A nurse is assisting in the care of a client who is taking metoprolol. The nurse should monitor the client for which of the following adverse effects?

Supporting families of clients newly diagnosed with depression involves therapeutic communication that promotes understanding, reduces anxiety, and assesses knowledge gaps. Depression is a complex mental health condition influenced by biological, psychological, and social factors, and recovery timelines vary widely depending on severity, treatment adherence, and individual response to therapy. Nurses should avoid giving false reassurance or vague predictions and instead engage the family in dialogue that helps tailor education to their needs. Effective communication strengthens coping and improves support for the client.

Rationale:
A. Providing generalized statements about improvement in other clients is non-therapeutic because it may create unrealistic expectations and does not address the partner’s specific concerns. Each client’s response to treatment for Major depressive disorder is individualized, so comparing outcomes can be misleading and unhelpful.

B. Stating that no one knows the answer may be truthful but is abrupt and non-therapeutic. It can increase anxiety and leave the partner without support or direction. Nursing communication should remain supportive while guiding the family toward understanding and coping.

C. Focusing only on the importance of improvement minimizes the partner’s concern about prognosis and does not provide education or emotional support. This type of response may shut down further discussion and fail to address the family’s need for information about recovery expectations.

D. Asking what the partner knows about depression is a therapeutic communication technique that assesses baseline understanding and allows the nurse to provide individualized education. It encourages dialogue, clarifies misconceptions, and supports emotional processing. This approach fosters engagement and helps build a realistic understanding of recovery.

The client underwent surgical intervention (right salpingostomy), which carries risks such as hemorrhage, hypovolemic shock, infection, and adverse anesthetic effects. Postoperative assessment findings must be carefully evaluated for early signs of deterioration. Hypotension combined with bradycardia, hypothermia, and cool clammy skin suggests potential shock or significant hemodynamic instability, which requires urgent intervention to prevent cardiovascular collapse.

Rationale for correct choices:

• Blood pressure 90/60 mm Hg: A blood pressure of 90/60 mm Hg indicates hypotension, which is a major postoperative warning sign for possible hemorrhage or shock following ectopic pregnancy surgery. Given the vascular nature of reproductive structures and recent surgical intervention, internal bleeding is a significant concern. This drop in perfusion pressure can rapidly progress to organ hypoperfusion and cardiovascular collapse if not addressed immediately. It is the most urgent abnormal finding requiring immediate follow-up.

• Heart rate 60/min: Bradycardia in the postoperative setting may indicate worsening hemodynamic instability, especially when combined with hypotension. While opioids or anesthesia may contribute, the presence of low blood pressure makes this finding more concerning for circulatory compromise. It may represent a late or atypical response in shock states where compensatory mechanisms are failing. Continuous is essential.

• Temperature 35.3° C (95.5° F): Hypothermia after surgery may result from anesthesia effects, environmental exposure in the operating room, or impaired thermoregulation. However, in combination with hypotension and bradycardia, it may indicate poor perfusion and early shock. Reduced core temperature can impair coagulation, increasing the risk of postoperative bleeding. This finding supports the concern for systemic instability rather than isolated temperature variation.

• Skin cool and moist to touch: Cool, moist skin is a classic sign of peripheral vasoconstriction and sympathetic activation seen in shock states. It reflects the body’s attempt to preserve blood flow to vital organs at the expense of peripheral circulation. When combined with hypotension, it strongly suggests decreased tissue perfusion. This finding supports the likelihood of postoperative hemorrhage or circulatory compromise requiring immediate intervention.

Rationale for incorrect findings:

• Pain rating 1/10: A pain score of 1/10 is an expected and reassuring postoperative finding following laparoscopic surgery. It indicates effective pain control and no evidence of acute complications such as severe internal bleeding or peritoneal irritation. In postoperative monitoring, significant worsening pain would be more concerning for complications. Therefore, a low pain score is a normal and non-alarming finding in this scenario.

• Neurological status: drowsy but easy to arouse: Mild drowsiness is common after anesthesia and opioid administration in the postoperative period. The client is easily arousable and responsive. This suggests intact airway protection and no immediate neurological emergency. In the absence of worsening confusion or unresponsiveness, this finding is expected and not the priority concern.