A child experienced a lacerated spleen in a motor vehicle accident. Which is the highest-priority nursing intervention on admission to the pediatric intensive care unit (PICU) following surgery?
1. Observing for signs of hypovolemic shock
2. Maintaining IV fluids
3. Implementing strict bedrest
4. Administering blood products as ordered
Correct Answer: 1
Rationale: The priority nursing intervention is observing for signs of hypovolemic shock due to bleeding from the lacerated spleen. The other interventions are appropriate but not the highest priority.
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