The nurse has reviewed the Vital Signs at 1000.

For each potential provider prescription, click to specify if the prescription is anticipated or non-anticipated for the client.

A. “I can take a bath today when I get home.”: Immersing the incision in water too soon increases the risk of infection. Clients are typically advised to shower rather than bathe until the incision has sufficiently healed.

B. “I can apply ice for my incisional pain if needed.”: Applying ice or cold packs to the surgical site can help reduce pain and inflammation. This is an appropriate self-care strategy for managing post-laparoscopic cholecystectomy discomfort.

C. “I should rest for the first 24 hours after surgery.”: Adequate rest immediately following surgery supports healing, reduces the risk of complications, and allows the client to recover from anesthesia. This statement reflects proper understanding of postoperative care.

D. “I can resume usual activities gradually over a week.”: Gradual resumption of normal activities prevents strain on the incision and supports recovery. Clients are encouraged to increase activity slowly as tolerated, reflecting appropriate teaching.

E. “I will now be able to tolerate multiple greasy foods.”: After cholecystectomy, the client may need to avoid high-fat foods initially because digestion is temporarily impaired. This statement indicates a misunderstanding of dietary restrictions.

F. “I will have a drain in place near my incision.”: Laparoscopic cholecystectomy usually does not require a drain unless complications arise. Expecting a drain reflects inaccurate understanding of the typical procedure.

Rationale for correct choices:

• Obtain IV access: The client demonstrates signs of acute hypovolemia, including hypotension, tachycardia, pallor, and a declining hemoglobin and hematocrit. Ongoing gastrointestinal bleeding is suggested by positive hemoccult stool and NSAID use. Establishing IV access is the immediate priority to allow rapid administration of fluids, blood products, and medications. Without IV access, the nurse cannot intervene promptly to stabilize circulation.

• Prepare to administer IV fluids: The progressive drop in blood pressure indicates worsening volume depletion likely from gastrointestinal bleeding. IV fluids are necessary to support circulating volume and maintain perfusion while further evaluation is underway. Fluid resuscitation helps prevent progression to hemorrhagic shock. Stabilization must occur before transporting the client for an invasive procedure such as endoscopy.

Rationale for incorrect choices:

• Recheck the client’s oxygen saturation: The client’s oxygen saturation remains stable at 98% on room air, indicating adequate oxygenation. Although monitoring is important, hypoxia is not the immediate concern in this scenario. Circulatory instability poses a greater and more urgent risk. Rechecking oxygen saturation does not address the underlying hemodynamic compromise.

• Place the client in a supine position with feet elevated: While positioning may temporarily support venous return, it does not correct the underlying cause of hypotension. This intervention may be supportive but is insufficient as a primary action. Definitive stabilization requires vascular access and volume replacement.

• Call the surgical suite to notify that the client is arrival: The client is not stable enough for transport or endoscopy at this time. Hypotension and anemia require immediate medical stabilization before any procedure. Proceeding with scheduling without addressing instability could place the client at serious risk. Stabilization takes priority over procedural coordination.

• Transport the client for endoscopy: Transporting an unstable client with hypotension and suspected active bleeding increases the risk of cardiovascular collapse. Endoscopy should be delayed until blood pressure and volume status improve. Immediate resuscitation is required prior to any diagnostic procedure. Safety considerations override procedural timing.

• Check the ECG: Although tachycardia is present, it is likely a compensatory response to hypovolemia rather than a primary cardiac issue. An ECG would not address the acute cause of the client’s instability. Restoring circulating volume is more urgent than cardiac rhythm evaluation. ECG assessment can occur after stabilization.

• Check arterial blood gases: There is no evidence of respiratory compromise or acid–base imbalance requiring ABG analysis at this time. Oxygenation and respiratory rate are stable. The primary concern is circulatory volume loss, not ventilation. ABG testing would delay necessary resuscitative care.