Difficulty: Medium
Average Score: 81%
Full-length
In the early postoperative period, the nurse notes a bright red, 3'┬Ø x 5'┬Ø area of drainage on the client's abdominal laparotomy dressing. What should be the nurse's first action in response to this observation?
Correct answer
C
Rationale
Bright red drainage suggests active bleeding, so taking vital signs to assess for hemodynamic instability is the priority.