A nurse is caring for a postoperative client on the surgical unit. The client’s blood pressure was 142/76 mm Hg, 30 minutes ago, and now is 88/50 mm Hg. What action would the nurse take first?

Rationale for Choice A: Ensuring the client is warm
While maintaining client warmth is important for comfort and to prevent hypothermia, it is not the immediate priority upon arrival in the postoperative unit. Thermoregulation can be addressed after more urgent assessments have been completed.
Rationale for Choice B: Participating in hand-off report
A thorough hand-off report is essential for continuity of care, but it does not take precedence over assessing the client's immediate physiological status. The nurse can gather information from the report while simultaneously performing essential assessments.
Rationale for Choice C: Checking the surgical dressings
Monitoring surgical dressings is a crucial aspect of postoperative care, but it does not take priority over assessing fluid and blood output. Excessive bleeding or fluid shifts can rapidly compromise the client's hemodynamic stability and require prompt intervention.
Rationale for Choice D: Assessing fluid and blood output
This is the priority action for several reasons:
Monitoring for Hemorrhage: Early detection of excessive bleeding is crucial to prevent hypovolemic shock, a life-threatening complication. Postoperative bleeding can occur internally or externally, and prompt assessment of fluid and blood output allows for timely interventions to control bleeding and maintain hemodynamic stability.

Assessing Fluid Balance: Maintaining fluid balance is essential for optimal organ function and electrolyte balance. Postoperative clients are at risk for fluid imbalances due to blood loss, fluid shifts, and the use of diuretics or IV fluids. Assessing fluid intake and output helps to identify and address fluid imbalances early.
Evaluating Renal Function: Urine output is a key indicator of renal function. Postoperative clients are at risk for acute kidney injury due to factors such as hypotension, blood loss, and nephrotoxic medications. Assessing urine output helps to detect early signs of kidney dysfunction and initiate appropriate interventions.
Guiding Fluid and Blood Product Replacement: The assessment of fluid and blood output provides essential information to guide the administration of fluids and blood products as needed. This ensures that the client's fluid status and oxygen-carrying capacity are maintained within safe parameters.
Therefore, assessing fluid and blood output takes priority as it allows the nurse to identify and address potential life- threatening complications promptly, as well as guide interventions to maintain fluid balance and organ function.

Choice A rationale:
While working in a facility affiliated with a medical or nursing school can offer opportunities for professional development and collaboration, it is not the most important factor to consider when choosing a new job.
Affiliation with a school does not guarantee a positive work environment, strong nursing leadership, or a commitment to quality patient care, which are all hallmarks of Magnet hospitals.
It's essential to consider other factors that directly impact job satisfaction, patient outcomes, and overall nursing excellence.
Choice B rationale:
Having the latest technology can be beneficial, but it does not ensure a supportive work environment or a high standard of nursing care.
Technology is only one aspect of a hospital's operations, and it should not be the primary focus when making a career decision. It's crucial to prioritize factors that directly influence the quality of nursing practice and patient outcomes.
Choice C rationale:
Inquiring about nurse-client ratios is important, as it can provide insight into the workload and staffing levels at a hospital. However, it's not the most comprehensive indicator of a hospital's commitment to nursing excellence.
Magnet status, in contrast, signifies a broader commitment to quality nursing care, professional development, and positive work environments.
Choice D rationale:
Magnet status is a prestigious designation awarded by the American Nurses Credentialing Center (ANCC) to hospitals that demonstrate excellence in nursing care, leadership, and innovation.
Magnet hospitals are known for:
Attracting and retaining highly qualified nurses Fostering a culture of collaboration and teamwork Investing in professional development and growth
Promoting evidence-based practice and quality improvement Demonstrating outstanding patient outcomes
Seeking employment at a Magnet hospital is strongly recommended for nurses who prioritize professional growth, job satisfaction, and the delivery of exceptional patient care.