An older adult client who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially?

A. Ibuprofen: NSAIDs such as ibuprofen are on the Beers List due to the risk of gastrointestinal bleeding, renal impairment, and hypertension in older adults. Safer alternatives are recommended when possible.

B. Diazepam: Long-acting benzodiazepines like diazepam are included because they increase the risk of sedation, confusion, and falls in older adults. Shorter-acting agents or nonpharmacologic approaches are preferred.

C. Warfarin: Warfarin is not broadly listed as inappropriate but requires careful monitoring of INR and diet. It is often necessary for anticoagulation and is not automatically contraindicated for older adults.

D. Digoxin: Digoxin is on the Beers List at doses greater than 0.125 mg/day due to the risk of toxicity, particularly with reduced renal clearance in older adults. Lower doses or alternatives are often considered safer.

E. Metformin: Metformin is not on the Beers List and is commonly used safely in older adults, except in cases of severe renal impairment where lactic acidosis risk is increased. It is generally a preferred first-line therapy for type 2 diabetes.

• Mid-abdominal pain for 4 days, rating pain 7 on a 0 to 10 pain scale: Unrelieved abdominal pain of this severity and duration is clinically significant. The nurse must prepare to assess the pain further, ensure pain management protocols are available, and alert the provider for urgent evaluation upon arrival.
• Upper abdomen distention present with decreased bowel sounds in lower abdomen: This indicates a possible bowel obstruction, a condition that can rapidly become life-threatening. Distention and hypoactive bowel sounds are signs of impaired gastrointestinal motility that warrant immediate assessment and preparation for timely interventions.
• Client reports nausea and started vomiting orange-brown emesis yesterday afternoon that has foul odor: Foul-smelling, brownish emesis suggests fecal vomiting, a classic sign of a lower intestinal obstruction. This is a surgical emergency. The nurse must ensure suction equipment is ready, initiate NPO status, and anticipate imaging and provider notification.
• Last bowel movement 7 days ago: Prolonged absence of bowel movements in conjunction with vomiting and abdominal distention strengthens the concern for complete bowel obstruction. This requires immediate evaluation and cannot be ignored during transfer.

Rationale for Incorrect Choices:

• Lungs clear to auscultation: Clear lung sounds indicate the client is not experiencing acute respiratory distress. Since oxygenation appears intact and there are no signs of pulmonary compromise, this finding does not require urgent intervention before arrival.
• Heart sounds moderate and regular: The presence of regular, moderate heart sounds suggests a stable cardiac rhythm and adequate perfusion. In the absence of arrhythmias, chest pain, or abnormal heart tones, this cardiovascular assessment does not raise urgent concern.
• Vitals: Temperature 37.8° C (100° F), BP 120/80 mm Hg, pulse rate 100/min, respirations 20/min and regular: Although the temperature and heart rate are mildly elevated, they remain within acceptable clinical ranges. These values may reflect a response to discomfort, dehydration, or early infection, but they are not immediately alarming.