CCTN Certified Clinical Transplant Nurse 3 — Questions and Answers
Question 1: 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:
- Acute cellular rejection
- Bronchiolitis obliterans syndrome (BOS) (Correct answer)
- Pneumonia
- Pleural effusion
Correct answer: Bronchiolitis obliterans syndrome (BOS)
Bronchiolitis obliterans syndrome is the most common form of chronic lung allograft dysfunction, characterized by progressive obstructive airflow decline.
Question 2: Which electrolyte abnormality is MOST commonly associated with tacrolimus and cyclosporine use in transplant recipients?
- Hyponatremia
- Hyperkalemia (Correct answer)
- Hypophosphatemia
- Hypercalcemia
Correct answer: Hyperkalemia
Calcineurin inhibitors cause hyperkalemia by impairing renal tubular potassium excretion through aldosterone inhibition and direct tubular effects.
Question 3: A transplant nurse is educating a renal transplant patient about food safety. Which of the following instructions is MOST appropriate?
- Avoid all fresh fruits and vegetables permanently
- Raw shellfish and undercooked meats should be strictly avoided (Correct answer)
- Grapefruit is safe in small amounts if taken away from medications
- Probiotic yogurt is contraindicated in all immunosuppressed patients
Correct 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.
Question 4: The primary purpose of panel reactive antibody (PRA) testing in transplant candidates is to:
- Assess the candidate's ABO blood type compatibility
- Identify pre-formed antibodies that could cause hyperacute rejection (Correct answer)
- Determine the candidate's viral serology status
- Measure renal function prior to listing
Correct 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.
Question 5: 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:
- Tacrolimus nephrotoxicity
- New-onset diabetes after transplantation (NODAT) (Correct answer)
- Adrenal insufficiency from steroid withdrawal
- Hepatitis C recurrence
Correct 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.
Question 6: In organ procurement, the term 'cold ischemia time' refers to:
- Time from donor brain death declaration to incision
- Time from organ perfusion with cold preservation solution to revascularization in the recipient (Correct answer)
- Duration the organ spends in the operating room
- Time from recipient incision to graft reperfusion
Correct 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.
Question 7: 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:
- They always lead to graft loss within 48 hours
- Immunosuppression masks symptoms and increases risk of urosepsis and pyelonephritis of the allograft (Correct answer)
- E. coli is universally resistant to all antibiotics in transplant patients
- UTIs cause irreversible tacrolimus toxicity
Correct 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.
CCTN Certified Clinical Transplant Nurse 3
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: