NCLEX Question of the Day – Saturday, May 23, 2026

Today’s question focuses on Med-Surg nursing and the skill of spotting a patient who is becoming unstable after surgery. This matters because bedside nurses are often the first to notice subtle signs of deterioration. A fast, correct response can prevent shock, respiratory failure, or an emergency return to the operating room.

Clinical Scenario

A 67-year-old client is 6 hours post-op after an open right hemicolectomy for colon cancer. The client is on a surgical unit and has an IV of lactated Ringer’s running at 125 mL/hr. History includes hypertension, type 2 diabetes, and chronic kidney disease stage 2. A Foley catheter was removed 2 hours ago. The client has a midline abdominal dressing and a Jackson-Pratt drain.

During the nurse’s reassessment, the client says, “I feel weak and a little dizzy.” The nurse notes the client is pale and restless. Vital signs are: temperature 37.1 C, heart rate 118/min, blood pressure 88/54 mm Hg, respiratory rate 24/min, and oxygen saturation 95% on 2 L nasal cannula. The abdominal dressing has a small amount of old drainage, but the Jackson-Pratt drain now contains 180 mL of dark red output collected in the past hour. Urine output for the last 2 hours is 20 mL total.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Reposition the client onto the left side and encourage slow deep breathing
2. B. Notify the surgeon of suspected postoperative hemorrhage and prepare for rapid intervention
3. C. Administer the prescribed PRN opioid for pain to reduce the client’s restlessness
4. D. Clamp the Jackson-Pratt drain to reduce further blood loss

Correct Answer

B. Notify the surgeon of suspected postoperative hemorrhage and prepare for rapid intervention

Detailed Rationale

This client is showing multiple signs of postoperative hemorrhage with hypovolemia. The nurse should recognize the pattern, not just one abnormal value.

The key clues are:

• Tachycardia at 118/min
• Hypotension at 88/54 mm Hg
• Restlessness and dizziness
• Pallor
• Low urine output
• A sudden increase in dark red drainage from the surgical drain

These findings suggest active blood loss and reduced organ perfusion. Restlessness is often an early sign of poor oxygen delivery to the brain. Low urine output shows the kidneys are not being perfused well. A large increase in bloody drain output after abdominal surgery is especially concerning because some bleeding may be collecting internally while the drain captures only part of it.

The first priority is to escalate immediately by notifying the surgeon or rapid response team per facility policy and preparing for urgent treatment. In real practice, this is not just a phone call. The nurse should act while escalating care.

What the nurse should assess and do next:

• Stay with the client and perform a focused reassessment
• Check level of consciousness, skin temperature, capillary refill, and abdominal firmness or distention
• Verify current vital signs and repeat them frequently
• Ensure IV access is patent; anticipate more IV fluids or blood products
• Review recent hemoglobin, hematocrit, coagulation studies, and type and screen if available
• Apply oxygen as needed based on condition and facility protocol
• Measure and document drain output accurately
• Prepare for provider orders such as CBC, fluid bolus, blood transfusion, or return to surgery

The “why” is simple: this client may be progressing toward shock. Delaying definitive action to do a comfort measure or a nonessential task could worsen tissue hypoxia and organ injury. NCLEX priority questions often test whether you can recognize a life-threatening pattern and respond before the situation crashes.

Why the Other Options Are Wrong

A. Reposition the client onto the left side and encourage slow deep breathing

This does not address the likely cause of the instability. Deep breathing is useful after surgery to prevent atelectasis, but it will not fix active bleeding. Repositioning may be appropriate in some situations, but here it delays urgent intervention.

C. Administer the prescribed PRN opioid for pain to reduce the client’s restlessness

Restlessness in this case is more likely from hypovolemia than pain. Giving an opioid could worsen hypotension, mask changes in mental status, and distract from the true problem. The nurse should first identify and act on the unstable hemodynamic picture.

D. Clamp the Jackson-Pratt drain to reduce further blood loss

This is unsafe. Drains are placed to remove fluid and allow monitoring. Clamping the drain does not stop internal bleeding. It can cause blood to collect in the surgical space, hide the seriousness of the hemorrhage, and increase complications. The source of bleeding must be evaluated and treated, not concealed.

Key Takeaways

• After surgery, tachycardia + hypotension + low urine output + increased bloody drainage should make you think hemorrhage until proven otherwise.
• Restlessness can be an early sign of poor perfusion, not just anxiety.
• A surgical drain helps detect bleeding. A sudden increase in dark red output is a warning sign.
• The priority is rapid recognition, escalation, and preparation for fluids, labs, blood products, and possible return to the OR.

• What you’d do on shift:
• Reassess vital signs and mental status right away
• Check the incision, drain, and abdomen
• Confirm IV access is working
• Measure urine and drain output accurately
• Call the provider or rapid response per policy
• Get ready for stat labs, fluid bolus, and possible transfusion

Quick Practice Extension

1. A postoperative client has a firm, distended abdomen, rising heart rate, and minimal visible wound drainage. What complication should the nurse suspect first?

2. A provider orders a fluid bolus for a client with suspected postoperative bleeding. Which reassessment findings would show the client is responding well to treatment?

Strong NCLEX test-takers do not just memorize signs. They connect the signs to the underlying problem. In this case, the pattern points to blood loss and falling perfusion, so the nurse’s job is to recognize the emergency early and move fast.

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