The nurse receives the following information in the hand-off report. Which client should the nurse assess first?

Question

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The nurse should first assess the client with alcoholic cirrhosis, as this condition is associated with gastritis, clotting abnormalities (eg, thrombocytopenia, coagulation disorders), and esophageal varices that increase the risk for hemorrhage (coffee ground emesis from oxidized blood). Hypotension and tachycardia in the presence of blood loss can indicate hypovolemia. The nurse should monitor for signs of hemodynamic instability (eg, hypotension, decreased urine output, peripheral vasoconstriction, pallor) and notify the health care provider of any significant changes from baseline as immediate esophagogastroduodenoscopy is necessary to determine the bleeding site. Treatment to stop the bleeding (eg, heat probe, sclerotherapy) may be indicated. (Option A) A paralytic ileus is a non-mechanical intestinal obstruction that can occur following abdominal surgery. Expected manifestations include absent or hypoactive bowel sounds due to the lack of bowel motility and peristalsis, and abdominal distension and nausea due to the accumulation of gas and fluids in the bowel. (Option C) Bacterial peritonitis (peritoneal inflammation) involves the entry of bacteria into the peritoneal cavity and is associated with a ruptured appendix. Elevated temperature would be an expected finding. (Option D) Sore throat discomfort from irritation of the oropharynx is expected in a client with a nasogastric tube. Educational objective: Clients with alcoholic cirrhosis are at increased risk for hemorrhage due to esophageal varices and coagulation disorders. Hypotension and tachycardia in the presence of blood loss can indicate hypovolemia and require immediate assessment.

The Nurse Receives the Following Information in the Hand-Off Report