Certified Clinical Transplant Nurse MCQ 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.

Which condition is BK polyomavirus nephropathy MOST likely to be mistaken for on kidney transplant biopsy, creating a diagnostic challenge?

Answer: Acute cellular rejection (T-cell mediated)

BK nephropathy causes tubulitis and interstitial nephritis that histologically mimics acute T-cell-mediated rejection, but treatment differs radically — steroids for rejection vs. immunosuppression reduction for BK.

A living-donor kidney transplant is being planned. Which statement BEST describes the nurse's role in donor evaluation and advocacy?

Answer: The nurse serves as an independent donor advocate, ensuring the donor's consent is fully informed, voluntary, and free of coercion

The transplant nurse and the independent donor advocate (IDA) role ensure that living donors are fully informed of all risks and that donation is voluntary and uncoerced, protecting donor autonomy.

A liver transplant patient taking mycophenolate mofetil (MMF) develops severe diarrhea. What is the MOST appropriate nursing response?

Answer: Notify the transplant team; MMF dose reduction or conversion to enteric-coated mycophenolate sodium may be indicated

GI toxicity (diarrhea, nausea) is the most common MMF side effect and can lead to dehydration and non-adherence; dose reduction or formulation change requires transplant team evaluation to avoid compromising immunosuppression.

Which statement is TRUE regarding expanded criteria donors (ECD) for kidney transplantation?

Answer: ECD kidneys carry higher risk of delayed graft function but remain preferable to continued dialysis for most recipients

ECD kidneys (from donors >60 or >50 with comorbidities) have higher rates of delayed graft function and reduced long-term survival, but for most dialysis patients the survival benefit of transplantation outweighs this risk.

A heart transplant nurse is teaching a recipient about cardiac allograft vasculopathy (CAV). Which statement BEST describes CAV?

Answer: CAV is a diffuse, chronic immune-mediated coronary artery disease that is the leading cause of late graft loss in heart recipients

CAV is a diffuse, concentric intimal hyperplasia of coronary vessels driven by chronic allograft immune injury and is the leading cause of death beyond the first year post-heart 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.