Certified Clinical Transplant Nurse MCQ Flashcards

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 laboratory trend is MOST consistent with calcineurin inhibitor (CNI) nephrotoxicity in a stable kidney transplant recipient?

Answer: Gradual creatinine rise with supratherapeutic CNI trough levels and no proteinuria

CNI nephrotoxicity typically presents as a gradual, dose-dependent rise in creatinine associated with elevated drug troughs, without the systemic signs of 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.

A renal transplant nurse notes a recipient's urine output drops from 200 mL/hr to 20 mL/hr at post-operative hour 6. What is the PRIORITY intervention?

Answer: Check for Foley catheter kinking or obstruction first

The first step in evaluating sudden oliguria post-transplant is to rule out a mechanical cause such as Foley catheter obstruction, which is common and easily correctable.

A liver transplant recipient on tacrolimus is started on fluconazole for a fungal infection. What does the nurse anticipate?

Answer: Tacrolimus levels will increase due to CYP3A4 inhibition

Fluconazole is a potent CYP3A4 inhibitor that markedly reduces tacrolimus metabolism, causing drug levels to rise and increasing the risk of toxicity.

Which donor-derived infection poses the HIGHEST risk of undetected transmission during the standard infectious disease screening window period?

Answer: HIV during acute infection (NAT window period)

HIV NAT testing has a window period during acute infection when viral load may be below detection limits, making recent high-risk donor behavior the primary residual transmission risk.

When assessing a transplant candidate's psychosocial readiness, which factor is considered an ABSOLUTE contraindication by most transplant programs?

Answer: Active substance use disorder with ongoing use and denial

Active, ongoing substance use disorder — particularly with denial — represents an absolute contraindication at most centers because it directly predicts post-transplant non-adherence and poor outcomes.