FREE CMSRN Transplant Questions and Answers Flashcards
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A patient awaiting a liver transplant has a MELD score of 32. The nurse understands this score primarily reflects which factors?
Answer: Bilirubin, INR, and serum creatinine
The MELD score is calculated using serum bilirubin, INR, and creatinine to predict 90-day mortality and prioritize organ allocation.
A renal transplant patient on mycophenolate mofetil presents with severe diarrhea and a white blood cell count of 2,800/mm³. What is the priority nursing action?
Answer: Hold the medication and notify the transplant team
Mycophenolate commonly causes GI side effects and bone marrow suppression; leukopenia with severe diarrhea warrants holding the drug and notifying the provider.
Which clinical finding in a cardiac transplant recipient should alert the nurse to possible chronic rejection?
Answer: Progressive exercise intolerance and coronary artery vasculopathy on angiography
Cardiac allograft vasculopathy is the hallmark of chronic rejection in heart transplants, presenting as gradual exercise intolerance rather than typical angina.
A nurse is caring for a patient who received a living-donor liver transplant. Which postoperative complication is UNIQUE to living-donor liver recipients compared to deceased-donor recipients?
Answer: Small-for-size syndrome
Small-for-size syndrome occurs when the transplanted partial graft is insufficient for the recipient's metabolic demands, a complication specific to living-donor and split-liver transplants.
A nurse notes that a kidney transplant patient's cyclosporine trough level is 450 ng/mL (therapeutic range: 100-300 ng/mL). Which symptom should the nurse monitor for MOST closely?
Answer: Tremors and elevated serum creatinine
Supratherapeutic cyclosporine levels cause nephrotoxicity (elevated creatinine) and neurotoxicity (tremors), which are the most clinically significant adverse effects.
Which nursing intervention is ESSENTIAL before administering antithymocyte globulin (ATG) to a transplant patient?
Answer: Premedicate with acetaminophen, diphenhydramine, and corticosteroids
ATG is a polyclonal antibody that frequently causes cytokine release syndrome, so premedication with antipyretics, antihistamines, and steroids is essential to reduce infusion reactions.