Question

A nurse is caring for a client who is 8hr postoperative following a coronary artery bypass graft (CABG). Which of the following findings should the nurse report?

A. Mediastinal drainage 100mL/hr
B. Blood pressure 160/80 mmHg
C. Temperature 37.1C (98.8F)
D. Potassium 4.0 mEq/L

Answer 1

The nurse should report finding A. Mediastinal drainage 100mL/hr as it suggests possible complications after the coronary artery bypass graft (CABG) surgery.

Step-by-step explanation:

The nurse should report finding A. Mediastinal drainage 100mL/hr.

After a coronary artery bypass graft (CABG) surgery, it is expected to have mediastinal drainage, which is the drainage of blood and fluids from the surgical site. However, a drainage rate of 100mL/hr is considered excessive and may indicate bleeding or a possible complication. Therefore, the nurse should report this finding to the healthcare provider for further evaluation.