Free CCTN Practice Test

The Certified Clinical Transplant Nurse (CCTN) examination tests the competency of a physician-aided nurse to support the process of patient care with respect to organ transplant procedures. The test examines recall of required medical monitoring techniques and the application of those techniques to a variety of high-priority concerns. Successful passage of the CCTN exam requires an extensive knowledge of the physiology of the human body and its various systems, and the pathological conditions that may afflict donors and patients.

The CCTN exam consists of 150 items in a multiple-choice format. The questions are either of the best-answer type or the performance-level type. A basic requirement is knowledge of the parameters for collaboration with primary medical transplant teams in pre-transplant preparations. A total of 24 questions fall into this category. In the preparation phase of organ transplant operations, the certified clinical transplant nurse must be familiar with the techniques for monitoring the patient for viability or diminishing life signs while awaiting further procedures. Blood product types are also covered in the test section pertaining to pre-transplant activities.

There are 80 questions in the content area of post-transplantation monitoring and maintenance. This content area includes evaluation of vital signs, pain, catheterization, drainage, dressings, weight monitoring, bleeding, and neurological signs. Post-transplantation lab-test procedures are basic to patient after-transplant care and monitoring, and figure heavily on the examination. The stages of wound healing and contraindications must be recognized in this section of the test, and the indications of complications due to grafting must be noted and recorded.

The CCTN examination has 29 questions on the administration of immunosuppressive drugs, including side-effects and interactions. The successful candidate must have a thorough knowledge of the range of drug therapies, including antimicrobials, analgesics, cardiovascular agents, postaglandins, insulin, and hypoglycemic medications.

Education and Discharge of the patient and family is an area of concern to which 12 questions are addressed. This area includes possible dialysis in the case of kidney transplants, and patient care in the areas of discharge instructions, fluid intake, monitoring of medications, and possible reactions to life events like travel, pregnancy, birth control, and diet.

The last section of the CCTN exam covers the professional responsibilities of the certified clinical transplant nurse, including research, continuing education, ethical issues, and legal guidelines. There are 5 questions in this content area.

Practice Questions

1. The type of insulin most commonly used to treat hyperglycemia post-cardiac transplantation is

  1. intermediate-acting NPH insulin, Humulin N, or Novolin N.
  2. short-acting regular insulin, such as Novolin R.
  3. long-acting (glargine) Lantus insulin.
  4. rapid-acting (lispro H) Humalog or (aspart) NovoLog.

2. A kidney recipient presents with high fever, pain at surgical site, leukocytosis, renal allograft dysfunction, and urinary sediment. Which diagnostic test is indicated?

  1. Clean-catch midstream urine specimen for culture (bacterial and fungal)
  2. Catheterized urine specimen for culture
  3. Clean-catch midstream urine specimen for urinalysis
  4. Catheterized urine specimen for culture and blood culture

3. If a lung recipient exhibits stridor and intermittent hypoxemia, which is resolved by coughing up sputum, the most likely diagnosis is

  1. primary graft dysfunction.
  2. inadequate bronchial anastomosis.
  3. pneumothorax.
  4. tracheobronchial stenosis.

4. A patient with end-stage liver disease has a paracentesis to relieve massive ascites causing severe shortness of breath. Which of the following is used to reduce hyponatremia and renal dysfunction resulting from decreased effective arterial volume?

  1. Packed red blood cells
  2. Spironolactone
  3. Acetazolamide
  4. Albumin infusion

5. A patient is markedly neutropenic following immunosuppressive therapy. Which actions are included in measures to prevent infection?
I. Restrict fresh salads and unpeeled fresh fruit or vegetables from diet.
II. Provide patient with HEPA filter mask when patient is outside of room.
III. Change water in fresh flowers daily.
IV. Restrict visitors with illness, including colds or sore throats.

  1. I and IV
  2. I, II, and IV
  3. I, II, III, and IV
  4. I, III, and IV

Answers

1. B: Short-acting regular insulin, such as Novolin R. Insulins include: Humalog (Lispro H): Rapid-acting, short duration insulin that acts within 5-15 minutes, peaking between 45-90 minutes and lasting 3-4 hours. NovoLog (aspart): Rapid-acting, short duration insulin, acting within 5-10 minutes, peaking in 1-3 hours, and lasting 3-5 hours. Regular (R) (Humulin R, Novolin R): Short-acting within 30 minutes, peaking in 2-5 hours, and lasting 5-8 hours. NPH (N): Intermediate-trachealstenosis Trach acting with onset in 1-3 hours, peaking at 6-12 hours (Humulin N) or 4-12 hours (Novolin N) and lasting 16-24 hours. Lantus (glargine): Long-acting insulin with onset in 1 hour and lasting 24 hours with no peak.

2. A: High fever, pain at surgical site, leukocytosis, renal allograft dysfunction, and urinary sediment are consistent with urinary tract infection, such as pyelonephritis. A clean-catch midstream urine specimen should be obtained for culture (bacterial and fungal). Treatment depends on the results of the culture and sensitivities although treatment may begin with TMP-SMX or fluoroquinolones, which may also be used prophylactically to prevent infection. Routine urine cultures should be obtained after kidney transplant for surveillance purposes.

3. D: Stridor and intermittent hypoxemia, which are resolved by coughing up sputum, are characteristic of tracheobronchial stenosis. On palpation, a tracheal rumble may be noted for tracheal stenosis. Bronchial stenosis is most common and may occur at the site of anastomosis or distal to the site. The patient should have an emergent bronchoscopy to confirm diagnosis. CT may be done to show luminal diameter on inspiration and expiration. Treatment may include corticosteroids (high dose) and balloon dilation or stenting.

4. D: Albumin infusions are used to reduce hyponatremia and renal dysfunction resulting from decreased effective arterial volume after paracentesis. Paracentesis is usually done only to relieve severe symptoms, such as shortness of breath, after sodium restriction and use of diuretics (usually spironolactone) have proven ineffective. Spironolactone helps to prevent potassium loss. Other diuretics, such as furosemide, may be added but must be carefully monitored as severe hyponatremia may result. Acetazolamide is contraindicated because it increases risk of hepatic coma.

5. B: I, II, and IV. Fresh vegetables and fruits may harbor bacteria, so salads and unpeeled fresh fruit or vegetables should be restricted from the neutropenic diet. Patients with ANC <1000 should be placed in private rooms and use HEPA filters if leaving the room. Visitors with any type of contagious illness should be restricted. Fresh flowers are prohibited because stagnant water can breed bacteria. Fluids in all other containers, including humidifiers, should be changed daily. Patients should be provided good oral care and personal hygiene.

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Last Updated: 03/01/2017


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