A client with a gunshot wound is brought to the emergency department (ED) with a bullet entry at the spinal level of C8 and T1.The client is able to move the upper arms. To further assess the client's spinal nerve function, which action should the nurse implement?

A. Junctional tachycardia: Junctional tachycardia originates from the AV node, typically with a narrow QRS, absent or inverted P waves, and a rate of 100–180 bpm. The strip does not show these features.
B. Second-degree Type II AV block (3:1).Type II AV block (Mobitz II) shows dropped QRS complexes with constant PR intervals before conducted beats. This strip does not show missing QRS complexes in a 3:1 pattern.
C. Ventricular fibrillation. VF is characterized by a chaotic, disorganized rhythm with no discernible P waves, QRS complexes, or T waves, completely different from this organized flutter pattern.
D. Atrial flutter is characterized by regular, rapid atrial depolarizations (flutter waves) at a rate of 250–350 bpm. These waves create a "sawtooth" pattern on the ECG.The ventricular response may be regular or irregular, depending on AV conduction. This is different from atrial fibrillation (which has irregularly irregular R-R intervals and no discrete P waves).

• Increase the fraction of inspired oxygen (FiO₂). The client has severe COVID pneumonia and is on mechanical ventilation with high inspiratory pressures, suggesting acute respiratory distress syndrome (ARDS). Increasing FiO₂ is indicated if oxygenation is inadequate (e.g., low PaO₂ or SpO₂). However, oxygen toxicity should be avoided, so adjustments should be made based on arterial blood gases (ABGs) and oxygen saturation.
• Collect equipment for a needle aspiration. Needle aspiration is typically used for pneumothorax management, but there is no mention of clinical signs such as sudden hypotension, absent breath sounds, or tracheal deviation. While ventilated COVID-19 patients are at risk for barotrauma, this procedure is not justified without evidence of pneumothorax.
• Replace the ventilator. There is no indication that the ventilator is malfunctioning or that the settings are inappropriate. If ventilation issues arise (e.g., high plateau pressures, auto-PEEP, or ventilator asynchrony), adjustments to settings, sedation, or lung-protective strategies should be considered before replacing the ventilator.
• Measure the nasogastric tube output. The client is intubated and sedated, meaning they cannot protect their airway or tolerate oral intake. A nasogastric (NG) tube is commonly placed for gastric decompression and feeding. Monitoring NG output is essential to assess for gastrointestinal bleeding, ileus, or high residual volumes, which can affect feeding tolerance.
• Place the client in Trendelenburg. The Trendelenburg position increases the risk of aspiration, impairs lung expansion, and worsens ventilation-perfusion mismatch, especially in ARDS patients. Instead, prone positioning is often preferred in severe COVID pneumonia to improve oxygenation and alveolar recruitment.