During a postoperative assessment of a client who had a total knee arthroplasty, the nurse recognizes a sudden decrease in hemoglobin level. What should the nurse suspect?

Choice A rationale Joint dislocation after a total knee arthroplasty would manifest as severe pain, deformity of the limb, and an inability to move the joint. While a dislocation is a serious postoperative complication that requires immediate orthopedic intervention, it does not typically cause a sudden or significant drop in hemoglobin levels. Hemoglobin reflects the oxygen-carrying capacity of the blood, and its normal range is approximately 12 to 16 g/dL for women and 14 to 18 g/dL for men. Choice B rationale An infection at the surgical site usually presents with localized redness, warmth, purulent drainage, and a systemic increase in the white blood cell count. While a severe, chronic infection could eventually lead to anemia of chronic disease, an acute infection would not cause a sudden decrease in hemoglobin in the immediate postoperative period. The nurse would monitor the incision site and the patient's temperature to rule out sepsis or localized cellulitis. Choice C rationale A sudden decrease in hemoglobin levels following major orthopedic surgery is a primary indicator of internal or external hemorrhage or the formation of a large hematoma. The knee is a highly vascular area, and surgical trauma can lead to significant blood loss into the joint space or surrounding tissues. The nurse must assess the surgical dressing, check the drain output, and monitor for signs of hypovolemia, such as tachycardia and decreased blood pressure, to ensure hemodynamic stability. Choice D rationale Deep vein thrombosis is a risk after total knee arthroplasty and is characterized by unilateral calf pain, swelling, and redness. While it is a critical complication that can lead to a pulmonary embolism, it does not involve the loss of red blood cells or a decrease in hemoglobin. Prevention involves pharmacological prophylaxis and early ambulation. A drop in hemoglobin is specifically related to the loss of blood volume, pointing toward bleeding rather than a clotting event.