A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. Which assessment should the nurse monitor most closely in the preoperative period?

• A. Vital Signs
• B. Intake and Output
• C. Blood Urea Nitrogen (BUN)
• D. Urine Glucose and Ketones

Answer: (A)

Pheochromocytoma causes massive, unpredictable release of catecholamines, which can drive dangerous spikes in blood pressure and heart rate during the preoperative period and especially during tumor manipulation. Because the main danger is hemodynamic instability, watching the vital signs provides the most direct and actionable information. Frequent blood pressure and heart rate checks help assess how well the patient’s alpha-blockade (and any other antihypertensive therapy) is controlling catecholamine effects, guide dose adjustments, and alert the team to impending hypertensive crises or tachyarrhythmias. While intake/output, BUN, and urine glucose/ketones are important for overall care, they do not address the immediate perioperative hemodynamic risk posed by the tumor.