The nurse caring for a patient with a history of diverticulosis who was brought to the emergency department for severe abdominal pain, 10/10 on the numeric pain scale. The nurse observes bright red stools in the bedside commode when entering the patient's room. The patient's initial vital signs are BP 92/40, HR 124, RR 22, Temp 98.7°F (37.1°C), and Sa02 of 95% on room air. The patient's hemoglobin is 4.6 mg/dL (reference range 12-16 mg/dl). The patient has a 20g IV in the left hand. Which of the following orders should the nurse implement first?

A. Administer 1 unit of PRBCs over 3 hours: The patient has severe hemorrhagic shock evidenced by hypotension (BP 92/40), tachycardia (HR 124), and critically low hemoglobin (4.6 mg/dL). Rapid blood transfusion is the priority intervention to restore circulating volume, improve oxygen-carrying capacity, and prevent organ hypoperfusion. B. Call the respiratory therapist: While oxygenation is important, the patient’s oxygen saturation is 95% on room air, which is adequate. Respiratory intervention is not immediately needed compared with the urgent need to restore intravascular volume and treat hypovolemic shock. C. Insert a 14-gauge nasogastric tube (NGT): An NGT may be indicated for gastric decompression or to monitor gastrointestinal bleeding, but it does not address the acute life-threatening hypovolemia. Blood replacement must occur first to stabilize the patient. D. Administer morphine 4 mg IV: Pain management is important, but administering opioids before stabilizing hemodynamics can worsen hypotension and mask changes in clinical status. Analgesia should be delayed until the patient is hemodynamically stable.