Which client with chronic obstructive pulmonary disease (COPD) will the nurse assess first?

Choice A reason: Administering pain medication is important for comfort but not the most critical action upon PACU transfer. Pain is typically managed in the PACU, and respiratory complications like atelectasis or hypoxia are life-threatening, making respiratory assessment the priority to ensure client stability.

Choice B reason: Assessing respiratory status is critical upon PACU transfer, as postoperative clients risk respiratory complications like atelectasis or airway obstruction from anesthesia. Ensuring adequate oxygenation and ventilation prevents hypoxia, making this the priority to ensure client safety and detect early signs of respiratory distress.

Choice C reason: Checking the surgical dressing assesses for bleeding or infection but is secondary to respiratory status. Wound complications are less immediately life-threatening than respiratory issues, which can cause rapid hypoxia, making dressing checks a lower priority upon transfer to the medical-surgical unit.

Choice D reason: Monitoring urine output assesses renal function and fluid status but is not the most urgent upon PACU transfer. Respiratory complications pose a greater immediate risk, as anesthesia and surgery impair lung function, making respiratory assessment the priority to prevent hypoxia-related complications.

Choice A reason: Dilated and reactive pupils are unrelated to albuterol’s effect. Albuterol, a bronchodilator, relaxes bronchial smooth muscles to improve airflow in emphysema. Pupil changes may indicate neurological or systemic issues but are not a direct indicator of albuterol’s effectiveness in relieving bronchoconstriction and respiratory distress.

Choice B reason: Decreased respiratory rate indicates albuterol’s therapeutic effect in emphysema. Albuterol relaxes constricted airways, improving airflow and reducing the work of breathing. This leads to a slower, more effective respiratory rate, reflecting better oxygenation and relief of bronchospasm, making it the primary sign of therapeutic success.

Choice C reason: Urine output of 50 mL/hr is normal but unrelated to albuterol’s effect. Albuterol targets bronchial smooth muscles to relieve bronchoconstriction in emphysema, improving respiratory function. Urine output reflects renal function, not airway improvement, making it an irrelevant indicator of albuterol’s therapeutic effectiveness in this context.

Choice D reason: A heart rate of 100 beats/minute may occur as a side effect of albuterol’s beta-adrenergic stimulation but is not the primary therapeutic indicator. Albuterol aims to improve airflow and reduce respiratory distress, evidenced by a decreased respiratory rate, not tachycardia, which is a secondary effect.