A nurse in the postanesthesia 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?

A. Increase fiber intake to reduce the adverse effect of constipation. Warfarin does not commonly cause constipation, so increasing fiber intake is not a necessary recommendation related to this medication. While fiber is beneficial for general health, it does not specifically impact warfarin’s effects.
B. Mild nosebleeds are common during initial treatment. Nosebleeds are not an expected effect of warfarin therapy. Any unusual bleeding, including nosebleeds, gum bleeding, or excessive bruising, should be reported to the provider, as they may indicate an increased risk of hemorrhage.
C. If a dose of the medication is missed, double the dose at the next scheduled time. Doubling a dose of warfarin can lead to dangerously high anticoagulation levels and an increased risk of bleeding. If a dose is missed, the client should take it as soon as possible on the same day but should not take two doses at once unless instructed by a healthcare provider.
D. Use an electric razor while on this medication. Warfarin increases the risk of bleeding, making an electric razor a safer option to prevent accidental cuts. Clients should also take other bleeding precautions, such as using a softbristled toothbrush and avoiding activities with a high risk of injury.

A. Lower back or groin pain. Early signs of an abdominal aortic aneurysm (AAA) include deep, constant pain in the abdomen, lower back, or groin due to pressure on surrounding structures. The pain is often steady and not relieved by position changes. As the aneurysm expands, the risk of rupture increases, making early recognition critical.
B. Presence of Cullen’s sign. Cullen’s sign (periumbilical bruising) is associated with intraperitoneal hemorrhage, often due to pancreatitis or ruptured ectopic pregnancy rather than an early sign of an AAA. However, if the aneurysm ruptures, flank or periumbilical bruising (Grey Turner’s or Cullen’s sign) may appear as a late finding.
C. Hunger after eating. Abdominal aortic aneurysms do not affect hunger or digestion in early stages. However, compression of surrounding organs in larger aneurysms may lead to early satiety, nausea, or bowel changes, but this is not an early manifestation.
D. Pain in the chest. While thoracic aortic aneurysms can cause chest pain, an abdominal aortic aneurysm primarily causes abdominal, lower back, or flank pain due to its location below the diaphragm. Chest pain would be more concerning for a thoracic aortic aneurysm or acute aortic dissection rather than an AAA.