CMSRN Transplant 3

Question 1

A patient is being evaluated for kidney transplant candidacy. Which finding is an absolute contraindication?

Accepted Answer

Active metastatic malignancy

Answer

Active malignancy is an absolute contraindication to transplant due to the risk of accelerated tumor growth under immunosuppression.

Question 2

Which post-transplant malignancy is most strongly linked to Epstein-Barr virus (EBV) reactivation?

Accepted Answer

Post-transplant lymphoproliferative disorder (PTLD)

Answer

PTLD is primarily driven by EBV reactivation under immunosuppression and ranges from benign hyperplasia to aggressive lymphoma.

Question 3

A renal transplant recipient is started on fluconazole for a fungal infection. The nurse anticipates which medication adjustment?

Accepted Answer

Decrease tacrolimus dose due to CYP3A4 inhibition

Answer

Fluconazole inhibits CYP3A4, dramatically increasing tacrolimus levels and requiring a significant dose reduction to avoid toxicity.

Question 4

In deceased-donor organ allocation, which criterion gives highest priority for kidney offers to a recipient on the waiting list?

Accepted Answer

Zero HLA mismatch with the donor

Answer

Zero HLA antigen mismatch (full-house match) confers mandatory sharing across UNOS regions due to superior long-term outcomes.

Question 5

A living-related donor is being evaluated for kidney donation. Which finding would disqualify the donor?

Accepted Answer

Bilateral kidney stones with residual nephrocalcinosis

Answer

Bilateral nephrolithiasis with nephrocalcinosis places the remaining kidney at risk post-donation and disqualifies the candidate.

CMSRN - Medical-Surgical Nursing Practice Test