A nurse is caring for a client who has received an albuterol nebulization treatment. Which of the following findings should the nurse instruct the client to observe as an adverse effect of this medication?

Postoperative pain management requires rapid onsetof action to maintain the client within a therapeutic comfort window. During the immediate post-anesthesiaperiod (the first 24 hours), the gastrointestinal tract may have decreased motility, making systemic absorption via the bloodstream the most reliable method. Effective analgesia is crucial for early mobilization and preventing complications like venous thromboembolism.

Rationale:

A.The intravenous route is the priority for a client who is only 6 hours postoperative because it provides immediate bioavailability and rapid peak effect. Following a major orthopedic surgery like a hip fixation, pain levels are typically high and require the fast-acting relief that IV opioids or non-opioids provide. This route allows for precise titration of the medication based on the client’s immediate pain response.

B.The oral route is generally avoided in the very early postoperative period due to the risk of postoperative ileus and nausea related to anesthesia. Oral medications have a slower onset of action, typically taking 30 to 60 minutes to reach peak effect, which is insufficient for acute, severe surgical pain. This route is more appropriate once the client is stable and bowel sounds have returned.

C.Sublingual administration is useful for certain medications but is not the standard of care for acute postoperative pain following major surgery. Most potent surgical analgesics are not formulated for sublingual use. The nurse requires a route that can deliver a wide range of analgesic agents reliably, making the intravenous route superior for the immediate recovery phase of a hip surgery.

D.The intramuscular route is generally discouraged for postoperative pain because it is painful, results in inconsistent absorption, and has a slower onset than the intravenous route. Repeated IM injections can cause tissue damage and hematomas, especially in surgical clients who may be on anticoagulants. Modern nursing practice favors IV access for acute pain to ensure consistent and rapid relief.

Total parenteral nutritioncontains high concentrations of glucose, which stimulates the pancreas to secrete significant amounts of insulin. Abrupt cessation of this hypertonic solution can lead to a rapid drop in blood glucose levels, resulting in rebound hypoglycemia. Maintaining a consistent dextrose source is critical until the next TPN bag is prepared.

Rationale:

A.Dextrose 10% in water (D10W) is the appropriate fluid to administer because it provides enough glucose to prevent rebound hypoglycemia when TPN is unavailable. The patient's pancreas is primed to release high levels of insulin in response to the TPN; without a continued dextrose source, the patient's blood sugar will plummet. D10W serves as a temporary bridge to maintain glycemic stability.

B.0.9% sodium chloride is an isotonic solution that provides volume and electrolytes but contains no glucose. Administering this fluid alone would fail to prevent the severe hypoglycemia that occurs when the high-glucose TPN infusion is suddenly stopped. While it is useful for many clinical situations, it is inappropriate as a substitute for TPN in a patient requiring glucose maintenance.

C.0.45% sodium chloride is a hypotonic solution used for cellular dehydration and does not contain the calories or sugar necessary to counteract the patient's high insulin levels. Using this solution when TPN runs out would leave the patient vulnerable to symptomatic hypoglycemia and potential neurological complications. It is an inadequate substitute for the high dextrose concentration required by the patient's current metabolic state.

D.Lactated Ringer's is a balanced crystalloid solution used for fluid resuscitation and electrolyte replacement, but it contains negligible amounts of carbohydrate. It cannot maintain the blood glucose levels of a patient who has been receiving hypertonic TPN. The nurse must prioritize a dextrose-containing solution to avoid the life-threatening consequences of a sudden cessation of parenteral nutrition support.