A patient in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter does the nurse monitor most closely on a patient who is postoperative following an embolectomy?

Correct Answer: D

Rationale: Post-embolectomy for pulmonary embolus (PE), the nurse most closely monitors pulmonary arterial pressure (PAP) via a pulmonary artery catheter, as it directly reflects the procedure's success in relieving pulmonary vascular obstruction. Elevated PAP pre-surgery indicates blockage; post-surgery, a decrease signals clot removal efficacy, while persistent elevation suggests residual emboli or reperfusion issues, guiding further intervention (e.g., thrombolytics). Pupillary response assesses neurological status, irrelevant unless cerebral hypoxia occurred. Vena cava pressure isn't routinely monitored and lacks specificity for PE outcomes. White blood cell differential tracks infection or inflammation, not acute hemodynamic status. PAP monitoring, alongside urinary output for perfusion, equips the nurse to detect complications (e.g., re-embolization), ensuring optimal postoperative management in this critical ICU patient.

Correct Answer: B

Rationale: Bronchospasm in COPD, a sudden airway narrowing from smooth muscle contraction, is suggested by wheezes or diminished breath sounds on auscultation. Wheezing a high-pitched sound from turbulent airflow through constricted passages is classic, while diminished sounds reflect reduced air entry, both audible in acute exacerbation. Crackles (fine or coarse) indicate fluid or mucus, typical in pneumonia or heart failure, not bronchospasm's dry obstruction. Reduced respiratory rate or lethargy suggests severe hypoxia or fatigue, not specific to bronchospasm COPD patients often show tachypnea. Slow, deliberate respirations may be compensatory but aren't diagnostic. The nurse's detection of wheezes or diminished sounds confirmed by stethoscope prompts bronchodilator use, aligning with COPD exacerbation management to reverse this reversible component.

Correct Answer: B

Rationale: Reviewing laboratory tests and allergies occurs in the preoperative phase, before surgery begins, to establish a baseline and identify risks like drug reactions or abnormal clotting. This preparation ensures the surgical team can tailor anesthesia and interventions, reducing complications. Perioperative spans all phases pre, intra, and post but isn't specific to this task. Intraoperative care happens during surgery in the operating suite, focusing on the procedure, not initial assessments. Postoperative care, in settings like the PACU, monitors recovery, not pre-surgery data. By completing this in the preoperative phase, the nurse mitigates physiological risks, such as bleeding from unrecognized coagulopathy or anaphylaxis from allergens, aligning with safety protocols to optimize surgical success and patient stability throughout the process.

Correct Answer: B

Rationale: A pillow during coughing splints the abdominal incision, supporting it to reduce strain on sutures and tissues cut through surgery. Coughing stresses the incision, risking dehiscence or pain from nerve irritation; splinting with a pillow or hands minimizes this pull, enhancing comfort and safety. It doesn't directly relieve pain analgesics do nor distract, as focus remains on coughing. Anxiety may lessen indirectly via comfort, but splinting's primary role is mechanical support. The nurse's use of this technique ensures effective airway clearance without compromising the incision, aligning with postoperative care to prevent complications like wound disruption.

Correct Answer: A

Rationale: Ascertaining the surgical site is correctly marked per universal protocol with indelible ink prevents wrong-site surgery, a critical error with severe consequences, making it most important. Marking the right great toe ensures surgical precision, mandated for all invasive procedures. Family location aids communication but isn't safety-critical. A clean gown and removing hairpins/cosmetics are standard but less urgent than site verification. The nurse's focus on this step upholds patient safety, aligning with Joint Commission standards to eliminate procedural mistakes.