Item

Pre-

test

Post-

test

Improvement

rate

I. True/false questions

1.       Water-soluble povidone-iodine solution and physiological saline are used to disinfect the transplanted arm every day before an aseptic dressing change is performed.

31.6%

89.5%

↑57.9%

2.       Blood is drawn 1 hour after taking the anti-rejection drug Prograf to measure FK506 and the therapeutic concentration is 5–20.

63.2%

84.2%

↑21%

3.       Grapefruit (juice) must be avoided during treatment with the anti-rejection drug Prograf, as grapefruit contains a flavonoid that will affect important enzymes in the liver and interact with the drug.

100%

100%

0%

4.       It is recommended that the anti-rejection drug Prograf be taken after meals and the drug should be taken quickly if missed. If the time to the next dose is less than 4 hours, the missed dose should be omitted and the next dose should be taken as scheduled. Avoid taking a double dose of the drug.

63.2%

84.2%

↑21%

5.       Prednisolone can inhibit T-lymphocyte division and interleukin-2 production to achieve immunosuppressant and anti-inflammatory effects.

94.7%

100%

↑5.3%

6.       The skin is the major site of acute rejection reactions and should be observed in every shift.

94.7%

94.7%

0%

7.       We must administer antibiotics and increase the immunosuppressant dose when skin inflammation or necrosis and fever occurs.

21.1%

84.2%

↑63.1%

8.       Anti-rejection drugs for hand transplantation must be taken for life; antibiotics and antiviral prophylaxes must be taken for 3–6 months.

89.5%

89.5%

0%

9.       Blood is drawn 30 minutes before dosing to measure Prograf and Certican concentration (peak blood concentration).

10.5%

100%

↑89.5%

10.    An A-line or IC must not be performed in the hand-transplant graft site.

89.5%

100%

↑10.5%

II. Multiple-choice questions

1.       Which of the following are symptoms of acute rejection reaction after allogeneic arm transplantation: (A) Fever; (B) Dark urine; (C) Swelling in the transplanted arm; (D) All of the above.

94.7%

94.7%

0%

2.       Which of the following are not symptoms of venous thrombosis in the transplanted arm: (A) The transplanted arm appears dark purple; (B) Decreased skin temperature; (C) No bleeding at the injection site; (D) Pulse cannot be detected in Doppler ultrasound.

42.1%

84.2%

↑42.1%

3.       Which of the following are not symptoms of arterial thrombosis in the transplanted arm: (A) The transplanted arm appears pale; (B) Capillary filling is under 1 second; (C) Finger pulp depression; (D) Decreased or no bleeding in the injection site.

68.4%

84.2%

↑15.8%

4.       Which of the following are postoperative care precautions for allogeneic arm transplantation: (A) Visitors should be restricted and must wear a cap, mask, isolation gown, and slippers in the changing room when entering the ward; (B) Ward temperature should be maintained at < 23℃ to decrease the likelihood of pathogen growth; (C) Patients can enter wards with many patients after surgery but the patients in neighboring beds should be free from infection symptoms; (D) Nurses with colds can still care for patients if they wear masks.

94.7%

0%

5.       Which of the following are postoperative dietary precautions for allogeneic arm transplantation:

(A)    Only meals designated for hand-transplantation patients can be consumed in the hospital.

(B)    Patients must drink at least 2000 ml of mineral water daily.

(C)    Patients must avoid spicy and cold, alcohol-containing, and caffeine-containing foods.

(D)    Outside food can be purchased and used directly if the materials are fresh and the cooking process is clean.

100%

↑26.3%

6.       What are the time points for skin-tissue sectioning?

(A)    Once a week during the first month

(B)    Once every month for 6 months

(C)    Once every 3 months for 2 years

(D)    All of the above

73.7%

94.7%

↑21%

7.       Which of the following are hand-transplant rejection complications?

(A)    Acute cellular rejection;

(B)    Vascular embolism

(C)    Graft versus host disease (GVHD)

(D)    Post-transplant lymphoproliferative disorders (PTLD)? a) a + b, b) a + b + c

(E)    All of the above

(F)     None of the above

94.7%

94.7%

0%

8.       Which immunosuppressants are calcineurin inhibitors (CNIs)?

(A)    Anti-thymocyte globulin (ATG)

(B)    Prograf

(C)    Simulect

(D)    Cellcept

52.6%

84.2%

↑31.6%

9.       Neurotoxicity (e.g., hand numbness or tremors) and increased carcinogenicity risk (e.g. Skin cancer) are the side effects of which of the following immunosuppressants?

(A)    Prograft

(B)    Certican

(C)    Cellcept

(D)    Myfortic

52.6%

84.2%

↑31.6%

10.    Which of the following are recipient criteria?

(A)    Aged 18–65 years

(B)    Hepatitis B or C can be present

(C)    Requires professional evaluation by two psychiatrists

(D)    The ABO blood type, gender, and skin color of the donor must match the recipient

(E)    All of the above

57.9%

84.2%

↑26.3%

Mean accuracy

68.2%

91.3%

23.1%