Practice Question
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?
Answer Choices:
Correct Answer:
Arterial blood gases
Rationale:
🟣 After a thoracotomy and lobectomy, the client is at high risk for impaired gas exchange due to loss of lung tissue, pain, anesthesia effects, and potential complications.
🟣 Arterial blood gases (ABGs) provide direct information on oxygenation (PaO₂), ventilation (PaCO₂), and acid–base balance, which are critical in the immediate postoperative period.
🟣 ABG results help identify hypoxemia, hypercapnia, or respiratory acidosis, guiding urgent respiratory interventions.
🟣 Monitoring ABGs is aligned with the ABCs priority framework, focusing on breathing and oxygenation.
🟣 Therefore, among the given choices, ABGs should receive the highest priority.
Pain level.
🟣 Adequate pain control is very important after thoracotomy because severe pain can impair deep breathing and coughing.
🟣 Uncontrolled pain can contribute to atelectasis and pneumonia, so it must be addressed.
🟣 However, pain is a secondary priority compared with immediate assessment of oxygenation and ventilation via ABGs.
🟣 The nurse should still assess pain, but life-threatening respiratory compromise takes precedence.
🟣 Therefore, pain level is high priority but not highest compared to breathing assessment.
Urinary output.
🟣 Urinary output reflects kidney perfusion and fluid status, both of which are important postoperative considerations.
🟣 However, in thoracic surgery, the most immediate threat is respiratory failure, not renal function.
🟣 A brief delay in assessing urine output is generally tolerated, whereas delayed recognition of hypoxemia may be fatal.
🟣 While urine output must be monitored, it falls below airway and breathing in the priority hierarchy.
🟣 Therefore, it is not the primary postoperative assessment in this scenario.
Chest tube drainage.
🟣 Chest tube drainage is very important to monitor for bleeding, air leaks, and proper lung re-expansion.
🟣 Excessive output or sudden changes could indicate hemorrhage or complications, requiring prompt response.
🟣 However, the client’s global gas exchange, measured by ABGs, is more directly tied to life-threatening hypoxia and ventilation failure.
🟣 ABGs reflect the integrated effect of surgery, pain, ventilation, and chest tube function on oxygenation.
🟣 Thus, while chest tube assessment is crucial, ABGs still hold the higher priority for immediate postoperative safety.
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This question is from Custom Concept Quiz 2 which contains 40 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN Custom Exam(s)
- Answer Choices: 4