The nurse is assisting with the care of a client.

Complete the following sentence by using the lists of options. The nurse is assisting with the plan of care for the client. The nurse should first assist with

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and then

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• Initiating IV: The client shows signs of hypovolemia—tachycardia, hypotension, dry mucous membranes, and elevated BUN/creatinine—all of which indicate fluid deficit from vomiting and third-spacing due to the small-bowel obstruction. Immediate IV access is needed to begin fluid resuscitation and stabilize perfusion before any further interventions.

• Administering antibiotics: There is no evidence of infection requiring immediate antibiotic therapy—WBC count is normal, and there are no signs of peritonitis. Fluid resuscitation takes priority before any medication administration in a hemodynamically unstable client.

• Preparing for surgery: Although surgery may be needed later, the immediate priority is to stabilize circulation and decompress the bowel. The client is hypotensive and tachycardic, making preparation for surgery unsafe until volume status is corrected.

• Preparing to place a nasogastric tube: An NG tube is essential in small-bowel obstruction to decompress the bowel, relieve distention, reduce vomiting, and prevent perforation. After IV access is established for stabilization, NG tube placement becomes the next priority to reduce gastrointestinal pressure and prevent further complications.

• Weighing the client: This is not an urgent intervention and does not affect immediate treatment for a small-bowel obstruction. Stabilizing fluids and gastric decompression take precedence over baseline weight data.

• Monitoring intake and output: While important for ongoing assessment of hydration and renal perfusion, it is not the first or second priority. The client must first receive IV resuscitation and bowel decompression to prevent worsening shock.