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NCLEX · Safety and Infection Control

Which assessment finding is most consistent with internal haemorrhage following abdominal surgery?

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Correct answer

Decreasing blood pressure AND increasing heart rate — early signs of haemorrhage: tachycardia as the body compensates for volume loss; narrowing pulse pressure; restlessness and anxiety; then hypotension develops as compensatory mechanisms fail

  1. A Rising blood pressure with decreasing heart rate
  2. B Bradycardia and hypertension
  3. C Blood pressure 140/90, HR 68
  4. D Decreasing blood pressure AND increasing heart rate — early signs of haemorrhage: tachycardia as the body compensates for volume loss; narrowing pulse pressure; restlessness and anxiety; then hypotension develops as compensatory mechanisms fail

Why this is the answer

HAEMORRHAGE RECOGNITION — HAEMODYNAMIC RESPONSE: EARLY COMPENSATED HAEMORRHAGE (Class I-II, up to 1,500 mL blood loss): Heart rate INCREASES (tachycardia) — compensatory sympathetic response; Blood pressure may be maintained or slightly decreased; Anxiety, restlessness; Skin pallor, cool, diaphoretic; LATE DECOMPENSATED HAEMORRHAGE (Class III-IV, >1,500 mL): Blood pressure DROPS — compensatory mechanisms overwhelmed; Severe tachycardia (>120-140); Confusion, lethargy; Oliguria;

Classic early warning pattern: Rising HR + falling BP = haemorrhage until proven otherwise; CUSHING'S TRIAD: Rising BP + dropping HR + irregular respirations = INCREASED INTRACRANIAL PRESSURE — not haemorrhage.

Post-surgical monitoring: Vital signs every 15 min × 4, then every 30 min × 4, then hourly — catch early deterioration; Assess incision/drain output; Assess urine output.

Pn scope: Monitor vital signs; report early warning signs; do not wait for obvious hypotension before notifying RN.

Source: NCLEX-PN Safe Care — Post-op Safety, Internal Haemorrhage Recognition

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About this topic: Safety and Infection Control

Safety and infection control questions cover Standard and transmission-based precautions, hand hygiene, fall and injury prevention, restraints, fire safety and handling hazardous materials. This is one of 35 PN: Coordinated Care questions on safety and infection control, each with a full explanation on a single study page.

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