Certified Clinical Transplant Nurse Flashcards

A lung transplant recipient develops a new obstructive pattern on pulmonary function testing at 18 months post-transplant with an FEV1 decline of 25% from baseline. This is MOST consistent with:

Answer: Bronchiolitis obliterans syndrome (BOS)

Bronchiolitis obliterans syndrome is the most common form of chronic lung allograft dysfunction, characterized by progressive obstructive airflow decline.

Which electrolyte abnormality is MOST commonly associated with tacrolimus and cyclosporine use in transplant recipients?

Answer: Hyperkalemia

Calcineurin inhibitors cause hyperkalemia by impairing renal tubular potassium excretion through aldosterone inhibition and direct tubular effects.

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.

The primary purpose of panel reactive antibody (PRA) testing in transplant candidates is to:

Answer: Identify pre-formed antibodies that could cause hyperacute rejection

PRA testing detects pre-formed donor-specific antibodies (DSA) that can mediate hyperacute or antibody-mediated rejection upon exposure to the donor organ.

A post-liver transplant patient on prednisone and tacrolimus reports new-onset polydipsia, polyuria, and fatigue. Fasting glucose is 210 mg/dL. The MOST likely diagnosis is:

Answer: New-onset diabetes after transplantation (NODAT)

New-onset diabetes after transplantation (NODAT) is common and is driven by glucocorticoid-induced insulin resistance and calcineurin inhibitor-mediated beta-cell toxicity.

In organ procurement, the term 'cold ischemia time' refers to:

Answer: Time from organ perfusion with cold preservation solution to revascularization in the recipient

Cold ischemia time begins when the organ is flushed with cold preservation solution and ends when blood flow is restored to the organ in the recipient.

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.