The nurse is caring for a client with massive gastrointestinal bleeding from a gastric ulcer who received 6 units packed red blood cells (PRBCs) and 2 units fresh frozen plasma (FFP). The most recent laboratory results are a hemoglobin of 8.0 g/dL (4.96 mmol/L), platelets of 82,000/mm3 (82 X 109/L), a prothrombin time (PT) of 11.1 seconds, an international normalized ratio (INR) of 1.9, and a partial thromboplastin time (PTT) of 58 seconds. Vital signs are a heart rate of 110 beats/minute, respirations of 24 breaths/minute, a blood pressure of 80/50 mm Hg, and an oxygen saturation of 94% on 4 L/minute oxygen via nasal canula. Which intervention should the nurse implement first? Reference Range: Hemoglobin [14 to 18 g/dL (8.69 to 11.17 mmol/L)] Platelets [150,000 to 400,000/mm3 (150 to 400 x 109/L)] Prothrombin time (PT) [11.0 to 12.5 seconds] International Normalized Ratio (INR) [0.8 to 1.1] Partial Thromboplastin Time (PTT) [60 to 70 seconds]

A. Administer a PRN bolus normal saline. The client is exhibiting signs of hypovolemic shock, including tachycardia (HR 110 bpm), tachypnea (RR 24), and hypotension (BP 80/50 mmHg) following massive gastrointestinal bleeding and multiple blood transfusions. Immediate fluid resuscitation with a normal saline bolus is the priority to restore intravascular volume, maintain perfusion, and prevent further deterioration. B. Obtain a blood specimen for hematocrit. While monitoring hematocrit is important to assess ongoing blood loss, it does not take priority over treating the client’s current hypovolemia. A delay in resuscitation could worsen hypotension, decrease organ perfusion, and lead to shock. C. Measure strict hourly urinary output. Monitoring urine output is important in assessing renal perfusion and fluid balance, but the client’s immediate need is volume replacement. If fluid resuscitation is delayed, renal perfusion could worsen, leading to acute kidney injury. D. Switch oxygen delivery to a face mask. The client’s oxygen saturation is 94% on 4 L/min nasal cannula, indicating adequate oxygenation at this time. Increasing oxygen delivery is not immediately necessary compared to fluid resuscitation. However, if the client’s condition worsens, oxygen therapy adjustments may be needed.