NCLEX-RNReduction of Risk PotentialMedium
Two hours after a cardiac catheterization performed via the right femoral artery, a client reports severe low back and flank pain. Vital signs have changed from BP 130/80 mmHg and HR 84/min to BP 92/58 mmHg and HR 124/min. The groin site is dry with no hematoma. The nurse suspects which complication?
- AAllergic reaction to contrast dye
- BVasovagal response requiring atropine
- CAnxiety related to the procedure
- DRetroperitoneal hemorrhage
Show answer & explanationAnswer & explanation
Correct answer: D. Retroperitoneal hemorrhage
Flank or back pain with hypotension and tachycardia after femoral artery catheterization, even with a normal-appearing groin site, is a hallmark of retroperitoneal bleeding, a hidden but life-threatening complication requiring immediate intervention.
Why the other options are wrong
- A. Contrast allergy typically presents with hives, itching, or respiratory symptoms, not flank pain and hypotension.
- B. Vasovagal responses usually cause bradycardia, not tachycardia.
- C. Anxiety would not explain the objective drop in BP and rise in HR.
Retroperitoneal Bleed Post-Cardiac Catheterization
A hidden hemorrhage into the retroperitoneal space following femoral artery access, presenting with flank/back pain and signs of hypovolemic shock despite a normal groin site.
- Femoral artery access is the main risk factor
- Groin site may appear normal despite significant blood loss
- Requires immediate provider notification, possible CT scan, and transfusion
Memory trick: Back pain + BP drop = bleed you can't see