Mixed Deck — All CCTN Topics Flashcards

A kidney transplant recipient presents with a creatinine that has doubled over 5 days with no fever, oliguria, or graft tenderness, and a therapeutic tacrolimus level. What is the MOST appropriate next diagnostic step?

Answer: Renal transplant biopsy to differentiate rejection from other causes

A transplant biopsy is the gold standard for diagnosing the cause of graft dysfunction and distinguishing acute rejection from CNI toxicity, BK nephropathy, or recurrent disease.

A kidney transplant patient presents with fever, dysuria, and a positive urine culture for E. coli. The transplant nurse recognizes that urinary tract infections post-transplant are particularly dangerous because:

Answer: Immunosuppression masks symptoms and increases risk of urosepsis and pyelonephritis of the allograft

Immunosuppression blunts the febrile and inflammatory response, allowing UTIs to progress rapidly to urosepsis or allograft pyelonephritis before clinical recognition.

Which side effect is most associated with long-term tacrolimus use in transplant recipients?

Answer: Hypertension and nephrotoxicity

Long-term tacrolimus use commonly causes nephrotoxicity and hypertension, both of which require ongoing monitoring in transplant recipients.

A deceased-donor organ allocation nurse receives a kidney offer for a highly sensitized patient with a panel reactive antibody (PRA) of 98%. What is the MOST critical pre-transplant test to perform?

Answer: Virtual or prospective crossmatch

In highly sensitized recipients, a virtual or prospective crossmatch is critical to detect donor-specific antibodies (DSA) that could cause hyperacute rejection.

Which term describes the phenomenon where a transplanted kidney does not function immediately after transplantation, requiring temporary dialysis?

Answer: Delayed graft function (DGF)

Delayed graft function (DGF) is when a transplanted kidney requires dialysis in the first week post-transplant, often due to ischemia-reperfusion injury.

A transplant nurse is educating a renal transplant patient about food safety. Which of the following instructions is MOST appropriate?

Answer: Raw shellfish and undercooked meats should be strictly avoided

Immunosuppressed transplant recipients are at high risk for foodborne illness from pathogens like Listeria and Vibrio, making raw shellfish and undercooked meats dangerous.

What does 'first-person consent' mean in the context of organ donation in the US?

Answer: An individual's documented decision to donate (e.g., on a driver's license) is legally binding

First-person consent means a person's registered decision to donate is legally binding and cannot be overridden by family, though family collaboration is still encouraged.

Which of the following is the most important factor in determining a patient's risk for rejection in the first year after transplant?

Answer: Number of HLA mismatches

The number of HLA mismatches between donor and recipient is the most important immunologic factor determining rejection risk in the first year post-transplant.

Under the Organ Procurement and Transplantation Network (OPTN) rules, who is legally responsible for a transplant program's compliance with OPTN policies?

Answer: The hospital's transplant program and its designated transplant physicians/surgeons

OPTN membership obligates each transplant program — including its designated transplant physicians and hospital administration — to comply with OPTN policies, with the program bearing primary accountability.

Which of the following is an absolute contraindication to living kidney donation?

Answer: Active malignancy with metastatic disease

Active malignancy, particularly with metastatic potential, is an absolute contraindication to living donation due to the risk of transmitting cancer to the immunosuppressed recipient.

What is the primary purpose of performing a liver biopsy on a donor liver before transplantation?

Answer: To assess the degree of hepatic steatosis, which affects graft function

Donor liver biopsy primarily assesses macrovascular steatosis — livers with greater than 30–40% steatosis have increased risk of primary non-function.

What is the most common reason for graft loss in long-term kidney transplant recipients related to patient behavior?

Answer: Non-adherence to immunosuppressive medications

Non-adherence to immunosuppressive medications is the leading preventable cause of late graft loss, often resulting in chronic rejection.

Which opportunistic infection prophylaxis is standard for ALL solid organ transplant recipients in the first 3–6 months post-transplant?

Answer: Trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii

TMP-SMX is universally recommended for PCP prophylaxis in all solid organ transplant recipients during the high-immunosuppression period, and also provides coverage for Toxoplasma and Nocardia.

Which of the following patients must be assigned to a surgical unit nurse who is transferred to the general unit?

Answer: Emergency appendectomy

A nurse transferred from a surgical unit would possess specialized skills and experience in surgical patient care. An emergency appendectomy patient requires post-operative care directly related to surgical recovery, making this assignment the most appropriate and within the nurse's immediate area of expertise compared to general medical conditions.

A cLean-catch midstream urine specimen for urinalysis

Answer: 18 to 25

This question is incomplete and lacks context, making a direct explanation for the answer '18 to 25' difficult in relation to 'A clean-catch midstream urine specimen for urinalysis'. Assuming there is missing information, this age range might refer to the typical age of kidney transplant recipients or donors, or perhaps a demographic group where certain medical conditions are prevalent. Without the full question, any explanation linking the prompt to the answer is speculative.

A liver transplant patient is started on sirolimus. Which side effect should the nurse educate the patient about?

Answer: Impaired wound healing and hyperlipidemia

Sirolimus commonly causes impaired wound healing and hyperlipidemia, and is often avoided in the early post-transplant period for these reasons.

A nurse is caring for a deceased-donor liver recipient whose family asks about brain death. Which explanation is MOST accurate?

Answer: Brain death is the irreversible cessation of all brain and brainstem function, meeting legal and medical criteria for death

Brain death is legally and medically defined as the irreversible cessation of all functions of the entire brain, including the brainstem, and is determined by standardized clinical criteria.

The typical length of a kidney transplant patient's hospital stay is

Answer: 7 to 10 days

Following a kidney transplant, patients typically have a hospital stay of approximately 7 to 10 days. This period is essential for close monitoring of the new kidney's function, managing post-operative pain, initiating and adjusting immunosuppressive medications, and providing comprehensive education on post-transplant care. This timeframe allows for initial graft stability and addresses immediate complications before the patient is discharged.

What does the term 'crossmatch' refer to in transplantation?

Answer: Testing recipient serum against donor lymphocytes for preformed antibodies

A crossmatch tests whether recipient serum contains antibodies that react against donor cells, predicting hyperacute rejection risk.

During the first month post-transplant, which category of infections predominates and reflects the patient's pre-transplant health status and surgical complications?

Answer: Donor-derived and recipient pre-existing infections, plus surgical-site and nosocomial infections

In the first month post-transplant, infections are similar to those in any post-surgical patient and reflect pre-existing conditions, donor-derived pathogens, and hospital-acquired organisms rather than immunosuppression-driven opportunists.