Reference no: EM133803098

Question

The nurse is caring for a client who underwent an endoscopic sleeve gastrectomy this morning for the treatment of morbid obesity. Based on the client's clinical data, which action by the nurse is appropriate at this time? Click the exhibit button for more information. 1. Assist the client to ambulate in the hall to dispel retained carbon dioxide 2. Give a PRN bolus of fentanyl from the client's PCA pump 3. Notify the health care provider or surgeon immediately 4. Reposition the client's nasogastric tube to ensure patencyhibit 3 Vital signs Temperature 100.4 F (38 C) oral Blood pressure 102/59 mm Hg Heart rate 128/min Respirations 29/min SpO 94% on room airNurse's notes Now Client is restless and reports abdominal pain as 8 on a scale of 1-10, radiating to the back. Client has self-administered a demand dose of fentanyl via patient-controlled analgesia (PCA) pump every 10 min for the past 30 min. Nasogastric tube placed to low, intermittent suction. Indwelling urinary catheter patent; no urine output at this time. Will continue to monitor. , RNMedication prescriptions 0.9% sodium chloride 100 mL/hr via continuous IV infusion Enoxaparin 40 mg subcutaneous q12h for thromboembolism prophylaxis Fentanyl 8 mcg/hr basal IV infusion.