NCLEX-RN practice › Reduction of Risk Potential
NCLEX question: concealed bleeding after hip surgery
Reduction of Risk Potential · Multiple choice · Clinical judgment step: Prioritize hypotheses
Client record
Vital signs
| Time | 2000 | 2200 | 0000 | 0200 |
|---|---|---|---|---|
| BP (mm Hg) | 132/78 | 124/76 | 112/74 | 104/72 |
| HR (/min) | 82 | 94 | 106 | 118 |
| RR (/min) | 16 | 18 | 20 | 22 |
| Urine (mL/hr) | 60 | 45 | 30 | 20 |
Laboratory results
- Hemoglobin
- 12.6 g/dL preop → 8.9 g/dL at 0100
Assessment
Dressing dry and intact. Right thigh firmer and larger than left. Client restless.
A client is 12 hours after a total hip arthroplasty. Based on the client record, what is the nurse's priority?
- A. Report suspected internal hemorrhage to the surgeon
- B. Encourage oral fluids to increase urine output
- C. Reinforce the dressing and recheck in 1 hour
- D. Give the prescribed oxycodone for restlessness
Show the answer and rationales
Answer: A
Concealed bleeding shows in trends: tachycardia, narrowing pulse pressure, falling urine output and hemoglobin, with local swelling. A dry dressing does not rule out hemorrhage.
- A. Correct. Correct. A falling hemoglobin, rising heart rate, narrowing pulse pressure, falling urine output and a swelling thigh with a dry dressing indicate concealed bleeding into the thigh. This is compensated hypovolemic shock.
- B. Incorrect. Oral fluids do not treat hemorrhage, and the client may need surgery.
- C. Incorrect. The dressing is dry; the bleeding is concealed and needs escalation, not reinforcement.
- D. Incorrect. Restlessness here is a sign of hypoperfusion; an opioid could mask it and lower blood pressure.
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