A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

Rationale:

• Insert a nasogastric tube and maintain low intermittent suction: This is anticipated to help decompress the stomach, reduce nausea and vomiting, and prevent aspiration in a client with severe pancreatitis who is vomiting and has abdominal distension.
• Administer IV lactated Ringer's: IV fluids are critical for hydration and to correct electrolyte imbalances in acute pancreatitis. Lactated Ringer’s is preferred over normal saline because it better maintains acid-base balance.
• Insert an indwelling urinary catheter: This is generally contraindicated unless necessary, as it increases the risk of infection. No information indicates urinary retention or need for strict output monitoring that outweighs infection risks.
• Administer IV famotidine: Famotidine reduces gastric acid secretion, which helps protect the gastric mucosa and may be beneficial in preventing stress ulcers in critically ill clients. It is appropriate in this situation.

Rationale:

A. Evaluate the client's ability to help with repositioning: Assessing the client's motor function and ability to assist is essential for planning a safe and effective repositioning strategy. It helps prevent injury to both the client and staff and allows for appropriate use of equipment or assistance.

B. Reposition the client without the use of assistive devices: Clients with impaired mobility due to stroke are at increased risk for injury during movement. Assistive devices should be used as needed to ensure safe and proper repositioning.

C. Raise the side rails on both sides of the client's bed during repositioning: Raising both side rails can create a restraint-like situation and may increase fall risk. Only the side rail on the opposite side of movement should be raised for safety during repositioning.

D. Discuss the client's preferences for determining a repositioning schedule: While involving the client in care decisions is important, repositioning schedules are primarily based on clinical needs (e.g., immobility, pressure ulcer prevention), not solely on preference.