# A nurse on a medical-surgical unit reviews the morning labs for a 67-year-old male client who is postoperative day 2 from a left total hip arthroplasty. Hemoglobin yesterday was 8.2 g/dL; the value today is 7.0 g/dL. Vital signs: BP 102/64, HR 102, RR 18, T 36.8°C, SpO2 96% on room air. The surgical dressing has a small amount of dried sanguineous drainage. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: System-Specific Assessments  
> category: ROR

## Question

A nurse on a medical-surgical unit reviews the morning labs for a 67-year-old male client who is postoperative day 2 from a left total hip arthroplasty. Hemoglobin yesterday was 8.2 g/dL; the value today is 7.0 g/dL. Vital signs: BP 102/64, HR 102, RR 18, T 36.8°C, SpO2 96% on room air. The surgical dressing has a small amount of dried sanguineous drainage. Which is the priority nursing action?

## Option

1. Recheck the hemoglobin by repeat venous draw in 4 hours to confirm the drop, and contact the provider if the client develops dizziness or the repeat value is less than 7.0 g/dL.
2. Increase oral fluid intake to 2 L per day, encourage the client to ambulate in the hallway with assistance, and reassess vital signs at the next routine 4-hour interval to monitor for changes.
3. Document the downward trend in hemoglobin, hold the next scheduled dose of low-molecular-weight heparin, and escalate the concern to the provider if the client develops symptomatic anemia.
4. Notify the provider promptly, perform a focused bleeding assessment (vital signs, dressing, drain output, abdomen for occult bleeding), and prepare for possible transfusion or imaging. **✔ Correct answer**

**Correct answer: 4**

## Explanation

A 12-hour hemoglobin drop of 1.2 g/dL in a postoperative client is clinically significant and warrants immediate provider notification. Hgb 7.0 g/dL approaches the AABB transfusion threshold (

## In-depth explanation

Clinical Judgment
Apply NCJMM: Recognize cues (Hgb 8.2 → 7.0 + HR 102 + BP 102/64 + hip arthroplasty POD 2 = possible active bleeding) → Analyze cues (a 1.2 g/dL drop in 12 hours is significant; tachycardia and borderline BP suggest compensated hypovolemia) → Generate solutions (provider notification + focused bleeding assessment + preparation for transfusion or imaging) → Take action (notify, assess, prepare) → Evaluate outcomes (bleeding source identified, transfusion if indicated, no progression to decompensated shock).

Memory Tip
Hgb drop ≥1 g/dL = STAT notify. Trend matters more than a single value. Tachycardia + borderline BP is a compensatory hypovolemia signal — even when the client looks stable, notify immediately.

KR vs US
Korean wards often defer morning lab findings to the round-the-bed team brief, but NCLEX requires immediate notification of any critical lab trend. Wait-and-see, deferral until rounds, or independent anticoagulant hold are all wrong on NCLEX.

## Clinical scenario

Clinical Practice Guide
AABB transfusion guidelines: Hgb

## Key concepts

- **Hemoglobin (Hgb)** — An iron-containing protein in red blood cells that carries oxygen. Adult reference is approximately 12–17 g/dL. A drop of ≥1 g/dL within 24 hours, or values
- **CBC trend** — The serial change in complete blood count values (Hgb, Hct, platelets) over time. Trend rather than a single value drives most postoperative bleeding decisions; a downward Hgb trajectory combined with tachycardia or hypotension prompts urgent evaluation.
- **Compensated hypovolemia** — An early stage of volume loss in which the body maintains blood pressure through tachycardia, vasoconstriction, and increased respiratory rate. BP often appears normal or borderline. Recognizing this stage prevents progression to decompensated shock.

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