NursingPlex
    Sign In
    ATI Nurs 100 Nursing Fundamentals proctored Exam

    A nurse is admitting a client to the post-anesthesia care unit. Which of the following actions should the nurse take first?

    Explanation & Rationale

    Choice A reason: Checking the airway is the priority in post-anesthesia care, as anesthesia can cause respiratory depression or obstruction due to reduced pharyngeal muscle tone. Ensuring airway patency prevents hypoxia, maintaining oxygen delivery to vital organs, critical for patient safety and stabilization post-surgery. Choice B reason: Level of consciousness is assessed after ensuring airway and breathing, as anesthesia (e.g., propofol) depresses the central nervous system. While important for neurological status, it is secondary to airway patency, as hypoxia from an obstructed airway poses an immediate life-threatening risk in the post-anesthesia period. Choice C reason: Blood pressure monitoring is crucial to assess hemodynamic stability post-anesthesia, as hypotension may result from anesthetic agents or blood loss. However, airway obstruction causes hypoxia faster than cardiovascular instability, making airway assessment the first priority to ensure oxygenation before addressing circulatory parameters. Choice D reason: Pain assessment is important for patient comfort and recovery but is not the first priority. Uncontrolled pain may increase sympathetic activity, affecting heart rate, but airway compromise causes rapid hypoxia, posing a greater immediate threat, requiring airway evaluation before addressing pain levels.

    🔒 Submit your answer to reveal