CCTC Immediate Postoperative Care 4 — Questions and Answers
Question 1: A pancreas transplant recipient develops hyperglycemia on postoperative day 1. What is the most important first step?
- Initiate insulin drip immediately
- Assess graft perfusion with Doppler ultrasound (Correct answer)
- Increase tacrolimus dose
- Administer glucagon
Correct answer: Assess graft perfusion with Doppler ultrasound
Sudden hyperglycemia after pancreas transplant may indicate graft thrombosis or failure, so vascular assessment with Doppler should precede insulin therapy.
Question 2: Which sign on physical examination is most concerning for intraabdominal hemorrhage in the immediate post-transplant period?
- Mild periumbilical tenderness
- Increasing abdominal girth with hemodynamic instability (Correct answer)
- Low-grade fever
- Decreased bowel sounds
Correct answer: Increasing abdominal girth with hemodynamic instability
Expanding abdominal girth combined with tachycardia and hypotension indicates significant intraabdominal bleeding requiring urgent surgical evaluation.
Question 3: What is the recommended target blood pressure range for most kidney transplant recipients in the immediate postoperative period?
- 90/60 to 100/70 mmHg
- 120/80 to 140/90 mmHg (Correct answer)
- 150/100 to 170/110 mmHg
- Below 90/60 mmHg
Correct answer: 120/80 to 140/90 mmHg
Maintaining blood pressure in the normal range ensures adequate renal perfusion without risking anastomotic stress or hypertensive complications.
Question 4: A lung transplant patient on postoperative day 2 develops a fever of 38.9°C, purulent sputum, and worsening hypoxia. What is the most appropriate next step?
- Increase immunosuppression to treat rejection
- Obtain bronchoalveolar lavage (BAL) and start broad-spectrum antibiotics (Correct answer)
- Perform emergent re-transplantation
- Administer IV methylprednisolone pulse therapy
Correct answer: Obtain bronchoalveolar lavage (BAL) and start broad-spectrum antibiotics
Early post-transplant pneumonia requires BAL for culture-directed therapy and empiric broad-spectrum antibiotics given the immunocompromised state.
Question 5: In a liver transplant patient, which value best indicates early primary graft nonfunction (PNF)?
- Mild rise in bilirubin over 72 hours
- Absence of bile production with coagulopathy and encephalopathy within 24 hours (Correct answer)
- Moderate elevation of alkaline phosphatase
- Low-grade fever on postoperative day 2
Correct answer: Absence of bile production with coagulopathy and encephalopathy within 24 hours
Primary graft nonfunction presents early with failure of all liver functions — absent bile, severe coagulopathy, and encephalopathy — requiring urgent re-listing.
Question 6: Which post-transplant complication is correctly managed by placing the patient in a supine position with legs elevated?
- Pulmonary edema
- Acute graft rejection
- Orthostatic hypotension (Correct answer)
- Elevated intracranial pressure
Correct answer: Orthostatic hypotension
Orthostatic hypotension is common early post-transplant due to volume depletion and vasodilation; Trendelenburg positioning improves venous return.
Question 7: Which of the following is NOT a routine monitoring parameter in the immediate postoperative period for solid organ transplant recipients?
- Hourly urine output
- Serial echocardiograms every 4 hours (Correct answer)
- Core body temperature
- Drain output volume and character
Correct answer: Serial echocardiograms every 4 hours
Serial echocardiograms every 4 hours are not routine; echocardiography is reserved for specific indications such as suspected cardiac dysfunction.
CCTC Immediate Postoperative Care 4
A pancreas transplant recipient develops hyperglycemia on postoperative day 1.
What is the most important first step?