The nurse is reviewing the preoperative checklist for a 66-year-old client scheduled for open abdominal surgery in one hour. The client has a history of hypertension, GERD, and smokes one pack per day. He is NPO since midnight. On assessment, the nurse notes the following:

•    Vital signs: BP 142/86, HR 96, RR 18, Temp 98.7°F, O₂ sat 98% on room air
•    Current labs: 
o    Hemoglobin: 10.5 g/dL (low)
o    Platelets: 100,000/mm³ (low)
o    INR: 10 (critically elevated)
o    Blood glucose: 144 mg/dL
o    Potassium: 3.1 mEq/L (low)
The client states, “I took my water pill this morning with a sip of water. Was that okay?”
Which finding should the nurse recognize as most likely to lead to a postoperative complication and report to the provider before proceeding with surgery?

Choice A reason: Clients receiving high-dose brachytherapy require radiation precautions, including private rooms to minimize exposure to others. A shared room is contraindicated due to radiation safety protocols.

Choice B reason: While minimizing close contact is part of radiation safety, the priority nursing intervention involves managing visitor exposure, which is more strictly regulated.

Choice C reason: Encouraging client independence is important unless contraindicated. Performing all care independently is not necessary and may reduce autonomy unnecessarily.

Choice D reason: Visitors must limit their time at the bedside due to radiation exposure risks. Guidelines typically restrict visits to short durations and require maintaining a safe distance, making this the most appropriate intervention.

Choice A reason: Fatigue and changes in consciousness are not typical adverse effects of inhaled fluticasone. These symptoms may indicate systemic corticosteroid toxicity but are not common with inhaled formulations at therapeutic doses.

Choice B reason: Dyspnea and increased secretions are more likely related to asthma exacerbations or infections, not directly caused by fluticasone. Inhaled corticosteroids aim to reduce inflammation and secretions.

Choice C reason: Cough and oral thrush are well-documented adverse effects of inhaled fluticasone. Thrush results from fungal overgrowth due to local immunosuppression in the oropharynx. Rinsing the mouth after use helps prevent this.

Choice D reason: Increased appetite and weight gain are more associated with systemic corticosteroids. Inhaled fluticasone has minimal systemic absorption when used correctly.