A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 280 mg/dL (60.8 mmol/L) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority? Reference Range: Blood alcohol level (BAL) [0 to 50 mg/dL (0 to 10.9 mmol/L)]

A. Provide thiamine and folate supplements as prescribed: Thiamine and folate help prevent Wernicke’s encephalopathy and other nutritional deficiencies associated with chronic alcohol use, but these interventions do not address the client’s immediate risk of airway compromise from decreased consciousness. B. Give lorazepam PRN for signs of withdrawal: Lorazepam is indicated for alcohol withdrawal management; however, during the first hours after admission, the client is already difficult to arouse. Administering sedating medications at this stage could worsen CNS depression and compromise airway and breathing. C. Place in a side-lying position with head of bed elevated: The client’s decreased level of consciousness increases the risk for airway obstruction, aspiration, and respiratory compromise. Positioning the client on the side with the head elevated maintains airway patency, reduces aspiration risk, and is the immediate priority for patient safety. D. Administer disulfiram immediately: Disulfiram is used for long-term alcohol abstinence but is contraindicated in acute intoxication. Administration during this stage could precipitate severe reactions and is not relevant to immediate care priorities.