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Answer :
Final answer:
The high blood pressure reading (196/100) after abdominal aortic aneurysm repair is a cause for immediate action by the nurse due to potential strain on the cardiovascular system.
Explanation:
In this scenario, the patient's vital sign result that necessitates immediate action by the nurse is D. Blood pressure 196/100. An elevated blood pressure, especially in a patient recovering from abdominal aortic aneurysm repair which is a major surgery, is a cause for concern. This high blood pressure stands out as it could potentially put strain on the cardiovascular system, possibly complicating the recovery process or even causing damage to the heart, brain, kidneys and other organs. High blood pressure is often a sign of hypertension which can manifest as a continuous problem or as a temporary condition caused by stress or other health issues. The other vitals like temperature, pulse rate and respiratory rate mentioned here are within normal ranges and do not require immediate intervention. However, this blood pressure reading is significantly higher than the normal blood pressure range (less than 120/80).
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