CCTN Certified Clinical Transplant Nurse MCQ 5 — Questions and Answers
Question 1: A kidney transplant recipient presents with a creatinine that has doubled over 5 days with no fever, oliguria, or graft tenderness, and a therapeutic tacrolimus level. What is the MOST appropriate next diagnostic step?
- Empiric pulse-dose steroids for presumed rejection
- Renal transplant biopsy to differentiate rejection from other causes (Correct answer)
- Increase tacrolimus dose to higher target
- Initiate dialysis immediately
Correct answer: Renal transplant biopsy to differentiate rejection from other causes
A transplant biopsy is the gold standard for diagnosing the cause of graft dysfunction and distinguishing acute rejection from CNI toxicity, BK nephropathy, or recurrent disease.
Question 2: Which condition is BK polyomavirus nephropathy MOST likely to be mistaken for on kidney transplant biopsy, creating a diagnostic challenge?
- Chronic antibody-mediated rejection
- Acute cellular rejection (T-cell mediated) (Correct answer)
- Recurrent focal segmental glomerulosclerosis
- CNI toxicity
Correct answer: Acute cellular rejection (T-cell mediated)
BK nephropathy causes tubulitis and interstitial nephritis that histologically mimics acute T-cell-mediated rejection, but treatment differs radically — steroids for rejection vs. immunosuppression reduction for BK.
Question 3: A living-donor kidney transplant is being planned. Which statement BEST describes the nurse's role in donor evaluation and advocacy?
- The nurse focuses solely on the recipient's well-being and clinical needs
- The nurse serves as an independent donor advocate, ensuring the donor's consent is fully informed, voluntary, and free of coercion (Correct answer)
- The nurse coordinates surgery scheduling as the primary role
- The nurse determines donor eligibility based on creatinine alone
Correct answer: The nurse serves as an independent donor advocate, ensuring the donor's consent is fully informed, voluntary, and free of coercion
The transplant nurse and the independent donor advocate (IDA) role ensure that living donors are fully informed of all risks and that donation is voluntary and uncoerced, protecting donor autonomy.
Question 4: A liver transplant patient taking mycophenolate mofetil (MMF) develops severe diarrhea. What is the MOST appropriate nursing response?
- Recommend over-the-counter loperamide and continue MMF at the same dose
- Notify the transplant team; MMF dose reduction or conversion to enteric-coated mycophenolate sodium may be indicated (Correct answer)
- Discontinue MMF immediately without consulting the team
- Advise the patient to increase dietary fiber to manage symptoms
Correct answer: Notify the transplant team; MMF dose reduction or conversion to enteric-coated mycophenolate sodium may be indicated
GI toxicity (diarrhea, nausea) is the most common MMF side effect and can lead to dehydration and non-adherence; dose reduction or formulation change requires transplant team evaluation to avoid compromising immunosuppression.
Question 5: Which statement is TRUE regarding expanded criteria donors (ECD) for kidney transplantation?
- ECD kidneys have equivalent outcomes to standard criteria donor kidneys
- ECD kidneys carry higher risk of delayed graft function but remain preferable to continued dialysis for most recipients (Correct answer)
- ECD kidneys should only be offered to pediatric recipients
- ECD status applies to living donors over age 55
Correct answer: ECD kidneys carry higher risk of delayed graft function but remain preferable to continued dialysis for most recipients
ECD kidneys (from donors >60 or >50 with comorbidities) have higher rates of delayed graft function and reduced long-term survival, but for most dialysis patients the survival benefit of transplantation outweighs this risk.
Question 6: A heart transplant nurse is teaching a recipient about cardiac allograft vasculopathy (CAV). Which statement BEST describes CAV?
- CAV is an acute rejection episode that resolves with steroid treatment
- CAV is a diffuse, chronic immune-mediated coronary artery disease that is the leading cause of late graft loss in heart recipients (Correct answer)
- CAV presents with chest pain identical to classic angina because the heart is re-innervated
- CAV primarily affects the right coronary artery only
Correct answer: CAV is a diffuse, chronic immune-mediated coronary artery disease that is the leading cause of late graft loss in heart recipients
CAV is a diffuse, concentric intimal hyperplasia of coronary vessels driven by chronic allograft immune injury and is the leading cause of death beyond the first year post-heart transplant.
Question 7: Under the Organ Procurement and Transplantation Network (OPTN) rules, who is legally responsible for a transplant program's compliance with OPTN policies?
- The Organ Procurement Organization (OPO) for that region
- The hospital's transplant program and its designated transplant physicians/surgeons (Correct answer)
- UNOS directly manages compliance for all centers
- The Centers for Medicare & Medicaid Services (CMS) alone
Correct answer: The hospital's transplant program and its designated transplant physicians/surgeons
OPTN membership obligates each transplant program — including its designated transplant physicians and hospital administration — to comply with OPTN policies, with the program bearing primary accountability.
CCTN Certified Clinical Transplant Nurse MCQ 5
A kidney transplant recipient presents with a creatinine that has doubled over 5 days with no fever, oliguria, or graft tenderness, and a therapeutic tacrolimus level.
What is the MOST appropriate next diagnostic step?