CCTN Certified Clinical Transplant Nurse MCQ 2 — Questions and Answers
Question 1: A kidney transplant recipient is on tacrolimus and develops a trough level of 18 ng/mL in the first week post-transplant. What is the most appropriate nursing action?
- Continue current dose and recheck in one week
- Notify the transplant team for dose reduction (Correct answer)
- Increase the tacrolimus dose to achieve higher levels
- Discontinue tacrolimus and switch to cyclosporine
Correct answer: Notify the transplant team for dose reduction
A tacrolimus trough of 18 ng/mL exceeds typical early post-transplant targets (10–15 ng/mL) and raises the risk of nephrotoxicity, requiring prompt notification of the transplant team for dose adjustment.
Question 2: Which finding in a liver transplant recipient at post-operative day 3 would be MOST concerning for primary non-function (PNF)?
- ALT 500 IU/L with improving trend
- Serum bilirubin 3.2 mg/dL
- AST >5,000 IU/L with coagulopathy and rising creatinine (Correct answer)
- Mild ascites on ultrasound
Correct answer: AST >5,000 IU/L with coagulopathy and rising creatinine
Markedly elevated transaminases (>5,000 IU/L) combined with coagulopathy and renal failure in the early post-transplant period are hallmarks of primary non-function, a graft-threatening emergency.
Question 3: A heart transplant patient develops a new resting heart rate of 58 bpm with fatigue and dyspnea on post-operative day 10. What etiology should the nurse prioritize?
- Sinus bradycardia from vagal tone
- Acute cellular rejection (Correct answer)
- Beta-blocker toxicity
- Donor heart denervation effect
Correct answer: Acute cellular rejection
New fatigue and dyspnea with hemodynamic changes in the first weeks post-heart transplant are classic signs of acute cellular rejection until proven otherwise and require urgent endomyocardial biopsy.
Question 4: When educating a renal transplant recipient about food safety, which instruction is MOST important due to immunosuppression?
- Avoid all raw fruits and vegetables permanently
- Use separate cutting boards for raw meat and produce
- Consume only pasteurized dairy products and avoid raw shellfish (Correct answer)
- Limit fluid intake to prevent graft hypertension
Correct answer: Consume only pasteurized dairy products and avoid raw shellfish
Immunosuppressed transplant recipients are at high risk for Listeria and other foodborne pathogens, making avoidance of unpasteurized dairy and raw shellfish a critical safety measure.
Question 5: A pancreas transplant recipient's fasting blood glucose rises from 90 to 210 mg/dL on post-operative day 14. What should the nurse suspect FIRST?
- Normal post-operative stress response
- Graft rejection or thrombosis (Correct answer)
- Dietary non-compliance
- Steroid-induced hyperglycemia from recent pulse dose
Correct answer: Graft rejection or thrombosis
A sudden rise in glucose in a pancreas transplant recipient signals potential graft rejection or vascular thrombosis, both of which impair insulin secretion and require immediate investigation.
Question 6: Which immunosuppressant is classified as an mTOR inhibitor and is known to impair wound healing?
- Mycophenolate mofetil
- Tacrolimus
- Sirolimus (Correct answer)
- Azathioprine
Correct answer: Sirolimus
Sirolimus (rapamycin) is an mTOR inhibitor that inhibits cell proliferation, which impairs wound healing and is often avoided or delayed in the early post-operative period.
Question 7: A lung transplant recipient reports new-onset dyspnea and a 10% decline in FEV1 at the 12-month clinic visit. Which condition should the transplant nurse suspect?
- Acute cellular rejection
- Chronic lung allograft dysfunction (CLAD)/BOS (Correct answer)
- Pulmonary embolism
- Pneumocystis jirovecii pneumonia
Correct answer: Chronic lung allograft dysfunction (CLAD)/BOS
A persistent decline in FEV1 beyond the early post-transplant period is the hallmark of bronchiolitis obliterans syndrome (BOS), the most common form of chronic lung allograft dysfunction.
CCTN Certified Clinical Transplant Nurse MCQ 2
A kidney transplant recipient is on tacrolimus and develops a trough level of 18 ng/mL in the first week post-transplant.
What is the most appropriate nursing action?