The nurse working night shift recognizes the value of allowing clients to sleep uninterrupted whenever possible. Which client would the nurse wake to assess vital signs?

Question

1. Postoperative client who had surgery 5 days ago and will be discharged in the morning
2. Client who has been afebrile for 3 days on antibiotics
3. Client who required medication earlier in the day for chest pain
4. A client who required the insertion of an indwelling catheter this evening secondary to urine retention related to an enlarged prostate

Answer 1

Correct Answer: 3

The client who complained of chest pain earlier in the day requires careful monitoring of vital signs, and would need to be awakened. The postoperative client is stable enough to be discharged, and would not need to be awakened. The client who has been afebrile for 3 days would not need to be awakened, and insertion of an indwelling urinary catheter would require careful monitoring of urine output but would not necessitate awakening. If any of these clients were to exhibit any symptoms of concern, the nurse would assess vital signs.