CMSRN Transplant 5

Question 1

A pancreas transplant patient develops hyperglycemia requiring insulin on post-op day 5 after previously achieving normoglycemia. Which complication should be investigated first?

Accepted Answer

Acute rejection of the pancreas graft

Answer

Return of hyperglycemia after initial normoglycemia is a sign of pancreatic graft rejection; rising amylase/lipase and imaging confirm the diagnosis.

Question 2

A patient awaiting a liver transplant develops acute-on-chronic liver failure with hepatic encephalopathy. The nurse recognizes this patient will receive transplant priority because:

Accepted Answer

Status 1A listing is assigned for fulminant hepatic failure

Answer

UNOS Status 1A designates patients with fulminant hepatic failure or acute decompensation with life expectancy < 7 days, giving them highest priority.

Question 3

Which cytomegalovirus (CMV) risk category has the highest risk for post-transplant CMV disease?

Accepted Answer

Donor positive / Recipient negative (D+/R-)

Answer

D+/R− (donor CMV-seropositive, recipient CMV-seronegative) carries the highest risk because the recipient has no pre-existing immunity against the donor's CMV.

Question 4

When performing post-transplant patient education, the nurse emphasizes sun protection because transplant recipients are at highest risk for which skin cancer?

Accepted Answer

Squamous cell carcinoma

Answer

Squamous cell carcinoma is the most common skin malignancy in transplant recipients and is far more aggressive than in the general population due to immunosuppression.

Question 5

A renal transplant patient's cyclosporine level is subtherapeutic. The patient reports starting rifampin for latent TB prophylaxis. This interaction occurs because rifampin:

Accepted Answer

Induces CYP3A4, accelerating cyclosporine metabolism

Answer

Rifampin is a potent CYP3A4 inducer that markedly increases cyclosporine metabolism, leading to subtherapeutic levels and risk of rejection.

CMSRN - Medical-Surgical Nursing Practice Test

CMSRN - Medical-Surgical Nursing Practice Test

CMSRN Transplant 5