A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to?
Chest tube drainage
Arterial blood gases
Urinary output
Pain level
The Correct Answer is B
Oxygenation is an important and priority assessment. Assessing the arterial blood gases provide information on the oxygenation and ventilation status in the client post thoracotomy
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Related Questions
Correct Answer is ["C","D","E"]
Explanation
A. In cases of dehydration, urine output may decrease, resulting in a more concentrated urine that appears darker in color. Therefore, the nurse may expect the urine to be darker in color.
B. Tachycardia is more commonly observed due to dehydration and the body's compensatory mechanisms.
C. Poor skin turgor is a classic sign of dehydration and may be observed in clients with vomiting and diarrhea.
D. Flat neck veins aretypically associated with dehydration. This occurs due to reduced intravascular volume leading to collapse of the veins.
E. Hypotension is commonly associated with dehydration resulting from vomiting and diarrhea. Loss of fluids and electrolytes can lead to decreased blood volume and subsequent hypotension.
Correct Answer is B
Explanation
This question is more focused and directly addresses the reason for the client's current admission. It prompts the client to discuss their chief complaint or presenting symptoms, which is essential information for the nurse to gather during the health history interview.
A. This question is too broad and may overwhelm the client, especially during the initial stages of the health history interview.
C. While discussing the client's feelings about hospitalization is important for providing emotional support and understanding their perspective, this question may not directly promote the discussion of health history data.
D. This question invites the client to share their perspective and provides an opportunity for them to express any immediate health issues or worries they may have. However, it is too broad.
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