A nurse is caring for a patient who is postoperative day 1 with an abdominal incision following a hysterectomy. The patient states she is experiencing severe pain. Her blood pressure is 150/80 and her heart rate is 109. Which of the following actions should the nurse do first?

Choice A rationale Inspection is the first step of the physical assessment and involves a visual examination of the abdominal site. In a postoperative patient experiencing severe pain, tachycardia, and hypertension, the nurse must first look for obvious complications. This includes checking for wound dehiscence, evisceration, or signs of hemorrhage. Visual data provides immediate clues about the integrity of the surgical site and the potential cause of the patient's acute distress before any physical contact is made. Choice B rationale Auscultation involves using a stethoscope to listen to bowel sounds and vascular sounds within the abdomen. While important on postoperative day 1 to check for the return of peristalsis or the presence of an ileus, it is not the very first action. Inspection must always precede auscultation to ensure the area is intact. If the patient is in severe pain, a quick visual check for surgical complications is more urgent than listening for bowel sounds. Choice C rationale Percussion is used to estimate the size of organs and detect the presence of fluid or gas in the abdominal cavity. This technique involves tapping on the body surface, which can be quite painful for a patient who has just undergone an abdominal hysterectomy. Given the patient's reported severe pain and elevated vital signs, percussion is not the priority. It provides less immediate information regarding surgical emergencies compared to a thorough initial visual inspection of the incision. Choice D rationale Palpation is the act of feeling the abdomen with the hands to detect masses, tenderness, or guarding. In the sequence of abdominal assessment, palpation is performed last because it can alter bowel sounds and cause significant discomfort. For a postoperative patient in severe pain, deep or even light palpation could exacerbate their condition or cause injury if an underlying complication exists. The nurse must gather visual information first to ensure it is safe to proceed.