Which of the following is the warning sign of post renal transplantation?

HPSSC Staff Nurse - 2021

Medical & Surgical Nursing

Medium

Appeared in: HPSSC Staff Nurse - 2021

Explanation

Decreased urine output (oliguria), defined as less than 400 mL in 24 hours or less than 0.5 mL/kg/hr, is a primary warning sign of acute kidney injury (AKI) or graft dysfunction after transplantation.
This reduction in urine can signal serious complications such as acute rejection, vascular thrombosis (clot in the kidney's artery or vein), or a mechanical obstruction in the urinary tract (e.g., a kinked catheter or blocked ureter).
Oliguria is associated with more severe kidney injury and worse clinical outcomes, necessitating immediate investigation and intervention to save the graft.

Option B: Increased urine output (polyuria or diuresis) is typically an expected and positive sign immediately after a renal transplant. It indicates the new kidney is functioning and clearing accumulated waste and fluid.
Option C: Pale-colored urine is a consequence of high urine output (diuresis). The urine is dilute, so it lacks the typical yellow color. It is an expected finding, not a warning sign.
Option D: This option is incorrect because it includes 'Increased urine output,' which is generally an expected, not a warning, sign. The two conditions represent opposite states of kidney function in the immediate post-op period.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Post-operative care and monitoring following renal transplantation as background academic context rather than a clinical decision trigger.
A nurse's primary role in the immediate post-operative care of a renal transplant patient is meticulous monitoring of hourly urine output. A sudden decrease is a critical event requiring immediate action.
Failure to recognize and report oliguria promptly can lead to irreversible graft damage and loss of the transplanted kidney.
What if? If the patient had decreased urine output but also had a kinked Foley catheter, the first nursing action would be to resolve the obstruction (e.g., unkink the tube). If urine flow does not immediately resume, the problem is likely intrinsic to the kidney, and the physician must be notified.

How to Approach the Question

First, identify the core of the question: it asks for a 'warning sign' after a kidney transplant.
Think about the primary function of a kidney: to produce urine and filter waste. A new, healthy kidney should perform this function well.
Evaluate the options based on this function. 'Increased urine output' suggests the kidney is working, perhaps even over-working initially to clear out waste, which is generally good.
'Pale colour urine' is a direct result of high urine volume, so it's also linked to a working kidney.
'Decreased urine output' suggests the kidney is failing to do its basic job. This is a major red flag or 'warning sign' that something is wrong.
Therefore, decreased urine output is the most logical answer indicating a problem.

Concept Tested & Keywords

Concept Tested: Post-operative care and monitoring following renal transplantation.
Stem keywords: warning sign, post renal transplantation
Lead-in keywords: Which of the following

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E6 Medicine Harrison 22e Part 2 p. 284-286

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E6 Nursing Fundamentals Taylor p. 587-589