A client has a prescription for the insertion of a nasogastric tube to low intermittent suction. When inserting the nasogastric tube, the nurse observes an immediate return of "coffee ground" drainage. Which action should the nurse implement?

A. Giving a bolus of 1,000 mL 0.9% sodium chloride is typically used to treat hypovolemia or electrolyte imbalances, which are not indicated by the patient's current lab values or clinical
situation.
B. Repeating the blood gas in 1 hour is a reasonable order as it would provide information on whether the patient's respiratory status is improving following interventions for ventilator-associated pneumonia.
C. Placing the client in a prone position can improve oxygenation in patients with respiratory distress by redistributing lung perfusion, making it a suitable intervention for this patient with diminished breath sounds and crackles.
D. Performing endotracheal suctioning would help clear secretions, which may be contributing to the patient's diminished breath sounds and crackles, and is consistent with the care for a patient with pneumonia.
E. A chest x-ray now would typically be ordered if there was a suspicion of a new onset condition such as a pneumothorax or pleural effusion, which is not indicated by the patient's current presentation.
F. Administering an inhaled corticosteroid is generally used for long-term management of chronic respiratory conditions and is not typically used for acute management of ventilator-associated pneumonia.

- A: Raising the head of the bed to a 90-degree angle may help alleviate the client's nausea, but it is not the most comfortable position for someone experiencing epigastric pain due to pancreatitis. This position may also increase pressure on the diaphragm, which can worsen discomfort.
- B: The reverse Trendelenburg position, where the body is inclined with the head higher than the feet, may be used to promote gastric emptying and reduce reflux, but it is not specifically beneficial for relieving epigastric pain or nausea associated with pancreatitis.
- C: Reinforcing bed rest may be seen as ignoring the client's expressed need for a position change to relieve discomfort. While rest is important, the client's request to sit up and lean forward indicates a need for positional relief of pain.
- D: Positioning a bedside table for the client to lean across can provide the support they need to maintain a forward-leaning position, which is known to relieve epigastric pain by reducing tension on the abdominal region. This position is often instinctively chosen by clients with pancreatitis and should be facilitated by the nurse for comfort and pain relief.