A nurse is caring for a client who has esophageal varices and is hypotensive after vomiting 500 mL of blood. Which of the following actions is the nurse’s priority?

Choice a) is incorrect because elevating the client’s feet is not the priority action for a hypotensive client. Elevating the client’s feet may help increase the venous return to the heart, but it may also compromise the respiratory status of a client who has esophageal varices and is at risk of aspiration.

Choice b) is incorrect because administering a unit of packed RBCs is not the priority action for a hypotensive client. Administering a unit of packed RBCs may help increase the oxygen-carrying capacity of the blood, but it may also increase the blood viscosity and pressure, which can worsen the bleeding from the esophageal varices.

Choice c) is incorrect because initiating a dopamine IV infusion for the client is not the priority action for a hypotensive client. Initiating a dopamine IV infusion may help increase the blood pressure and cardiac output, but it may also cause vasoconstriction and tachycardia, which can increase the risk of hemorrhage and arrhythmias.

Choice d) is correct because increasing the client’s IV fluid rate is the priority action for a hypotensive client. Increasing the client’s IV fluid rate may help restore the intravascular volume and perfusion, which can prevent shock and organ damage. Increasing the client’s IV fluid rate may also dilute the blood and reduce its viscosity and pressure, which can decrease the bleeding from the esophageal varices.

Choice A Reason: This is correct. The nurse should remove both of the elastic bandages from the leg, as they can impair blood flow and increase tissue damage. The nurse should also elevate the leg and keep it immobile to reduce venom absorption.

Choice B Reason: This is incorrect. The nurse should not discharge the client, as they may develop serious complications from the snake bite, such as swelling, bleeding, infection, or shock. The client should be monitored closely and treated accordingly.

Choice C Reason: This is incorrect. The nurse should not obtain a prescription for the appropriate anti-venom, as this is not within their scope of practice. The nurse should notify the physician and provide supportive care until the physician arrives and decides whether to administer anti-venom or not.

Choice D Reason: This is incorrect. The nurse should not obtain a prescription for pain medication, as this may mask the symptoms of venom toxicity or cause adverse reactions with anti-venom. The nurse should use non- pharmacological methods to relieve pain, such as ice packs or distraction.