A client who had gastric bypass surgery 3 days ago is admitted to the intensive care unit (ICU) with shortness of breath and chest pain. The client has a 100% nonrebreather mask with an oxygen saturation of 88%. Which intervention should the nurse implement?

A. Prepare for oral intubation. The client is in severe respiratory distress with oxygen saturation at 88% despite receiving 100% oxygen via a nonrebreather mask. This suggests respiratory failure, likely due to a pulmonary embolism (PE), a known complication following bariatric surgery. Immediate intubation and mechanical ventilation are necessary to prevent further hypoxia and respiratory collapse. B. Apply leg compression hose. While deep vein thrombosis (DVT) prophylaxis is essential for postoperative bariatric patients, it is not the priority in an acute emergency. Compression devices help prevent clots but do not treat an existing life-threatening pulmonary embolism. C. Maintain head of bed at 45°. Elevating the head of the bed can help with breathing, but it will not significantly improve oxygenation in a client already failing on 100% oxygen. The priority is to secure the airway with intubation to provide controlled ventilation. D. Administer an anticoagulant. Anticoagulation is a key treatment for pulmonary embolism, but it does not immediately improve oxygenation or stabilize respiratory function. In a hemodynamically unstable client with severe hypoxia, securing the airway takes priority before initiating anticoagulation therapy.