CCTN Infection Prevention and Management in Transplant Recipients 3

Question 1

Which post-transplant complication is most strongly associated with Epstein-Barr virus (EBV) infection or reactivation in immunocompromised recipients?

Accepted Answer

Post-transplant lymphoproliferative disorder (PTLD)

Answer

BK virus nephropathy

Answer

Cytomegalovirus retinitis

Answer

Aspergillus pneumonia

Question 2

A transplant recipient returning from a trip to the Ohio and Mississippi River valleys presents with fever, night sweats, and mediastinal lymphadenopathy. Which endemic fungal infection should be suspected?

Accepted Answer

Histoplasma capsulatum

Answer

Coccidioides immitis

Answer

Cryptococcus neoformans

Answer

Aspergillus fumigatus

Question 3

What monitoring strategy is recommended for early detection of CMV infection in transplant recipients who are at intermediate risk (D+/R+ or D-/R+)?

Accepted Answer

Pre-emptive therapy guided by regular CMV quantitative PCR surveillance

Answer

Universal prophylaxis with valganciclovir for 12 months

Answer

Clinical monitoring only, treating when symptoms develop

Answer

Monthly CMV antigenemia testing (pp65) as the sole surveillance method

Question 4

Which infection control precaution is most critical for transplant nurses to implement when caring for a transplant recipient with suspected Clostridioides difficile (C. diff) infection?

Accepted Answer

Contact precautions with gown and gloves, using soap and water for hand hygiene (not alcohol gel)

Answer

Droplet precautions with surgical mask and eye protection

Answer

Airborne precautions with N95 respirator and negative-pressure room

Answer

Standard precautions alone are sufficient for C. diff management

Question 5

Which factor in the immunosuppression regimen most significantly increases the risk of invasive fungal infections, particularly Aspergillus, in transplant recipients?

Accepted Answer

High-dose corticosteroid use, especially pulse steroids for rejection treatment

Answer

Routine maintenance calcineurin inhibitor (tacrolimus) therapy at therapeutic levels

Answer

Standard mycophenolate mofetil dosing within normal range

Answer

Prophylactic TMP-SMX therapy

Question 6

A transplant recipient asks when it is safe to receive the inactivated influenza vaccine post-transplant. What is the recommended timing?

Accepted Answer

At least 3–6 months post-transplant when maintenance immunosuppression is stable

Answer

Within the first 2 weeks post-transplant before immunosuppression takes effect

Answer

Influenza vaccine is permanently contraindicated in all transplant recipients

Answer

Immediately at discharge regardless of time post-transplant

Question 7

Which clinical presentation in a kidney transplant recipient should prompt immediate evaluation for CMV disease rather than simple viremia?

Accepted Answer

CMV viremia with fever, leukopenia, thrombocytopenia, and organ-specific symptoms such as colitis or pneumonitis

Answer

Asymptomatic CMV viremia detected on routine weekly surveillance PCR

Answer

Low-level CMV PCR positivity in a D-/R- recipient without any symptoms

Answer

CMV IgG seroconversion without detectable viremia on PCR