NCLEX Acute Coronary Syndrome Practice Exam

The nurse should contact the surgeon regarding the chest tube drainage of 175 mL in the last hour because this amount is concerning. In the postoperative setting following coronary artery bypass graft (CABG) surgery, monitoring chest tube output is critical. An output of more than 150 mL per hour—particularly if it is persistent—can indicate possible complications such as bleeding or hematoma formation. This could lead to significant risks for the patient, requiring immediate medical evaluation and intervention.

While the other findings may warrant monitoring, they do not typically represent an urgent situation that requires immediate contact with the surgeon. A temperature of 98.2° F is considered within normal limits for a postoperative patient. A serum potassium level of 3.9 mEq/L is also within the normal range, indicating no immediate electrolyte disturbance. Although incisional pain rated at 6 on a scale of 1 to 10 is significant and may require management or further assessment, it is a common occurrence after surgery and does not pose an immediate threat compared to the implications of high chest tube drainage.