# An adult is in the post-anesthesia care unit after open abdominal aortic aneurysm repair. Review the serial findings and determine the priority response to the trend.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393147&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

An adult is in the post-anesthesia care unit after open abdominal aortic aneurysm repair. Review the serial findings and determine the priority response to the trend.

| Time | Data |
| --- | --- |
| 1400 | BP 128/76 mm Hg, HR 78/min, RR 14/min, SpO2 98% on 4 L/min, alert; drain has scant sanguineous output. |
| 1430 | BP 110/68 mm Hg, HR 92/min, RR 18/min, restless; drain output is increasing. |
| 1500 | BP 92/58 mm Hg, HR 110/min, RR 22/min; urine output is 15 mL during the prior hour. |
| 1530 | BP 82/50 mm Hg, HR 124/min, RR 26/min, pale and confused; 250 mL bright-red drain output accumulated in 30 minutes. |

Q1. How should the nurse interpret the overall trend?

Improving perfusion
Stable postoperative recovery
Rapid deterioration consistent with acute blood loss

Q2. What is the priority response?

Increase oxygen and resume routine monitoring
Activate emergency surgical escalation and prepare resuscitation and source-control support
Give PRN opioid medication before reporting the findings

Q3. Which additional action best supports the response?

Delay laboratory testing until the next scheduled round
Remove existing IV access to reduce bleeding
Encourage oral fluids before notifying the team
Prepare ordered blood products and maintain large-bore access while the team evaluates the bleeding source

## Explanation

The combined trajectory of falling blood pressure, rising heart and respiratory rates, restlessness, oliguria, and rapidly increasing bright-red drain output indicates acute postoperative blood loss with worsening perfusion. The nurse should activate the unit's emergency and surgical response, notify the surgeon and anesthesia team, support airway and circulation, obtain or verify large-bore access, prepare ordered blood products and laboratory testing, and prepare for urgent source control or return to the operating room as directed. Oxygen alone, routine reassessment, analgesia, or documentation without escalation does not address active hemorrhage.

## In-depth explanation

Correct Answer
The trend is rapidly deteriorating and is most consistent with acute postoperative hemorrhage and impaired perfusion. Activate emergency surgical escalation and prepare resuscitation and source-control support.

Why It Fits
No single value stands alone: hypotension, tachycardia, tachypnea, restlessness, oliguria, and brisk bright-red drainage worsen together over a short period after major open aortic surgery.

Clinical Picture
The trajectory moves from stable perfusion to shock physiology while visible blood loss accelerates. This requires parallel notification, circulation support, laboratory and blood preparation, and readiness for urgent intervention.

Memory Link
Falling pressure plus rising pulse plus fresh blood: escalate for source control.

NCLEX Rule
Trend items test the direction and combination of findings. When deterioration points to an internal or surgical source, bedside support and definitive escalation occur together.

Why the Alternatives Fail
Increasing oxygen alone does not replace circulating volume or stop bleeding. Waiting an hour, giving an opioid, or documenting only can allow shock to progress.

Sources
1ESVS 2024 Abdominal Aorto-Iliac Aneurysm Guidelines
2ERAS Society and SVS Open Aortic Surgery Consensus

## Clinical scenario

Post-anesthesia care unit
Over 90 minutes, blood pressure falls, heart rate and respiratory rate rise, urine output decreases, mental status changes, and a surgical drain begins filling rapidly with bright-red blood.

## Key concepts

- **Postoperative hemorrhage** — Acute blood loss after surgery that may cause hemodynamic instability and require urgent source control.
- **Oliguria** — Reduced urine output that can signal impaired renal perfusion during circulatory deterioration.
- **Source control** — Definitive intervention to stop or correct the anatomical source of bleeding.

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