The nurse has reviewed the Nurses' Notes and Provider Prescriptions at 1 100 and Diagnostic Results on Day 3. A nurse is assisting with the evaluation of the client following surgery. Which of the following findings indicate that the client is experiencing a potential complication of surgery that requires immediate follow-up? Click to highlight the finding that requires immediate follow-up. To deselect a finding, click on the finding again. Area assessed Findings Neurological Drowsy but easy to arouse Vital Signs Temperature 35.3° C (95.5° F) Heart rate 60/min Respiratory rate 16/min Blood pressure 90/60 mm Hg Oxygen saturation 94% (oxygen at 2 L/min via nasal cannula) Rates pain as 1 on 0/10 pain scale. Integumentary Skin cool and moist to touch Cardiopulmonary Heart rate regular. Pedal pulse +1 bilateral. Lungs clear bilateral. Respirations even, nonlabored. Abdomen Abdomen soft, nondistended. Bowel sounds hypoactive in all four quadrants. 2x2 gauze with a clear transparent dressing intact to right lower and upper abdominal quadrant. Moderate amount of sanguineous drainage noted on the lower dressing.

After surgical management of ectopic pregnancy, the priority is to monitor for complications such as hemorrhage, infection, and hemodynamic instability. Internal or external bleeding is the most immediate life-threatening concern, especially in gynecologic surgery involving highly vascular reproductive structures. Identifying abnormal postoperative drainage is critical for early detection of bleeding complications. Rationale for correct choices: • Blood pressure 90/60 mm Hg): A significant decrease in blood pressure from a stable baseline of 120/74 mm Hg (pre-op) to 90/60 mm Hg (post-op) indicates reduced circulating blood volume. This drop suggests possible hypovolemia secondary to internal or external bleeding, especially after ectopic pregnancy surgery involving vascular tubal tissue. In postoperative clients, hypotension is an early compensatory sign before full shock develops. This change is not consistent with routine recovery and requires urgent evaluation for hemorrhage. • Oxygen saturation drop 94% on 2 L/min oxygen: The oxygen saturation decreased from 97% on room air (pre-op) to 94% despite oxygen supplementation (post-op), indicating reduced oxygen delivery or impaired perfusion. In suspected bleeding, this can reflect decreased tissue oxygenation due to reduced circulating volume and cardiac output. This trend is clinically significant when combined with hypotension and cool skin. • Temperature 35.3°C: The temperature decline from 37.2°C (normal range) to 35.3°C (hypothermia) is concerning in a postoperative client. Hypothermia can occur in shock states due to decreased perfusion and impaired thermoregulation, especially with blood loss. It may also reflect exposure during surgery, but in combination with hypotension and bleeding, it suggests worsening systemic instability. • Skin cool and moist: The client’s skin changed from warm and dry (preoperative baseline) to cool and moist (postoperative finding), indicating sympathetic nervous system activation. This occurs as the body attempts to compensate for decreasing blood volume through peripheral vasoconstriction and diaphoresis. It is an early clinical sign of shock and reduced perfusion to peripheral tissues. • Sanguineous drainage, moderate amount on abdominal dressing: The presence of moderate sanguineous drainage indicates active bleeding from the surgical site. After laparoscopic right salpingostomy, only minimal serosanguinous drainage is expected; moderate bright red drainage suggests ongoing hemorrhage or inadequate hemostasis. This finding is especially significant when paired with hypotension and tachycardia trends. Rationale for incorrect choices: • Neurological: drowsy but easy to arouse: Mild drowsiness can be expected after anesthesia and surgical recovery. The fact that the client is easily arousable indicates no acute neurological compromise. There are no signs of severe hypoxia or neurologic deterioration. Therefore, this finding is within expected postoperative recovery parameters. • Abdomen: soft, nondistended, hypoactive bowel sounds: A soft, nondistended abdomen with hypoactive bowel sounds is expected in early postoperative recovery due to anesthesia and reduced gut motility. There are no signs of acute abdominal rigidity or distention suggesting internal hemorrhage. This finding is consistent with normal postoperative changes.