# 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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> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

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.

| Recovery assessment | Documented finding |
| --- | --- |
| Pain assessment | New right flank and lower-back pain is worsening. |
| Oxygenation | Oxygen saturation remains 96% on room air. |
| Distal circulation | Both feet are warm with palpable pedal pulses. |
| Access-site dressing | The right groin dressing remains dry without visible drainage. |
| Vital signs | Blood pressure is 88/54 mm Hg and pulse is 118/min. |
| Renal laboratory result | Creatinine remains 0.9 mg/dL, unchanged from baseline. |
| Blood count | Hemoglobin fell from 13.2 to 9.8 g/dL without visible blood loss. |
| Urinary assessment | The client voided clear yellow urine after the procedure. |
| Temperature | Oral temperature is 36.9 °C. |

## 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.

## In-depth explanation

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

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