CCTN Certified Clinical Transplant Nurse MCQ 3 — Questions and Answers
Question 1: 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?
- ABO blood typing repeat
- Virtual or prospective crossmatch (Correct answer)
- HLA-DR matching only
- Renal biopsy of the donor kidney
Correct 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.
Question 2: Which laboratory trend is MOST consistent with calcineurin inhibitor (CNI) nephrotoxicity in a stable kidney transplant recipient?
- Sudden 30% rise in creatinine with fever and graft tenderness
- Gradual creatinine rise with supratherapeutic CNI trough levels and no proteinuria (Correct answer)
- Proteinuria >3 g/day with subnephrotic creatinine
- Eosinophilia with hematuria
Correct 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.
Question 3: Which opportunistic infection prophylaxis is standard for ALL solid organ transplant recipients in the first 3–6 months post-transplant?
- Fluconazole for Aspergillus
- Trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii (Correct answer)
- Acyclovir for HSV only in seropositive donors
- Isoniazid for all recipients regardless of TB status
Correct 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.
Question 4: 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?
- Administer furosemide 40 mg IV
- Check for Foley catheter kinking or obstruction first (Correct answer)
- Increase IV fluid rate to 300 mL/hr
- Call for emergent dialysis
Correct 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.
Question 5: A liver transplant recipient on tacrolimus is started on fluconazole for a fungal infection. What does the nurse anticipate?
- Tacrolimus levels will decrease significantly
- Tacrolimus levels will increase due to CYP3A4 inhibition (Correct answer)
- No interaction; the drugs have different metabolism pathways
- Mycophenolate levels will increase instead
Correct 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.
Question 6: Which donor-derived infection poses the HIGHEST risk of undetected transmission during the standard infectious disease screening window period?
- Hepatitis B virus (HBV)
- HIV during acute infection (NAT window period) (Correct answer)
- Cytomegalovirus (CMV)
- Epstein-Barr virus (EBV)
Correct 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.
Question 7: When assessing a transplant candidate's psychosocial readiness, which factor is considered an ABSOLUTE contraindication by most transplant programs?
- History of treated depression
- Active substance use disorder with ongoing use and denial (Correct answer)
- Single marital status with adequate social support
- History of non-compliance that has since been corrected
Correct 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.
CCTN Certified Clinical Transplant Nurse MCQ 3
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?