CCTN Certified Clinical Transplant Nurse MCQ 4 — Questions and Answers
Question 1: A CMV-seronegative kidney recipient receives an organ from a CMV-seropositive donor (D+/R−). What is the standard prophylaxis approach?
- No prophylaxis needed; treat if symptoms arise
- Valganciclovir prophylaxis for 3–6 months post-transplant (Correct answer)
- Ganciclovir IV for 2 weeks followed by monitoring only
- CMV hyperimmune globulin alone for 3 months
Correct answer: Valganciclovir prophylaxis for 3–6 months post-transplant
D+/R− is the highest-risk CMV mismatch, and universal prophylaxis with valganciclovir for 3–6 months is the standard of care to prevent primary CMV disease.
Question 2: Which clinical finding differentiates hepatic artery thrombosis (HAT) from biliary stricture in a liver transplant recipient?
- Both present identically; only biopsy distinguishes them
- HAT causes dramatically elevated transaminases and can cause fulminant graft failure; biliary strictures cause cholestatic LFT pattern (Correct answer)
- Biliary stricture causes graft failure while HAT causes cholestasis
- HAT presents only with fever and bacteremia
Correct answer: HAT causes dramatically elevated transaminases and can cause fulminant graft failure; biliary strictures cause cholestatic LFT pattern
HAT presents acutely with ischemic hepatocyte injury (high AST/ALT) and can precipitate graft necrosis, while biliary strictures cause a more insidious cholestatic pattern with elevated bilirubin and alkaline phosphatase.
Question 3: A renal transplant recipient at 3 years post-transplant develops a skin lesion diagnosed as squamous cell carcinoma. What education should the transplant nurse prioritize?
- This is unrelated to immunosuppression; routine dermatology follow-up only
- Sun protection, annual full-body skin exams, and awareness that immunosuppression significantly elevates skin cancer risk (Correct answer)
- Discontinue mycophenolate immediately
- Skin cancer risk is highest in the first 6 months and then normalizes
Correct answer: Sun protection, annual full-body skin exams, and awareness that immunosuppression significantly elevates skin cancer risk
Transplant recipients have a 65–250 times higher risk of squamous cell carcinoma due to chronic immunosuppression, and lifelong sun protection plus annual dermatology screening is essential.
Question 4: A pediatric liver transplant patient is transitioning to adult care. Which nursing intervention is MOST critical for successful transition?
- Transfer all medical records before age 18 and end pediatric visits
- Structured transition program teaching self-management, medication adherence, and adult healthcare navigation starting at age 12–14 (Correct answer)
- Have parents continue managing medications indefinitely to ensure adherence
- Delay transition until the patient requests it
Correct answer: Structured transition program teaching self-management, medication adherence, and adult healthcare navigation starting at age 12–14
Early, structured transition programs that gradually transfer self-management responsibility are evidence-based and reduce the high rate of graft loss seen during adolescent transition to adult care.
Question 5: Which electrolyte abnormality is a well-known side effect of tacrolimus in kidney transplant recipients?
- Hypercalcemia
- Hypermagnesemia
- Hyperkalemia and hypomagnesemia (Correct answer)
- Hyponatremia
Correct answer: Hyperkalemia and hypomagnesemia
Tacrolimus causes hyperkalemia through impaired renal potassium excretion and hypomagnesemia through urinary magnesium wasting, both of which require monitoring and dietary management.
Question 6: A nurse is caring for a deceased-donor liver recipient whose family asks about brain death. Which explanation is MOST accurate?
- Brain death is a coma from which recovery is expected with time
- Brain death is the irreversible cessation of all brain and brainstem function, meeting legal and medical criteria for death (Correct answer)
- Brain death means the patient is in a persistent vegetative state
- Brain death is diagnosed solely by EEG showing flat activity
Correct answer: Brain death is the irreversible cessation of all brain and brainstem function, meeting legal and medical criteria for death
Brain death is legally and medically defined as the irreversible cessation of all functions of the entire brain, including the brainstem, and is determined by standardized clinical criteria.
Question 7: Post-transplant lymphoproliferative disorder (PTLD) is MOST strongly associated with which viral infection?
- Cytomegalovirus (CMV)
- Hepatitis C virus (HCV)
- Epstein-Barr virus (EBV) (Correct answer)
- BK polyomavirus
Correct answer: Epstein-Barr virus (EBV)
PTLD is strongly associated with EBV-driven B-cell proliferation occurring under immunosuppression, particularly in EBV-seronegative recipients of EBV-seropositive donors.
CCTN Certified Clinical Transplant Nurse MCQ 4
A CMV-seronegative kidney recipient receives an organ from a CMV-seropositive donor (D+/R−).
What is the standard prophylaxis approach?