CCTC Immediate Postoperative Care 5 — Questions and Answers
Question 1: Which immunosuppressive drug used in the immediate post-transplant period is most associated with hyperglycemia requiring insulin therapy?
- Mycophenolate mofetil
- Tacrolimus and corticosteroids (Correct answer)
- Azathioprine
- Sirolimus alone
Correct answer: Tacrolimus and corticosteroids
Tacrolimus impairs insulin secretion from beta cells, and corticosteroids cause insulin resistance, together producing significant post-transplant hyperglycemia.
Question 2: A kidney transplant patient's morning labs show a tacrolimus trough level of 24 ng/mL (target 8-12 ng/mL). What is the most appropriate action?
- Continue current dose and recheck in one week
- Hold next dose and notify the transplant physician (Correct answer)
- Double the dose to compensate for the high level
- Switch to cyclosporine immediately
Correct answer: Hold next dose and notify the transplant physician
A supratherapeutic tacrolimus level increases nephrotoxicity and neurotoxicity risk; the dose should be held and the physician notified for dose adjustment.
Question 3: What is the significance of pink or red-tinged drain output following a liver transplant in the immediate postoperative period?
- Expected normal bile drainage
- Possible arterial or venous bleeding requiring immediate assessment (Correct answer)
- Sign of normal fluid third-spacing
- Indication of early rejection
Correct answer: Possible arterial or venous bleeding requiring immediate assessment
Bloody drain output suggests intraabdominal hemorrhage, which is a surgical emergency requiring urgent evaluation and possible re-exploration.
Question 4: In the immediate postoperative period after heart transplant, pulmonary hypertension in the recipient increases the risk of which complication?
- Left ventricular failure of the donor heart
- Right ventricular failure of the donor heart (Correct answer)
- Acute cellular rejection
- Primary graft dysfunction of the lungs
Correct answer: Right ventricular failure of the donor heart
The donor right ventricle is unaccustomed to high pulmonary pressures in the recipient and can fail acutely when exposed to pre-existing pulmonary hypertension.
Question 5: A nurse reports that a post-renal transplant patient has not produced any urine for 2 hours. After ruling out catheter obstruction, what is the next step?
- Administer a fluid bolus and reassess (Correct answer)
- Immediately list the patient for re-transplantation
- Begin peritoneal dialysis
- Administer furosemide 200 mg IV
Correct answer: Administer a fluid bolus and reassess
A fluid bolus is the first step to optimize intravascular volume and perfusion before escalating to other interventions for post-transplant oliguria.
Question 6: Which post-transplant complication is characterized by the triad of hypertension, edema, and proteinuria occurring early after transplant?
- Calcineurin inhibitor toxicity presenting as nephropathy
- New-onset diabetes after transplant (NODAT)
- Graft versus host disease (GVHD)
- Thrombotic microangiopathy (TMA) related to calcineurin inhibitors (Correct answer)
Correct answer: Thrombotic microangiopathy (TMA) related to calcineurin inhibitors
TMA can occur as a complication of calcineurin inhibitors, presenting with hypertension, edema, and proteinuria from endothelial injury to glomerular capillaries.
Question 7: When assessing pain in an immediate post-transplant patient who cannot self-report, which validated tool is most appropriate?
- Numeric Rating Scale (NRS 0-10)
- Visual Analog Scale (VAS)
- Behavioral Pain Scale (BPS) or CPOT (Correct answer)
- Wong-Baker FACES scale
Correct answer: Behavioral Pain Scale (BPS) or CPOT
The Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT) are validated for assessing pain in non-verbal ICU patients based on behavioral indicators.
CCTC Immediate Postoperative Care 5
Which immunosuppressive drug used in the immediate post-transplant period is most associated with hyperglycemia requiring insulin therapy?