Which of the postoperative assessments of a patient subjected to kidney transplant has to be reported immediately to the physician?

Appeared in: Daman & Diu Staff Nurse - 2018

Explanation

A urine output of less than 20 mL/hour is defined as oliguria and is a critical indicator of graft dysfunction in a post-kidney transplant patient.
A newly transplanted kidney is expected to produce urine almost immediately. A sudden or significant decrease in output is a major red flag.
This finding can signal serious and urgent complications such as hyperacute rejection, thrombosis of the renal artery, urinary obstruction (e.g., a blood clot), or acute tubular necrosis (ATN).
Immediate notification of the physician is essential to diagnose the cause and intervene promptly to prevent irreversible damage to the transplanted kidney.

Option A: A serum potassium level of 4.2 mEq/L is within the normal physiological range (typically 3.5-5.0 mEq/L).
Option C: A temperature of 99°F (37.2°C) is a low-grade fever and, while it should be monitored, it is not an immediate, life-threatening emergency in the early postoperative period.
Option D: A serum sodium level of 137 mEq/L is well within the normal range (typically 135-145 mEq/L).

Clinical Relevance

Nursing practice connection: Use the key finding related to Postoperative Assessment and Complications of Kidney Transplantation to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary role in the immediate postoperative care of a kidney transplant recipient is vigilant monitoring for signs of graft failure. Hourly urine output is one of the most sensitive indicators of graft function.
Failure to promptly identify and report oliguria can lead to a delay in diagnosis and treatment, potentially resulting in the irreversible loss of the transplanted kidney.
What if? If the patient's blood pressure was also low (hypotension), the low urine output could be due to decreased perfusion to the new kidney rather than rejection. In this case, the immediate intervention would focus on restoring blood pressure and fluid volume.

How to Approach the Question

First, identify the question type. This is a clinical priority question asking for the most urgent finding to report.
Analyze the patient context: a postoperative kidney transplant recipient. This means the primary concern is the viability and function of the new organ.
Evaluate each option by comparing the given value to its normal range.
Option A (Potassium 4.2 mEq/L) is normal.
Option C (Temperature 99°F) is a mild elevation, not an acute crisis.
Option D (Sodium 137 mEq/L) is normal.

Concept Tested & Keywords

Concept Tested: Postoperative Assessment and Complications of Kidney Transplantation
Stem keywords: postoperative assessment, kidney transplant, reported immediately
Lead-in keywords: immediately
Clinical cues: The context is a postoperative patient, where early detection of complications is critical for graft survival.

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E6 Medicine Harrison 22e Part 2 pp. 313-315, 315-317

Practise the full Daman & Diu Staff Nurse - 2018

Attempt every question from this paper in a timed mock, then review the full solution for each one.