After change-of-shift report, which patient would the nurse assess first?

Choice A reason: Repositioning may ease discomfort but won’t address severe pain (7/10) or reduced breath sounds post-thoracotomy. It risks dislodging tubes and doesn’t improve atelectasis or bleeding, lacking urgency for this acute scenario.

Choice B reason: Incentive spirometry prevents atelectasis, but pain limits participation. Decreased breath sounds suggest collapse, yet without pain control, this intervention is ineffective, delaying relief and lung expansion needed post-surgery.

Choice C reason: Clamping a chest tube risks tension pneumothorax by trapping air or blood, worsening breathing. With 100 mL drainage, it’s functioning; clamping is contraindicated unless ordered, making it dangerous here.

Choice D reason: Morphine reduces severe pain (7/10), enabling deeper breathing to reverse atelectasis. It addresses the primary barrier to recovery post-thoracotomy, improving ventilation and comfort, aligning with acute pain management protocols.

Choice A reason: Cilostazol inhibits phosphodiesterase III, increasing cyclic AMP, which dilates arteries and reduces platelet aggregation. This improves blood flow and reduces intermittent claudication in PAD, directly targeting vascular symptoms by enhancing circulation and preventing thrombosis, making it a primary treatment option.

Choice B reason: Ramipril, an ACE inhibitor, lowers blood pressure and protects vascular endothelium, benefiting PAD indirectly. It reduces cardiovascular strain but doesn’t directly improve limb perfusion or claudication, so it’s not a primary PAD medication despite its role in managing comorbidities like hypertension.

Choice C reason: Metoprolol, a beta-blocker, slows heart rate and reduces myocardial oxygen demand, useful in heart disease. In PAD, it may worsen claudication by reducing peripheral blood flow via vasoconstriction, making it less commonly prescribed specifically for PAD management.

Choice D reason: Aspirin inhibits cyclooxygenase, reducing thromboxane A2 and platelet aggregation. This antiplatelet action prevents clot formation in narrowed PAD arteries, improving outcomes by reducing thrombotic events, making it a standard, evidence-based therapy for symptom relief and risk reduction.

Choice E reason: Clopidogrel blocks ADP receptors on platelets, preventing aggregation and thrombus formation. In PAD, it reduces ischemic events and improves patency, often used alone or with aspirin, making it a key medication for managing vascular complications and symptoms.