A client with pneumonia is experiencing ineffective airway clearance related to pain, fatigue, and толстые secretions. Which evaluation best indicates to the nurse a therapeutic response to treatment?

Choice A reason: Urine specific gravity of 1.010 is normal (1.005–1.030), indicating adequate hydration. Dehydration elevates specific gravity (>1.030) due to concentrated urine, so this client does not show dehydration signs, making this an incorrect choice for requiring fluid replacement interventions.

Choice B reason: Weight gain of 2.6 lbs in 24 hours suggests fluid retention, not dehydration. This may indicate hypervolemia, possibly from heart or renal failure, requiring diuretics. Dehydration involves weight loss, making this client’s finding inconsistent with dehydration needing intervention.

Choice C reason: Hematocrit of 45% is normal (38–50% males, 36–46% females). Dehydration elevates hematocrit due to hemoconcentration from reduced plasma volume. Normal hematocrit does not indicate dehydration, making this client an incorrect choice for requiring dehydration-specific fluid interventions.

Choice D reason: A BUN of 24 mg/dL is elevated (normal 7–20 mg/dL), indicating dehydration, as reduced renal perfusion concentrates blood urea nitrogen. This reflects hypovolemia, requiring fluid replacement to restore renal function and prevent acute kidney injury, making this client the priority for dehydration intervention.

Choice A reason: Administering pain medication is important for comfort but not the most critical action upon PACU transfer. Pain is typically managed in the PACU, and respiratory complications like atelectasis or hypoxia are life-threatening, making respiratory assessment the priority to ensure client stability.

Choice B reason: Assessing respiratory status is critical upon PACU transfer, as postoperative clients risk respiratory complications like atelectasis or airway obstruction from anesthesia. Ensuring adequate oxygenation and ventilation prevents hypoxia, making this the priority to ensure client safety and detect early signs of respiratory distress.

Choice C reason: Checking the surgical dressing assesses for bleeding or infection but is secondary to respiratory status. Wound complications are less immediately life-threatening than respiratory issues, which can cause rapid hypoxia, making dressing checks a lower priority upon transfer to the medical-surgical unit.

Choice D reason: Monitoring urine output assesses renal function and fluid status but is not the most urgent upon PACU transfer. Respiratory complications pose a greater immediate risk, as anesthesia and surgery impair lung function, making respiratory assessment the priority to prevent hypoxia-related complications.