# Situation: A 57-year-old woman is on post-operative day 3 after surgery for a small bowel obstruction. She has a nasogastric (NG) tube on low intermittent suction that drained 1,800 mL in the past 24 hours, and she receives 5% dextrose in water at 80 mL/h. She is on subcutaneous enoxaparin to prevent venous thrombosis. This morning she reports numbness and tingling of her fingers. Before the arterial blood gas (ABG) sample was drawn, the nurse completed the pre-puncture assessment. After withdrawing the needle from her radial artery, which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629808  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 57-year-old woman is on post-operative day 3 after surgery for a small bowel obstruction. She has a nasogastric (NG) tube on low intermittent suction that drained 1,800 mL in the past 24 hours, and she receives 5% dextrose in water at 80 mL/h. She is on subcutaneous enoxaparin to prevent venous thrombosis. This morning she reports numbness and tingling of her fingers.

Before the arterial blood gas (ABG) sample was drawn, the nurse completed the pre-puncture assessment. After withdrawing the needle from her radial artery, which action should the nurse take?

## 보기

1. Apply a tight pressure dressing and have her keep the wrist flexed
2. Press firmly on the site for 2 minutes, then apply a bandage
3. Apply an ice pack to the site and elevate the arm without pressure
4. Press firmly on the site for more than 5 minutes, then check it **✔ 정답**

**정답: 4**

## 해설

After an arterial puncture, firm direct pressure is held for more than 5 minutes, and longer in a client receiving an anticoagulant, because arterial pressure makes bleeding and hematoma likely. She is receiving enoxaparin, so pressure is held beyond 5 minutes, and the site is checked for bleeding and swelling before she is left.

## 심화 해설

Firm pressure for more than 5 minutes
An arterial puncture opens a vessel under high pressure, so bleeding and hematoma are more likely than after a venous puncture. After the needle is withdrawn from the radial artery, the nurse holds firm direct pressure on the site for more than 5 minutes, and longer when the client receives an anticoagulant. This client is on subcutaneous enoxaparin for venous thrombosis prevention, so pressure is held beyond 5 minutes and the site is checked for bleeding and swelling before she is left.

Why direct pressure, not a dressing
Bleeding from an artery stops only when the puncture is compressed firmly enough to oppose arterial pressure until a clot forms. A tight pressure dressing does not give the same controlled compression and, if wrapped around the wrist, can impair circulation to the hand. Keeping the wrist flexed does not compress the puncture. An ice pack without pressure may constrict surface vessels but cannot stop arterial bleeding. Two minutes of pressure is the kind of time used after a venipuncture and is too short for an artery, especially in a client receiving an anticoagulant.

| Option | Problem |
| --- | --- |
| Tight pressure dressing with the wrist flexed | Does not replace manual pressure; may impair hand circulation |
| Firm pressure for 2 minutes | Too short for an arterial puncture, especially on enoxaparin |
| Ice pack without pressure | Cold alone does not stop arterial bleeding |
| Firm pressure for more than 5 minutes, then check | Correct |

Context: why the ABG was drawn
She has lost 1,800 mL of gastric fluid through the NG tube in 24 hours while receiving only 5% dextrose in water, and she reports numbness and tingling of her fingers. Loss of gastric acid can cause metabolic alkalosis, and alkalosis lowers ionized calcium, which can produce tingling. The ABG will help confirm the acid-base disturbance. The pre-puncture assessment, including checking collateral circulation to the hand before a radial puncture, was already done; this item focuses on care after the puncture.

Watch out! After pressure is released, look at the site and feel the radial pulse. Check the hand for color, warmth, and sensation, and report swelling, continued bleeding, or a weak pulse.

Exam takeaway
Key point! Arterial punctures need firm direct pressure for more than 5 minutes, longer with anticoagulants or bleeding disorders. Then inspect the site and check distal circulation. Dressings, ice, or positioning do not replace manual compression.

## 임상 시나리오

After a Radial Arterial PuncturePreventing bleeding and hematoma
Hold firm direct pressure on the site for more than 5 minutes after withdrawing the needle. An artery bleeds under high pressure.

Hold pressure longer when the client receives an anticoagulant such as enoxaparin, then check the site for bleeding and swelling before leaving her.

Check the radial pulse and the color, warmth, and sensation of the hand. A tight wrap or ice pack does not replace manual pressure.

CautionA dressing wrapped tightly around the wrist can impair circulation to the hand and still fail to stop arterial bleeding.

## 핵심 개념

- **Arterial blood gas** — A test of arterial blood measuring pH, oxygen, carbon dioxide, and bicarbonate to assess oxygenation and acid-base status.
- **Hematoma** — A collection of blood in the tissues, common after arterial puncture without adequate pressure.
- **Enoxaparin** — A low-molecular-weight heparin given subcutaneously that increases bleeding after punctures.
- **Metabolic alkalosis** — A rise in blood pH from loss of acid or gain of bicarbonate, as with large gastric fluid losses.

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