Review the electronic health record. For each assessment finding, click to specify whether the finding is a likely complication or unlikely complication.

Rationale for correct choices

• Atelectasis: Atelectasis is a common post-operative pulmonary complication, especially after orthopedic surgery, due to immobility, shallow breathing, and pain that limits deep inspiration. The client’s elevated respiratory rate (26 breaths/min) and low oxygen saturation (88% on room air) indicate decreased lung expansion.

• Alveolar collapse: Atelectasis occurs when alveoli fail to expand fully or collapse, impairing gas exchange. Post-operative pain and reluctance to ambulate contribute to inadequate lung inflation, promoting alveolar collapse. The client’s recent surgery, immobility, and shallow breathing make alveolar collapse the underlying mechanism of this pulmonary complication.

Rationale for incorrect choices

• Bowel obstruction: Although post-operative clients are at risk for gastrointestinal complications, there is no indication of abdominal distention, absent bowel sounds, vomiting, or constipation. The client’s main issue is respiratory compromise, making bowel obstruction unlikely in this scenario.

• Infection: While surgical site infection is a potential post-operative risk, the client currently shows no fever, wound drainage, or local inflammation. The immediate concern is hypoxia and respiratory compromise, so infection is less likely at this time.

A. Open the sterile drape and place it on the table: Opening sterile supplies before preparing the environment increases the risk of contamination. The surface must be clean, dry, and positioned appropriately before any sterile items are opened. Environmental preparation precedes establishing the sterile field.

B. Put on sterile personal protective equipment: Sterile gloves and PPE are donned after the sterile field is set up, not before. Donning them too early increases the risk of contamination during setup. Hand hygiene and environment preparation come first.

C. Clean a work surface and raise it to waist level: The work surface must be disinfected and positioned at or above waist level to maintain visibility and prevent contamination. Sterile fields kept below waist level are considered contaminated. Preparing the environment is the first step in sterile setup.

D. Arrange sterile instruments on the sterile field: Sterile instruments are handled only after the sterile field has been properly established. Placing instruments occurs later in the setup sequence. This action depends on prior preparation of the field.