Transplant Flashcards
7 cards from real CMSRN practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Transplant flashcards as text
A pancreas transplant patient develops hyperglycemia requiring insulin on post-op day 5 after previously achieving normoglycemia. Which complication should be investigated first?
Answer: Acute rejection of the pancreas graft
Return of hyperglycemia after initial normoglycemia is a sign of pancreatic graft rejection; rising amylase/lipase and imaging confirm the diagnosis.
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:
Answer: Status 1A listing is assigned for fulminant hepatic failure
UNOS Status 1A designates patients with fulminant hepatic failure or acute decompensation with life expectancy < 7 days, giving them highest priority.
Which cytomegalovirus (CMV) risk category has the highest risk for post-transplant CMV disease?
Answer: Donor positive / Recipient negative (D+/R-)
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.
When performing post-transplant patient education, the nurse emphasizes sun protection because transplant recipients are at highest risk for which skin cancer?
Answer: Squamous cell carcinoma
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.
A renal transplant patient's cyclosporine level is subtherapeutic. The patient reports starting rifampin for latent TB prophylaxis. This interaction occurs because rifampin:
Answer: Induces CYP3A4, accelerating cyclosporine metabolism
Rifampin is a potent CYP3A4 inducer that markedly increases cyclosporine metabolism, leading to subtherapeutic levels and risk of rejection.
A nurse caring for a patient 48 hours after orthotopic heart transplant notes the patient lacks the normal heart rate response to the Valsalva maneuver. The best explanation is:
Answer: The transplanted heart is denervated and lacks autonomic reflex responses
The transplanted heart is surgically denervated; it does not respond to vagal or sympathetic maneuvers and relies on intrinsic automaticity and circulating catecholamines.
A patient post-bilateral lung transplant develops progressive obstructive airflow limitation on spirometry at 14 months, with an FEV1 decline > 20% from baseline. This pattern is consistent with:
Answer: Bronchiolitis obliterans syndrome (chronic lung allograft dysfunction)
Bronchiolitis obliterans syndrome is the hallmark of chronic lung allograft dysfunction, characterized by progressive, irreversible obstructive spirometry changes after the first post-transplant year.