The nurse assesses an adult client 24 hours following abdominal surgery and finds the client's blood pressure is 98/40 mm Hg. The client is tachycardic, restless, and irritable. Which action should the nurse perform first?

Choice A reason:The correct answer is a) because low blood pressure, tachycardia, restlessness, and irritability are signs of possible internal bleeding. Checking under the back for evidence of bleeding can quickly help identify if the client is hemorrhaging, which requires immediate intervention.Choice B reason: Listening to lung sounds is important but not the immediate priority when signs of bleeding are present.Choice C reason: Ensuring the IV solution is infusing correctly is important but secondary to identifying and managing potential bleeding.Choice D reason: Notifying the healthcare provider is necessary but comes after assessing for bleeding, which is the immediate concern.