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NEW VERIFIED 2025 VERSION (NCLEX Perioperative GUARANTEE PASS EXAM,QUESTION AND ANSWER 100% CORRECT)
The nurse checks the postoperative client for signs of infection. Which observations are indicative of a potential infection? Select all that apply.
1.Slight redness along the incision
2.The presence of purulent drainage
3.A temperature of 98.8° F (37.1° C)
4.The client states that he feels cold.
5.The client states that the incision itches.
6.Tender firmness palpable around the incision
2.The presence of purulent drainage
6.Tender firmness palpable around the incision
Rationale:A wound infection occurs when healing is delayed and pathogens such as bacteria grow in the wound. Signs and symptoms of a wound infection include warmth, redness, swelling, and tenderness of skin around the incision. The client may have fever and chills. Purulent material may exit from drains or from separated wound edges. Infection may be caused by poor aseptic technique or a wound that was contaminated before surgical exploration; it appears 3 to 6 days after surgery. Slight redness along an incision is a sign of inflammation and should be monitored to determine whether it progresses. A temperature of 98.8° F (37.1° C) is not an abnormal finding in a postoperative client. Itching around a wound may be from irritation or dryness and is not associated with infection. The fact that a client feels cold is not indicative of an infection, although chills and fever are signs of infection. The room temperature may be too cold for client comfort.
Test-Taking Strategy(ies):Focus on the subject, wound infection. Noting the words purulent, tender, and hardness will direct you to the correct options.Review:The signs of a wound infection.Color Key:Cyan = StrategyMagenta = Content Review
The nurse is assisting in providing surgical instructions to a preoperative client who will have abdominal surgery. Which instructions would be appropriate to include in the preoperative plan of care? Select all that apply.
1.Wound care
2.Personal hygiene
3.Activity restrictions
4.Frequent assessment of vital signs
5.Coughing and deep breathing exercises
6.Pain monitoring and medications to relieve pain
4.Frequent assessment of vital signs
5.Coughing and deep breathing exercises
6.Pain monitoring and medications to relieve pain
Rationale:The type of planning and instruction required varies with each individual and type of surgery. Preoperative education, including rationales related to a client's expected postoperative behavior, has a positive outcome on recovery and prevention of postoperative complications. Postoperatively, the client will be monitored closely with vital signs and the client should understand this is routine. General anesthesia predisposes clients to respiratory problems that can lead to atelectasis and pneumonia in the postoperative period. Therefore, coughing and deep breathing are important exercises to be taught in the preoperative period. Addressing that pain will be monitored and controlled with prescribed analgesia should allay client fears regarding pain. Specific instructions that the client needs to receive before discharge should include wound care, activity restrictions, dietary instructions, postoperative medication instructions, personal hygiene, and follow-up appointments.
Test-Taking Strategy(ies):Focus on the subject, preoperative instructions. Options 1, 2, and 3 refer to information that needs to be taught postoperatively. Options 4, 5, and 6 refer to information that should be taught preoperatively.
Review:Preoperative and postoperative care.Color Key:Cyan = StrategyMagenta = Content Review
The nurse just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit after abdominal surgery. The client has an indwelling urinary catheter in place. The vital signs are temperature 99.6° F (37.6° C), pulse 104 beats per minute, respirations 16 breaths per minute, and blood pressure (BP) 100/70 mm Hg. Urinary output is 20 mL for the past hour. Based on this data, which actions should the nurse take before notifying the registered nurse? Select all that apply.
1.Auscultate breath sounds.
2.Review vital signs from previous hour.
3.Observe the urinary catheter for patency and flow.
4.Observe the IV site for patency and correct flow rate.
5.Review when the client last received pain medication
The preoperative preparation is important to ensure that the surgery gets done with everything ready to ensure a successful outcome. The client may brush teeth and rinse with mouthwash but must not swallow any water. Any specific medications that the client was instructed to take on the day of surgery need to be administered and documented. This may include insulin or a blood pressure medication. The nurse cannot just verify the preoperative testing was done. The nurse needs to review the results of the preoperative laboratory studies and notify the primary health care provider of any abnormal results. Some increase in both blood pressure and pulse is common because of client anxiety regarding surgery. The client usually has a restriction of food and fluids for 8 hours before surgery instead of 24 hours.
Note the subject, preparing a client for surgery. Read each option carefully and decide whether it promotes client safety when answering the question. Preoperative testing results, NPO status, and medications ordered need to be documented as done. Any concerns regarding laboratory results or the medications should be discussed with the primary health care provider. Recall that surgery can produce anxiety and elevate BP slightly.
Following a surgical procedure, the nurse applies sequential compression devices to both lower extremities and turns the machine on. The nurse implements this intervention for which purpose?
1.To promote arterial circulation
2.To prevent muscle cramps in the legs
3.To prevent thrombosis formation in the veins
4.To maintain muscle strength despite inactivity
3.To prevent thrombosis formation in the veins
Compression devices, whether sequential, pneumatic, or intermittent, are external devices applied to the lower extremities to compress the calves of the legs and return blood to the heart similar to the way walking promotes venous return. These compression devices are used for clients who are in bed, especially during surgery and postoperatively, to prevent the complication of venous thrombotic embolism. This embolism can become a pulmonary embolism and cause death during the postoperative recovery period. Heart function determines arterial circulation. The compression devices are not significant in preventing muscle cramps or maintaining muscle strength.
Focus on the subject, purpose of sequential compression devices. Recall they are applied when the client is not walking and that with walking, the calf muscles contract and return blood through the veins to the heart. Note that venous thrombotic embolism disease is a major cause of postoperative deaths.
The nurse is preparing a client for a right below-the-knee amputation. The nurse anticipates that the client is likely to experience which psychosocial problems in the perioperative period? Select all that apply.
1.Pain
2.Anger
3.Grief
4.Anxiety
5.Altered body image
3.Grief
4.Anxiety
5.Altered body image
A client facing an elective amputation of a lower extremity will experience psychosocial as well as physical challenges during the perioperative period. The client is likely to experience grief because of the loss of the extremity as well as an alteration in body image. The client will also experience anxiety since this will be a new experience and life as an amputee is unknown. Pain is a physical problem influenced by psychosocial factors. There are no data in the question to support a problem of anger.
Focus on the subject, a client's psychosocial reaction to an amputation surgery. Noting the word psychosocial will direct you to consider the common reactions to an amputation, loss of a body part, and facing uncertainty. Remember to focus on client concerns as a priority in the perioperative period.
The nurse is caring for a client following a total abdominal hysterectomy. The nurse anticipates that which postoperative outcome will be the priority in the first 24 hours following surgery?
1.Pain
2.Changes in body image
3.Inability to cope with stressors
4.Lack of information about recovery
1.Pain
The client who has had abdominal surgery is most likely to experience pain in the first 24 hours after surgery. The other options identify less important issues during this time frame but could increase in importance later in recovery.
Preoperative instructions are important so that the client is readied adequately for surgery and all has been done to achieve a successful outcome. The client must understand the importance of following the timing of being NPO to lower the risk of aspiration associated with the anesthetic. Antiplatelet medications such as aspirin alter normal clotting factors and increase the risk of hemorrhage. Aspirin has properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. Prednisone, a corticosteroid, should not be discontinued abruptly. In fact, additional dosages of the corticosteroid may be necessary before stressful situations, such as surgery. There is no reason to discontinue prescribed exercises, and discontinuing exercises in this client may be harmful.
Focus on the subject, preparation of a client for surgery, and eliminate option 2 first because discontinuing exercises can be harmful to the client. Knowledge regarding the medications that affect the surgical client will assist in eliminating options 3 and 4. General principles related to preparing a client for surgery will direct you to option 1.
A client who had knee surgery 4 days ago reports to the home health nurse that he has not had a bowel movement since before the surgery. Which questions would assist the nurse in the collection of data regarding the client's problem? Select all that apply.
1."How often do you usually move your bowels?"
2."How often do you usually take a laxative?"
3."Have you been eating meat on a daily basis?"
4."What have you been eating and drinking since the surgery?"
5."Have you been experiencing any urge to move your bowels?"
6."What kind and how often have you been taking medications for pain?"
4."What have you been eating and drinking since the surgery?"
5."Have you been experiencing any urge to move your bowels?"
6."What kind and how often have you been taking medications for pain?"
Constipation is marked by difficult or infrequent passage of stools that are hard and dry. Constipation has numerous causative factors, including psychogenic factors, lack of physical activity, inadequate intake of food and fiber, and medication influences. A client recovering from knee surgery may have several factors influencing elimination patterns. The nurse needs to collect data regarding fluid and dietary intake since surgery, whether the client has been responding to the urge to defecate, and whether the pain medication type and frequency is likely to cause constipation. The presurgery bowel frequency and laxative use are not pertinent since the client has not had a bowel movement for 4 days. The intake of meat is unrelated to constipation.
Focus on the subject, the cause of the constipation. Options 1 and 2 can be eliminated first because they are unrelated to the subject of the question. From the remaining options, eliminate option 3 because it will not elicit adequate information that will assist the nurse in determining the cause of the constipation. Select the options that relate directly to bowel function at this time including dietary and fluid intake, client awareness of peristalsis, and pain analgesic use, which may be slowing gastrointestinal function.
The nurse is caring for a postoperative client who had a pelvic exenteration. The primary health care provider has changed the client's diet from nothing by mouth (NPO) to clear liquids. The nurse checks for which information before administering the clear liquids? Select all that apply.
1.Incision appearance
2.Pain rating of 3 or less
3.Presence of bowel sounds
4.Urinary output of 30 mL per hour
5.Whether the client has passed flatus
3.Presence of bowel sounds
4.Urinary output of 30 mL per hour
5.Whether the client has passed flatus
Pelvic exenteration is a radical surgery for treatment of gynecological cancer involving removal of the uterus, ovaries, fallopian tubes, vagina, bladder, and urethra. Sometimes the descending colon and rectum may also be removed. The client would have a colostomy and ileal conduit created if part of the colon and rectum and bladder are removed. This surgery is done when no metastases have been found outside the pelvis, and the client is agreeable. It is done less often today. The client is kept NPO until peristalsis returns, usually in 4 to 6 days postoperatively. When signs of bowel function return, clear fluids are given. If no distention occurs, the diet is advanced as tolerated. It is most important to monitor for return of peristalsis by the presence of bowel sounds and passing flatus before feeding the client. Before giving the client liquids, the nurse does not need to inspect the incision, assess pain, or monitor the urinary output. These interventions would be done but are not related to beginning the clear liquid diet.
Focus on the subject, the nurse's concern when changing the postoperative client's diet from nothing by mouth (NPO) to clear liquids after a radical surgery such as pelvic exenteration. Select the options that assess for the return of peristalsis.
Note the strategic word, priority. Use the ABCs—airway, breathing, and circulation—to answer this question. The correct option will maintain airway clearance.
The nurse is reinforcing instructions to a client and family regarding home care following cataract removal with lens implantation in the left eye. The nurse should provide the client with instructions to contact the surgeon promptly for which signs or symptoms? Select all that apply.
1.New floaters
2.Improvement in vision clarity
3.Increasing redness in the eye
4.Sensation of mild grittiness in the eye
5.Pain relieved by acetaminophen 500 mg
1.New floaters
3.Increasing redness in the eye
4.Sensation of mild grittiness in the eye
Following cataract surgery, in which the cloudy lens is removed and a new lens is implanted in the eye, clients are sent home to recover. Clients should contact the surgeon immediately if there is the presence of new floaters (seeing small dots) because this could be a sign of a detached retina. Some redness in the eye may be present but increased redness could indicate bleeding or infection and should also be promptly reported. Clients usually experience improved vision, a sensation of grittiness in the eye, and pain that is controlled with acetaminophen.
Focus on the subject, signs and symptoms to report immediately to the surgeon after cataract surgery. Consider each option and expect that mild symptoms of inflammation are expected as is improved vision. Select options that list signs and symptoms associated with complications.
The nurse is reinforcing instructions to a client following mastectomy who will be discharged with an axillary drain in place. The client will be receiving home care visits from the nurse to monitor drainage and perform dressing changes. Which client statement indicates a need for further teaching?
1."I need to keep my arm elevated when I sit or lie down."
2."I can massage the area with cocoa butter lotion once the incision heals."
3."I may feel pain in the breast area even though my breast has been removed."
4."I need to begin full range-of-motion (ROM) exercises to my upper arm as soon as I get home."
4."I need to begin full range-of-motion (ROM) exercises to my upper arm as soon as I get home."
The client should be instructed to limit upper arm ROM to the level of the shoulder only. After the axillary drain is removed, the client can begin full ROM exercises to the upper arm as prescribed by the primary health care provider. Elevating the arm above the heart level while sitting or lying down, massaging the area with cocoa butter after the incision is completely healed if prescribed by the primary health care provider, and having pain in the absent breast (phantom pain) are correct measures following a mastectomy.
Focus on the subject, client discharge with an axillary drain in place. Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Noting the word full in option 4 will direct you to this option.
The nurse is reinforcing instructions to a client about the use of an incentive spirometer in the postoperative period. The nurse should include which information in discussions with the client? Select all that apply.
1.Inhale as rapidly as possible.
2.Keep a loose seal between the lips and the mouthpiece.
3.After maximum inspiration, hold the breath for 10 seconds and exhale.
4.Use the incentive spirometer for 5 to 10 breaths every hour while awake.
5.The best results are achieved when sitting at least halfway or fully upright.
4.Use the incentive spirometer for 5 to 10 breaths every hour while awake.
5.The best results are achieved when sitting at least halfway or fully upright.
An incentive spirometer is a volume- or flow-oriented device used to encourage deep breathing by giving visual feedback to the client during its use. For optimal lung expansion with an incentive spirometer, the client should assume the semi-Fowler's or high-Fowler's position. The mouthpiece should be covered completely while the client inhales slowly with a constant flow through the unit. The breath should be held for 2 to 3 seconds before exhaling slowly.
Focus on the subject, the procedure for using the incentive spirometer, and visualize this procedure. Understand that the purpose is to promote lung expansion and evaluate the options related to that criterion to select the correct answers.
For optimal lung expansion with the incentive spirometer, the client should assume the semi-Fowler's or high- Fowler's position. The mouthpiece should be covered completely and tightly while the client inhales slowly, with a constant flow through the unit. The breath should be held for 5 seconds before exhaling slowly.
Focus on the subject, correct use of an incentive spirometer, and visualize the procedure. Note the words rapidly, loose, and 15 seconds in the incorrect options. Options 1, 2, and 3 are incorrect steps regarding incentive spirometer use.
The nurse is developing a plan of care for a client who is scheduled for surgery. The nurse should include which activities in the nursing care plan for the client on the day of surgery? Select all that apply.
1.Have the client void before surgery.
2.Avoid oral hygiene and rinsing with mouthwash.
3.Verify that the client has not eaten for the last 24 hours. 4.Determine that the client has signed the informed consent for the surgical procedure.
5.Report immediately any slight increase in blood pressure or pulse from the client's baseline vital signs.
1.Have the client void before surgery.
4.Determine that the client has signed the informed consent for the surgical procedure.
5.Report immediately any slight increase in blood pressure or pulse from the client's baseline vital signs.
The nurse caring for clients who will be having surgery must ensure that the client is properly identified and prepared according to the prescription(s) by the surgeon and anesthesiologist. The nurse should assist the client with voiding before surgery so that the bladder is empty at the beginning of the procedure. The nurse should verify that the client has signed the consent for the procedure. If the client has not signed a consent, no preoperative medications should be given, and the surgeon can obtain the consent before proceeding. Oral hygiene is allowed, but the client should not swallow any water. The client usually has a restriction of food and fluids for 8 hours before surgery rather than 24 hours (often NPO after midnight). A slight increase in blood pressure and pulse is common during the preoperative period; this is generally the result of anxiety. The nurse should verify what the normal blood pressure and pulse rate are for this client.
Focus on the subject, preoperative care. Recall that the purpose of preoperative preparation is to promote a successful surgical outcome and lower the risk of complications from surgery and anesthesia. Evaluate each option according to that standard and you will select the answers that assure a positive surgical outcome.
A client who had abdominal surgery complains of feeling as though "something gave way" in the incisional site. The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing interventions should the nurse take? Select all that apply.
1.Notify the registered nurse immediately.
2.Document the client's complaint with the exact times.
3.Place a sterile saline dressing and ice packs over the wound.
4.Prepare the client for wound closure by notifying surgery department.
5.Place the client in a supine position without a pillow under the head.
6.Instruct the client to remain quiet and reassure the situation is being taken care of.
1.Notify the registered nurse immediately.
2.Document the client's complaint with the exact times.
4.Prepare the client for wound closure by notifying surgery department.
6.Instruct the client to remain quiet and reassure the situation is being taken care of.
Wound dehiscence is the separation of the wound edges, and wound evisceration is the protrusion of the internal organs through an incision. If wound dehiscence or evisceration occurs, the registered nurse is notified, and he or she then contacts the surgeon immediately. The client is placed in a low-Fowler's position, kept quiet, and instructed not to cough. Protruding organs are covered with a sterile, saline dressing. Ice packs are not applied. The treatment for evisceration is immediate wound closure under local or general anesthesia.
Focus on the subject, a loop of bowel protruding through the incision, to assist you in determining that the client is experiencing wound evisceration. Visualizing this occurrence will assist you with determining that the client should not be placed supine and that ice packs should not be placed on the incision.
The student nurse is changing an abdominal dressing on a client with an open incision and notes the presence of sanguineous drainage. Which nursing action should be appropriate?
1.Notify the registered nurse.
2.Cover the wound and reassess in 1 hour.
3.Leave the wound open to air to assist in drying.
surgery so that the matter can be discussed and understood clearly before the surgery (informed consent). A history of a deep venous thrombosis (DVT) is pertinent because of an increased risk for DVT after the planned surgery, and precautions should be prescribed. A history of a childhood tonsillectomy and routine vitamin and mineral supplementation are part of the client history but are not pertinent data that needs to be reported specifically.
Focus on the subject, reporting pertinent client data that affects surgery. Considering each option and its effect on the client having the surgery will assist in answering the question.
A client has been taking prednisone for 3 years. She is scheduled for abdominal hysterectomy. The nurse plans care realizing that postoperatively the client is at risk for which conditions? Select all that apply.
1.Hypoglycemia
2.Increased risk for dehiscence
3.Excessive bleeding at the surgical incision
4.Increased likelihood of surgical site infection
5.Very early wound healing, causing excessive scarring
2.Increased risk for dehiscence
4.Increased likelihood of surgical site infection
Chronic use of glucocorticoids, such as prednisone, increases the risk of surgical site infections and the potential for dehiscence. Wound healing may be slow. Glucocorticoids increase the blood glucose. Excessive bleeding is not associated with glucocorticoids.
Focus on the subject, the client has been taking prednisone for 3 years. Identify prednisone as a glucocorticoid. Next note the words, at risk for. Recalling the adverse effects of long-term use of glucocorticoids will assist in directing you to the correct options.
After abdominal surgery, a client experiences an evisceration. Which client statement supports this diagnosis?
1."My incision is itching in several places."
2."It felt like something just slit me wide open."
3."My incision is painful, especially when I move."
4."There seems to be some redness along the incision line."
2."It felt like something just slit me wide open."
Wound evisceration is the total separation of the layers of the wound and extrusion of internal organs or viscera (usually abdominal) through the open wound. This disruption in wound healing may be preceded by excessive coughing, not splinting the surgical site, vomiting, or straining. The client may state, "something gave way," or "I feel as if I just split open." Itching, discomfort with moving, and redness along the incision line are not signs and symptoms directly associated with evisceration.
The subject of the question is evisceration. Note that the client in the question underwent abdominal surgery. Consider the meaning of "viscera" (organs) and the prefix "e." Understanding what an evisceration is and noting the relationship between the words abdominal surgery in the question and the statement in the correct option will direct you to option 2.
The nurse is monitoring an adult client for postoperative complications. Which is most indicative of a potential postoperative complication that requires further observation?
1.A urinary output of 20 mL/hour
2.A temperature of 37.6° C (99.6° F)
3.A blood pressure of 100/70 mm Hg
4.Serous drainage on the surgical dressing
1.A urinary output of 20 mL/hour
Urine output is maintained at a minimum of at least 30 mL/hour for an adult. An output of less than 30 mL/hour for each of 2 consecutive hours should be reported to the surgeon. A temperature more than 37° C (100° F) or less than 36.1° C (97° F) and a falling systolic blood pressure less than 90 mm Hg are to be reported. The client's preoperative or baseline blood pressure is used to make informed postoperative comparisons. Moderate or light serous drainage from the surgical site is considered normal.
Note the strategic word, most, and focus on the subject, normal assessment data in a postoperative client. Use knowledge of normal expected postoperative ranges to determine that the urinary output is the only finding that is not within normal range.
A surgeon is performing an abdominal hysterectomy. Before the surgery is completed, the operating room nurse counts the sponges and notes that the sponge count is not correlating with the preoperative count. Which action by the nurse is important?
Focus on the subject, return of peristalsis after abdominal surgery, and note the words, 1 day ago. Recalling that bowel sounds may not return for 3 to 4 postoperative days will direct you to the correct answers.
The nurse is caring for a client who is scheduled for surgery. The client states concern about the surgical procedure. How should the nurse initially address the clients concerns?
1.Tell the client that preoperative fear is normal.
2.Explain all nursing care and possible discomfort that may result. 3.Ask the client to discuss information known about the planned surgery.
4.Provide explanations about the procedures involved in the planned surgery.
3.Ask the client to discuss information known about the planned surgery.
The client is concerned about having surgery and needs to discuss it. This will offer the client the opportunity to verbalize his or her current and specific understanding. Explanations should begin with the information that the client knows. Option 1 is a block to communication and minimizes the client's feelings. Giving unsolicited explanations may produce additional anxiety and not address the real concerns of the client.
Note the strategic word, initially, and realize the question asks for the first response of the nurse. Use therapeutic communication techniques of open-ended questions and active listening, and focus on the client's feelings first. Option 3 is the only option that addresses data collection, which follows the steps of the nursing process.
The nurse is caring for a postoperative client who is wearing an abdominal binder following abdominal surgery. Which interventions should the nurse include in relationship to prescribed dressing change? Select all that apply.
1.Sit up for coughing while splinting the incision.
2.Remove the binder before assisting the client to ambulate. 3.Remove the binder only when the primary health care provider is present.
4.Apply the binder over the abdominal dressing as tight as possible. 5.Remove the binder to change the abdominal dressing as prescribed and reapply.
1.Sit up for coughing while splinting the incision.
5.Remove the binder to change the abdominal dressing as prescribed and reapply.
Binders are large bandages often made of elastic materials that attach together with Velcro and are applied over the abdominal dressing. After abdominal surgery, a binder is used to relieve tension from the suture line and provide support. This maintains the integrity of the incision, helps prevent dehiscence and wound evisceration, and thereby helps prevent infection. Using a binder, however, can hinder chest expansion, promote shallow breathing, and aggravate residual atelectasis and risk of pneumonia from surgery. The client is instructed to sit up to facilitate diaphragmatic excursion and to splint the incision for client comfort and suture line protection while coughing, deep breathing, and using the incentive spirometer. The binder is removed while the client is supine to have the dressing changed and then reapplied. The binder should be worn while the client ambulates. The binder can be removed when the primary health care provider is not present. The binder is applied fairly tight but not so tight as to impair circulation.
Focus on the subject, abdominal binder. Recall the binder is used to give support to the abdominal incision. Remember that abdominal restriction is likely to hinder chest expansion. The binder is removed to inspect and change the dressing as prescribed. Consider each option and select the answers that relate to giving the client care and providing support while ambulating.
A client has returned to the nursing unit following abdominal hysterectomy. To gather data on the client's postoperative bleeding, the nurse should implement which interventions? Select all that apply.
1.Observing perineal pad drainage
2.Observing the abdominal dressing
3.Rolling the client to one side to view bedding
4.Monitoring output from the Jackson-Pratt drain
5.Auscultation of bowel sounds, especially lower quadrants 6.Observing for abdominal distention and presence of ecchymosis
1.Observing perineal pad drainage
2.Observing the abdominal dressing
3.Rolling the client to one side to view bedding
4.Monitoring output from the Jackson-Pratt drain
The nurse should roll the client to one side after checking the perineal pad and abdominal dressing. This allows the nurse to check the rectal area, where blood may pool by gravity, particularly if the client is lying supine. The nurse should also observe the output from the Jackson-Pratt drain. Auscultation of bowel sounds is related to return of peristalsis. Abdominal distention may occur with air in the bowels not necessarily bleeding. Ecchymosis from the surgical bleeding would not be apparent so soon after surgery.
