@ 4 @ @ @ @ @ 14@@@@@ 5@@@@@ 15@@@@@ 6@@@@@l6@@@@@ 7 @ @ @ @ @17@@@@@ 8 @ @ @ @ @ 18@@@@@ 9 @ @ @ @ @ 19@@@@@ l o @ @ @ @ @ 20@@@@@
Program offered May 2003. The deadline for this program is May 3 I , 2006. 1. Record your AORN member identification number in the appropriate section below. (See your member card.) 2. Completely darken the spaces that indicate your answers to examination questions one through 10. Use blue or black ink only. 3. Our accrediting body requires that we verify the amount of time you required to complete this 5.5 contact hour (275 minutes) program. 4. Enclose fee if information is mailed. AORN (ID) # Name Address City State RN license # State Phone number (
Fee enclosed or bill the credit card indicated MC 0Visa American Express Card # Expiration date Signature
Zip
)
(for credit card authnr17altion)
969 AORN JOURNAL
0Discover
MAY 2003, VOL 77, NO 5
Learner Evaluation WHAT IS NEW WITH RENAL TRANSPLANTATION?
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5 . OBJECTIVES
To what extent were the following-objectives of this . Study Program achieved? Describe the history of renal transplantation based on end-stage renal disease. Describe the history of renal organ donation. Explain how compatibility testing helps minimize the risk of organ rejection. Describe chronic renal failure. Differentiate between the procedure to harvest a cadaveric versus living-related donor kidney. Describe the procedure to transplant a donated kidney into a recipient. Describe the postoperative course of a patient after having undergone renal transplantation.
w
Session Number
-
0000000000~ 0000000000 0000000000 0000000000
(Lorvj (High) (Low) L
PURPOSEIGOAL
To educate the perioperative nurse about advances in renal transplantation. CONTENT
(8) Did this article increase your knowledge of the subject matter? (9)Was the content clear and organized? (10) Did this article facilitate learning? (1 1) Were your individual objectives met? (12) How well did the objectives relate to the overall purpose/goal? TEST OUESTIONS/ANSWERS
(1 3) Were they reflective of the content? (14) Were they easy to understand? (1 5) Did they address important points? LEARNER INPUT
( 1 6) Will you be able to use the information from
this Home Study in your work setting? a. yes b. no (1 7) I learned of this Home Study via a. the Journal I receive as an AORN member. b. the Journal that I obtained elsewhere. c. the AORN web site.
d. SSM Online. (1 8) What factor most affects whether you take an
AORN Journal Home Study? a. need for contact hours b. price c. subject matter relevant to current position d. number of contact hours offered What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s): Author name(s) and address(es):
970 AORN JOURNAL