CMSRN Transplant 2

Question 1

A kidney transplant recipient on day 3 post-op develops fever, oliguria, and graft tenderness. Which complication is most likely?

Accepted Answer

Acute cellular rejection

Answer

Acute cellular rejection typically presents days to weeks post-transplant with fever, oliguria, and graft tenderness, and is T-cell mediated.

Question 2

Which immunosuppressant combination is standard maintenance therapy for solid organ transplant recipients?

Accepted Answer

Tacrolimus + mycophenolate mofetil + prednisone

Answer

The standard triple immunosuppression regimen is tacrolimus, mycophenolate mofetil, and a corticosteroid.

Question 3

A liver transplant patient develops jaundice, elevated liver enzymes, and pruritus 6 months post-transplant. These findings are most consistent with:

Accepted Answer

Chronic rejection (ductopenic rejection)

Answer

Chronic rejection, also called ductopenic rejection, presents months to years post-transplant with progressive cholestasis and loss of bile ducts.

Question 4

The nurse is caring for a post-renal transplant patient whose tacrolimus trough level is 18 ng/mL (therapeutic range 8–12 ng/mL). Which assessment finding is most concerning?

Accepted Answer

Serum creatinine rise from 1.0 to 1.8 mg/dL

Answer

Supratherapeutic tacrolimus causes nephrotoxicity; a rising creatinine indicates calcineurin inhibitor-induced renal injury requiring dose reduction.

Question 5

Which post-transplant infection is associated with a CD4+ count below 200 cells/µL and reactivation of a latent opportunistic organism?

Accepted Answer

Pneumocystis jirovecii pneumonia (PJP)

Answer

PJP occurs when profound immunosuppression lowers CD4+ counts, reactivating latent Pneumocystis jirovecii; TMP-SMX prophylaxis is standard.

CMSRN - Medical-Surgical Nursing Practice Test

CMSRN - Medical-Surgical Nursing Practice Test

CMSRN Transplant 2