# A nurse reviews the discharge medication list for a kidney transplant client. Which prophylactic regimen reflects standard care to prevent opportunistic infections?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391876&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A nurse reviews the discharge medication list for a kidney transplant client. Which prophylactic regimen reflects standard care to prevent opportunistic infections?

## Option

1. Trimethoprim-sulfamethoxazole for PCP/UTI prophylaxis, valganciclovir for CMV (if D+/R-), nystatin oral suspension for Candida, ± isoniazid if latent TB; vaccination updates as appropriate **✔ Correct answer**
2. Daily IV vancomycin
3. No prophylaxis needed
4. IV chemotherapy

**Correct answer: 1**

## Explanation

Correct (2): Post-transplant prophylaxis: TMP-SMX for PCP and UTI (6-12 months), valganciclovir for CMV (3-6 months in D+/R- mismatch), nystatin/clotrimazole for oropharyngeal Candida (1-3 months), isoniazid for latent TB. Live vaccines contraindicated; inactivated only after 3-6 months. (1,3,4) Incorrect.

## In-depth explanation

Memory Tip Transplant prophylaxis = "Bactrim·Valgan·Nystatin" first 3-12 months. AVOID live vaccines (MMR, varicella, yellow fever, live influenza, oral polio). Inactivated OK after 3-6 months.

## Clinical scenario

Scenario 40-year-old female 1 week post-kidney transplant; pre-discharge med reconciliation.

## Key concepts

- **TMP-SMX prophylaxis** — Prevents PCP and UTI in transplant recipients; usually 6-12 months post-transplant.
- **Valganciclovir** — Oral CMV prophylaxis in D+/R- (donor+/recipient-) transplant; 3-6 months.
- **Live vaccine contraindication** — Live vaccines (MMR, varicella, yellow fever, live flu, oral polio) contraindicated in immunosuppression.

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