During a digital removal of a fecal impaction, which assessment finding would indicate a significant adverse effect such as bradycardia?

• A. Pulse rate decreases from 78 to 52 beats/min
• B. Pulse rate increases to 100 beats/min
• C. Respirations become irregular but remain within normal range
• D. Blood pressure drops 20 mmHg from baseline

Answer: (A)

Rectal stimulation during digital removal can trigger the vagus nerve, leading to a slowed heart rate. A drop from a baseline around 78 to 52 beats per minute is bradycardia, a significant adverse sign in this procedure because it reflects a strong parasympathetic response that can compromise perfusion. The other findings don’t indicate bradycardia: a pulse of 100 is tachycardic, irregular respirations within normal range don’t point to heart rate change, and a 20 mmHg drop in blood pressure could signal hypotension but isn’t in itself bradycardia. If bradycardia occurs, stop the procedure and monitor the patient closely, addressing any symptoms and following clinical protocol.