The client returns to the recovery room following repair of an intrathoracic aneurism. Which of the following would require further investigation?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

A urine output of 20 mL in the past hour is significantly below the minimum acceptable rate of 30 mL/hr for an adult.
This condition, known as oliguria, is a critical indicator of inadequate renal perfusion and potential acute kidney injury (AKI).
During intrathoracic aneurysm repair, the aorta may be cross-clamped, which can temporarily reduce or stop blood flow to the kidneys, making renal assessment a top priority.
This finding requires immediate reporting to the healthcare provider for intervention to prevent permanent kidney damage.

Option A: Regular pedal pulses are a desirable finding after a major vascular surgery. It indicates that blood circulation to the lower extremities is adequate and has not been compromised by the procedure.
Option C: A blood pressure of 108/50 mmHg results in a Mean Arterial Pressure (MAP) of approximately 69 mmHg. A MAP above 65 mmHg is generally considered sufficient to perfuse vital organs. While it should be monitored, it is not as immediately critical as the severe oliguria.
Option D: An oxygen saturation of 97% is a normal and healthy finding. It indicates that the patient's gas exchange and respiratory function are adequate.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Postoperative assessment and identification of complications following major vascular surgery as background academic context rather than a clinical decision trigger.
Nurses must meticulously monitor urine output hourly in the immediate postoperative period for patients who have undergone major vascular surgery.
Any output less than 30 mL/hr must be reported to the surgeon immediately to allow for timely intervention (e.g., fluid bolus, medication) to prevent permanent kidney damage.
This vigilance is a key patient safety measure to prevent the serious complication of acute kidney injury.

How to Approach the Question

First, identify the core of the question: It asks you to find the ABNORMAL finding among the given options for a patient who just had a specific, high-risk surgery (intrathoracic aneurysm repair).
Next, consider the specific risks associated with this surgery. Aneurysm repair often involves clamping the aorta, which puts the kidneys at high risk for ischemia.
Then, evaluate each option against standard physiological norms:
Pedal pulses: Should be present and regular. 'Regular' is a good sign.
Urine output: Should be at least 30 mL/hr. '20 mL' is critically low.
Blood pressure: MAP should ideally be above 65 mmHg. '108/50' gives a MAP of ~69 mmHg, which is acceptable.

Concept Tested & Keywords

Concept Tested: Postoperative assessment and identification of complications following major vascular surgery.
Stem keywords: intrathoracic aneurism, recovery room, postoperative, repair
Lead-in keywords: require further investigation
Clinical cues: The patient's recent surgery (intrathoracic aneurysm repair) is a major clinical cue, as it carries a high risk of renal complications due to potential aortic cross-clamping.

Q6bqwKpdMJhCKBHFZ5ZSj_

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 195-197

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 pp. 128-130, 118-120

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.