A postoperative patient suddenly becomes restless, tachycardic, and has a falling blood pressure. The surgical dressing appears dry. What should the nurse suspect?

1. A

   Internal bleeding

2. B

   Wound infection

3. C

   Urinary retention

4. D

   Paralytic ileus

Appeared in: NORCET 8 Prelims-2025

Explanation

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• The combination of sudden restlessness, tachycardia (rapid heart rate), and hypotension (falling blood pressure) are the classic signs of hypovolemic shock.
• In a postoperative patient, hypovolemic shock is most commonly caused by hemorrhage (bleeding).
• Restlessness is an early and significant sign of cerebral hypoxia (decreased oxygen to the brain) resulting from reduced blood volume and perfusion.
• The dry surgical dressing is a crucial piece of information that rules out significant external bleeding from the incision, pointing strongly towards an internal source of blood loss.

Why Other Options Were Wrong

• Option B: A wound infection develops over several days (typically 3-6 days post-op), not suddenly. Its primary signs are localized inflammation (redness, warmth, swelling), purulent drainage, and fever, which are not described in the scenario.
• Option C: While urinary retention can cause restlessness and discomfort, it does not typically lead to hypotension. The patient would likely have a distended bladder and complain of an inability to void.
• Option D: Paralytic ileus is a gastrointestinal issue characterized by the cessation of peristalsis. Its signs are abdominal distension, absent bowel sounds, nausea, and vomiting, none of which are the primary symptoms presented.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition of postoperative hemorrhage and hypovolemic shock to guide bedside assessment, documentation, and the next nursing action.
• Prompt recognition of internal bleeding is a critical nursing responsibility to prevent irreversible shock and death. It is a 'must-not-miss' diagnosis in the postoperative setting.
• A nurse must never assume a dry dressing means no bleeding. Always perform a full assessment, correlating vital signs and the patient's mental status to get the complete clinical picture.
• What if the patient also had a rigid, board-like abdomen? This would further increase the suspicion of intra-abdominal hemorrhage and peritonitis, making the situation even more critical and requiring an even more urgent surgical consultation.

How to Approach the Question

• First, analyze the patient's context: The patient is in the postoperative period, a time of high risk for complications like bleeding.
• Next, identify the cluster of key signs and symptoms: sudden restlessness, tachycardia, and hypotension. Recognize this triad as the classic presentation of shock.
• Incorporate the negative finding: The surgical dressing is dry. This is a crucial clue that helps you differentiate the source of the problem.
• Synthesize the findings: The patient is in shock, but the bleeding is not external. Therefore, the bleeding must be internal.
• Evaluate the options based on this synthesis. Internal bleeding is the only option that perfectly explains the entire clinical picture (shock symptoms + no external blood loss). The other options have different timelines and symptom profiles.

Concept Tested & Keywords

• Concept Tested: Recognition of postoperative hemorrhage and hypovolemic shock.
• Stem keywords: postoperative, restless, tachycardic, falling blood pressure, dry dressing
• Lead-in keywords: suspect
• Clinical cues: The sudden onset of symptoms points to an acute event.
• Clinical cues: The dry dressing is a key negative finding that helps rule out external hemorrhage.

Question ID

Q3oRmHaYHy47u7w05GGXAo

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 6 pp. 196-198, 200-202