135k views
3 votes
The nurse provides care for a client after a breast biopsy. immediately after the procedure, which assessment finding causes the nurse the greatest concern?

a- the client is highly anxious to know the results
b- the client reports pain at the sight
c- the clients blood pressure is 150/80
d- the clients skin is pale and clammy

1 Answer

4 votes

Final answer:

The nurse should be most concerned with the client's skin being pale and clammy after a breast biopsy, as it can be a sign of shock or hemorrhage, which are emergency conditions.

Step-by-step explanation:

Among the assessment findings listed for the client after a breast biopsy, the nurse should be most concerned with the client's skin being pale and clammy. This can indicate potential shock or hemorrhage, which are medical emergencies requiring immediate intervention. While a client being highly anxious, reporting pain at the site, or having a blood pressure of 150/80 are all relevant to monitor, they do not present the same immediate threat to life as potential signs of shock do.

It is crucial for the nurse to continuously monitor for signs of complication after any surgical procedure, such as increased redness, swelling, and pain, as these can be indicative of an infection. Furthermore, the possibility of a client entering a state of shock, as evidenced by Barbara's clinical focus case with metastatic inflammatory breast cancer, showcases the severity of such a condition and the necessity for prompt action.

User Ewanc
by
8.2k points