A nurse is caring for a client who is 1day postoperative following a left lower lobectomy and has a chest tube in place. When assessing the client's threechamber drainage system, the nurse notes that there is no bubbling in the suction control chamber. Which of the following actions should the nurse take?

A. The client has hypertension and anuria. Hypertension is not a common feature of postoperative shock. Instead, shock is typically characterized by hypotension due to inadequate perfusion. Anuria, while concerning, is usually a later sign of severe hypovolemia or organ failure rather than an early indicator of shock.
B. The client develops bradycardia and bradypnea. Shock generally triggers a compensatory response, leading to tachycardia as the body attempts to maintain cardiac output. Bradycardia and bradypnea are more commonly associated with conditions such as neurogenic shock or opioid overdose rather than hypovolemic or septic shock, which are more frequent in postoperative settings.
C. The client has hypotension and is confused. Hypotension is a hallmark sign of postoperative shock, often resulting from blood loss, fluid shifts, or sepsis. Confusion occurs due to decreased cerebral perfusion and oxygenation. These symptoms indicate a state of inadequate circulation requiring immediate intervention, making this the most appropriate answer.
D. The client has metabolic alkalosis and warm extremities. Postoperative shock is more commonly associated with metabolic acidosis due to poor tissue perfusion and lactic acid buildup rather than alkalosis. Additionally, warm extremities are typical in early septic shock, whereas most types of shock, such as hypovolemic or cardiogenic shock, lead to cool, clammy skin due to vasoconstriction.

A. Chest xray. A chest xray may show an enlarged cardiac silhouette ("water bottle heart") due to the accumulation of pericardial fluid, but it is not the most immediate or definitive diagnostic tool for cardiac tamponade.
B. Echocardiogram. An echocardiogram is the firstline diagnostic test for suspected cardiac tamponade. It provides realtime imaging of the heart, allowing visualization of pericardial effusion, right ventricular collapse during diastole, and impaired cardiac filling, which are hallmark signs of tamponade. It is noninvasive, rapid, and highly sensitive, making it the preferred initial test.
C. Computed tomography (CT) scan. A CT scan can detect pericardial effusion, but it is not the first choice due to longer imaging time and lower practicality in an emergent setting. It is often used when echocardiography is inconclusive or when other mediastinal pathology is suspected.
D. Electrocardiogram (ECG). An ECG in tamponade may show low voltage QRS complexes, electrical alternans, or nonspecific ST changes, but these findings are not definitive. ECG cannot directly visualize pericardial fluid or hemodynamic compromise, making it less useful than echocardiography for confirming the diagnosis.