Which complication should a nurse monitor for in a client one hour after undergoing an adrenalectomy, prior to starting maintenance steroid therapy?

Monitoring for hypotension one hour after an adrenalectomy is crucial due to the risk of adrenal insufficiency, which can occur if sufficient adrenal hormones are not produced or if there's a disruption in the hormone balance following surgery. The adrenal glands play a key role in regulating blood pressure through the secretion of aldosterone and cortisol, among other hormones. If these hormones are lacking or absent after adrenal removal, it can lead to a drop in blood pressure.

In the post-operative phase, particularly before the initiation of maintenance steroid therapy, the client may experience a significant drop in cortisol levels, which can manifest as hypotension. This is a critical condition that requires immediate attention, as it could lead to inadequate perfusion of vital organs and subsequent complications.

While hyperglycemia, sodium retention, and potassium excretion are also considerations in post-surgical care, they are not immediate concerns within the first hour after surgery like hypotension is, especially in the context of potential adrenal crisis due to insufficient steroid levels. Therefore, the most immediate risk that the nurse should monitor for is hypotension.