A client with a history of a right radical mastectomy arrives on the postoperative unit following surgical repair of a fractured left radius and application of a short arm cast. Which action should the practical nurse implement while obtaining the client's blood pressure (BP)?

Choice A reason: Fat embolism syndrome (FES) is a serious complication that can occur after a long bone fracture. It happens when fat droplets from the bone marrow enter the bloodstream and travel to the lungs, brain, or other organs, causing a range of symptoms. These can include respiratory distress, cerebral symptoms like confusion or agitation, and petechial rash. The practical nurse must be vigilant for early signs of fat embolism, such as changes in mental status, tachypnea, and hypoxia, as timely intervention is critical to prevent severe outcomes. Monitoring the client's oxygen saturation, respiratory rate, and level of consciousness is essential in detecting this potentially life-threatening condition.
Choice B reason: Urinary retention can be a concern postoperatively due to anesthesia and immobility. While it is important to monitor urinary output and ensure the client is voiding adequately, urinary retention is not as immediately life-threatening as a fat embolism. The practical nurse should still assess bladder function and encourage measures to promote voiding, such as adequate hydration and mobility. However, this complication does not take precedence over the potential for a fat embolism in the early postoperative period following a long bone fracture repair.
Choice C reason: Nonunion refers to the failure of the fracture to heal properly, which can lead to chronic pain and functional impairment. It is a significant complication that requires attention, but it typically develops over a longer period rather than immediately postoperatively. The practical nurse should monitor for signs of nonunion, such as persistent pain and lack of healing on follow-up X-rays. However, this is not the most urgent concern in the immediate postoperative period when compared to the risk of a fat embolism.
Choice D reason: Muscular spasms can occur after a fracture as the muscles around the injury site contract to protect and stabilize the affected area. While muscle spasms can be painful and affect the client's comfort and mobility, they are generally not life-threatening. The practical nurse should address muscle spasms through pain management strategies and physical therapy, but this complication is not as critical as the potential for a fat embolism in the immediate postoperative period.

Choice A reason: Nausea is a common side effect of chemotherapy and can significantly affect the client's quality of life. Managing nausea is important for ensuring the client can maintain adequate nutrition and hydration. However, it is not the most critical problem when planning care for a client with leukemia, as it does not pose an immediate threat to life compared to the risk of infection.
Choice B reason: Fatigue is another common issue experienced by clients undergoing chemotherapy. It can result from the treatment itself, the underlying disease, or anemia. While addressing fatigue is essential for improving the client's daily functioning and well-being, it is not the most urgent concern in this scenario. The client's significantly low WBC count poses a more immediate risk to their health.
Choice C reason: Infection is the most significant problem to consider when planning care for this client. The client's WBC count of 2,500/mm³ (2.5 x 10⁹/L) is well below the normal range, indicating leukopenia, which increases their susceptibility to infections. Clients with leukemia receiving chemotherapy are at a higher risk for infections due to both the disease and the treatment's impact on the immune system. Monitoring for signs of infection, implementing infection control measures, and providing prompt treatment if an infection is detected are critical to prevent severe complications.
Choice D reason: Bleeding is a potential concern for clients with leukemia, especially if platelet counts are low. However, in this case, the client's platelet count is within the normal range (250,000/mm³ or 250 x 10⁹/L). While it is important to monitor for bleeding, the immediate risk of infection due to the low WBC count is more pressing and requires prioritized attention.