CCTN Certified Clinical Transplant Nurse 5 — Questions and Answers
Question 1: A pancreas transplant patient develops hyperglycemia and elevated serum amylase/lipase 2 weeks post-transplant with a normal kidney function (simultaneous pancreas-kidney recipient). This is MOST suggestive of:
- Kidney allograft rejection
- Pancreas allograft rejection or pancreatitis (Correct answer)
- Surgical anastomotic leak from the bowel
- Cytomegalovirus hepatitis
Correct answer: Pancreas allograft rejection or pancreatitis
In simultaneous pancreas-kidney (SPK) transplant, rising glucose combined with elevated pancreatic enzymes suggests pancreas rejection or graft pancreatitis.
Question 2: The United Network for Organ Sharing (UNOS) kidney allocation system prioritizes candidates based on all of the following EXCEPT:
- Time on the waiting list
- Degree of HLA mismatch
- Recipient's annual household income (Correct answer)
- Calculated panel reactive antibody (CPRA) level
Correct answer: Recipient's annual household income
UNOS allocation is based on medical and immunological factors including wait time, HLA mismatch, CPRA, and geographic proximity — not financial status.
Question 3: A liver transplant patient develops elevated bilirubin and alkaline phosphatase with a normal hepatic artery Doppler 6 weeks post-transplant. MRCP shows a stricture at the biliary anastomosis. The BEST initial treatment is:
- Emergency surgical revision
- Endoscopic retrograde cholangiopancreatography (ERCP) with balloon dilation and stenting (Correct answer)
- Increase immunosuppression to treat rejection
- Liver re-transplantation
Correct answer: Endoscopic retrograde cholangiopancreatography (ERCP) with balloon dilation and stenting
Anastomotic biliary strictures post-liver transplant are first managed endoscopically with ERCP balloon dilation and stenting, which is effective in most cases.
Question 4: Which of the following best describes the nurse's role in the Model for End-Stage Liver Disease (MELD) score used in liver transplant prioritization?
- Nurses calculate the MELD score using a proprietary bedside tool
- Nurses ensure labs (INR, creatinine, bilirubin, sodium) are drawn accurately and reported promptly for MELD calculation (Correct answer)
- The MELD score is calculated by the transplant surgeon only
- Nurses update the MELD score weekly in UNOS directly
Correct answer: Nurses ensure labs (INR, creatinine, bilirubin, sodium) are drawn accurately and reported promptly for MELD calculation
Transplant nurses play a critical role in ensuring accurate and timely laboratory collection, as MELD scores—used to prioritize liver allocation—are derived from INR, creatinine, bilirubin, and serum sodium.
Question 5: A heart transplant recipient experiences symptomatic bradycardia and hypotension in the immediate post-operative period. This is MOST likely due to:
- Acute cellular rejection causing conduction abnormalities
- Cardiac denervation, as the transplanted heart lacks autonomic innervation (Correct answer)
- Tacrolimus-induced conduction block
- Perioperative myocardial infarction
Correct answer: Cardiac denervation, as the transplanted heart lacks autonomic innervation
The transplanted heart is surgically denervated and lacks direct autonomic control, making it dependent on circulating catecholamines and prone to bradycardia requiring chronotropic support.
Question 6: BK virus nephropathy in kidney transplant recipients is best monitored by:
- Monthly chest X-rays
- Serial serum BK virus PCR (BK viremia) testing (Correct answer)
- Annual kidney biopsy regardless of creatinine
- Daily urinalysis for decoy cells only
Correct answer: Serial serum BK virus PCR (BK viremia) testing
Serum BK PCR (viremia) is the standard surveillance tool; BK viremia >10,000 copies/mL warrants immunosuppression reduction to prevent nephropathy.
Question 7: A transplant nurse is preparing to administer anti-thymocyte globulin (ATG) for induction therapy. Which of the following precautions is MOST important?
- Administer as a rapid IV push over 5 minutes
- Premedicate with acetaminophen, diphenhydramine, and corticosteroids to reduce infusion reactions (Correct answer)
- Obtain a urine culture before each dose
- Monitor tacrolimus levels hourly during infusion
Correct answer: Premedicate with acetaminophen, diphenhydramine, and corticosteroids to reduce infusion reactions
ATG commonly causes infusion reactions including fever, chills, and hypotension; premedication with antipyretics, antihistamines, and steroids is standard practice.
CCTN Certified Clinical Transplant Nurse 5
A pancreas transplant patient develops hyperglycemia and elevated serum amylase/lipase 2 weeks post-transplant with a normal kidney function (simultaneous pancreas-kidney recipient).
This is MOST suggestive of: