A nurse is preparing to witness a client's signature on an informed consent for a total knee arthroplasty. Which of the following client stat indicates the nurse should contact the surgeon?

Rationale for correct choices

• Shortness of breath: The client’s dyspnea indicates impaired oxygenation and potential progression of pneumonia or respiratory compromise. Rapid recognition is essential to prevent hypoxemia or respiratory failure. Persistent shortness of breath warrants immediate interventions such as supplemental oxygen, monitoring, and notifying the provider.

• Productive cough with yellow sputum: The sputum color and productivity suggest a bacterial respiratory infection, which is confirmed by the chest x-ray result (pneumonia) and elevated WBC count. This requires immediate treatment with antibiotics.

• Diminished lung sounds with crackles: Diminished breath sounds and crackles suggest alveolar consolidation or fluid accumulation in the lungs, consistent with pneumonia. These findings indicate impaired gas exchange and increased work of breathing. Prompt assessment ensures early intervention and prevents deterioration.

• Pleuritic chest pain rated 6/10: Moderate chest pain on inspiration can indicate inflammation of the pleura secondary to pneumonia or early complications such as empyema. Pain may limit deep breathing and coughing, increasing the risk of atelectasis and further respiratory compromise. Follow-up ensures pain management and effective pulmonary hygiene.

Rationale for Incorrect Findings

• Nausea without vomiting: While the client reports nausea, it is mild and not associated with dehydration or electrolyte disturbances at this time. It should be monitored but does not require immediate intervention.

• Able to move all extremities and oriented: Neurological status is intact, which is reassuring. No deficits are noted, and immediate follow-up is not required.

• Skin is moist, pedal pulses +2: Perfusion appears adequate. Vital signs and circulation findings do not indicate acute compromise needing urgent intervention.

• Bowel sounds normoactive, last bowel movement this morning, no difficulty urinating: Gastrointestinal and urinary functions are stable. These findings do not require immediate follow-up.

A. Holding the newborn in an en face position: Positioning the newborn face-to-face with the parent promotes eye contact and bonding. This action supports healthy attachment and is encouraged during early interactions.

B. Asking the father to change the newborn's diaper: Involving another caregiver in newborn care is appropriate and promotes family bonding. It does not indicate a problem with maternal-infant attachment.

C. Viewing the newborn's actions to be uncooperative: Interpreting normal newborn behaviors, such as crying or squirming, as deliberate uncooperativeness may indicate difficulty in bonding or unrealistic expectations. The nurse should intervene to provide guidance on normal newborn behavior and support attachment.

D. Requesting the nurse take the newborn to the nursery so she can rest: Asking for rest is appropriate, especially if the mother is fatigued. Temporary separation does not negatively impact bonding if the mother is able to interact and care for the newborn afterward.