A 12-year-old boy has broken his arm and is showing signs and symptoms of shock. Which of the following would the nurse do first.

Choice A rationale Drawing blood for a type and crossmatch is a crucial step in preparing for potential blood product administration, but it is not the first action in managing a pediatric patient presenting with signs of shock. Immediate priorities involve securing vascular access to deliver intravenous fluids and medications to reverse the state of hypoperfusion. Choice B rationale Establishing a suitable intravenous (IV) site is the paramount first step in managing a patient in shock, especially hypovolemic shock from a broken arm, as it allows for immediate, rapid volume replacement with isotonic crystalloid fluids. Restoring intravascular volume is the primary goal to improve perfusion, making vascular access the initial life-saving priority. Choice C rationale Hyperventilation, which refers to an increased rate and depth of breathing, can lead to respiratory alkalosis and is not generally indicated for managing hypovolemic shock due to trauma unless there is evidence of severe head injury with signs of cerebral herniation. The immediate treatment for hypovolemic shock is fluid resuscitation, not manipulating respiratory rate. Choice D rationale While providing analgesics is important for pain management, it is a secondary intervention. Administering oral analgesics to a patient who is showing signs of shock is dangerous because compromised circulation can impair absorption, and the priority must remain the stabilization of hemodynamic status through fluid resuscitation via IV access.