The nurse reviews recovery findings after femoral cardiac catheterization. Which findings require immediate follow-up for possible retroperitoneal hemorrhage? Highlight the findings that support concealed major bleeding.
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Choose your responses, then check the answer.
Explanation
New flank and back pain, hypotension with tachycardia, and an unexplained hemoglobin decrease support retroperitoneal bleeding. A dry groin dressing does not exclude bleeding into the retroperitoneal space.
Quick answer Highlight the new flank and back pain, the blood pressure decrease with tachycardia, and the hemoglobin drop. This pattern after femoral access can reflect blood collecting where it is not visible at the puncture site.
Why this is correct Retroperitoneal hemorrhage may follow femoral arterial access and can present with back or flank pain, hypotension, tachycardia, and an otherwise unexplained fall in hemoglobin. External dressing findings can remain deceptively quiet while internal blood loss progresses.[2]
Easy analogy or mental picture Think of a leak behind a wall. The floor in front may look dry, but falling pressure, hidden pooling, and pain behind the wall reveal the problem. The analogy explains concealed bleeding but does not identify its exact location without clinical evaluation.
Memory hook Femoral access plus back pain, falling pressure, and falling hemoglobin means hidden bleeding until proven otherwise.
NCLEX decision rule After an invasive vascular procedure, connect a new pain location with hemodynamic change and a falling blood count. Do not dismiss internal hemorrhage because the visible puncture site is dry or distal circulation remains intact.
Why the other choices are wrong Stable oxygen saturation, warm feet with palpable pulses, an unchanged creatinine, a dry dressing, normal temperature, and clear urine do not create the concealed-bleeding pattern. They are useful recovery data but do not offset the new hemodynamic and hemoglobin changes.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
AHRQ PSNet: Failure of a Femoral Closure DeviceAgency for Healthcare Research and Quality