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Difficulty: MediumReduction of Risk Potential

A licensed practical nurse (LPN) is assessing a client who is 4 hours postoperative following a partial nephrectomy. Which of the following findings indicate a potential complication and should be immediately reported to the registered nurse (RN)? Select all that apply.

  1. A hemoglobin level of 7.1 g/dL (71 g/L)Answer
  2. A heart rate steadily increasing from 78 to 114 beats per minuteAnswer
  3. A total urine output of 40 mL over the last three hoursAnswer
  4. D
    A serum potassium level of 4.3 mEq/L (4.3 mmol/L)
  5. E
    A blood pressure of 116/74 mmHg, previously 120/78 mmHg
  6. F
    Mild incisional pain rated 3 on a 0 to 10 scale during repositioning

Answer

The LPN should immediately report the hemoglobin level of 7.1 g/dL, the heart rate increasing to 114 beats per minute, and the total urine output of 40 mL over three hours.
Following a partial nephrectomy, the client is at risk for hemorrhage and acute kidney injury. A low hemoglobin (7.1 g/dL), an unexplained increasing heart rate (114 bpm), and severe oliguria (40 mL over 3 hours) all point to active bleeding, fluid volume deficit, or renal compromise. These are critical findings that exceed the LPN's independent scope of practice and demand immediate RN escalation.

Step-by-Step Solution

1
Analyze the client's postoperative status and risk factors.
The client had a partial nephrectomy, carrying a high risk for hemorrhage and renal impairment.
Identifying procedure-specific risks helps prioritize which assessments indicate life-threatening complications.
2
Evaluate the laboratory values.
The hemoglobin is critically low (7.1 g/dL), while the potassium is normal (4.3 mEq/L).
Differentiating between critical and expected lab findings ensures prompt escalation of potential hemorrhage.
3
Evaluate the vital signs and physical assessments.
The increasing heart rate (114 bpm) and oliguria (40 mL over 3 hours) are abnormal, while the minor blood pressure change and mild pain are expected.
Tachycardia and decreased urine output are classic early indicators of hypovolemic shock and kidney injury.

Key Concept

Recognizing Early Signs of Postoperative Complications
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Topics

Reduction of Risk Potential

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