A client with gastroesophageal reflux disorder (GERD), who has been self-medicating with famotidine for the past week, is admitted to the acute care center because the symptoms have worsened. The nurse should anticipate which treatment?

Choice A reason: Using a heating pad is contraindicated in Raynaud’s, as reduced sensation from vasospasm risks burns. Raynaud’s involves cold-triggered arteriolar constriction, reducing blood flow. Heat does not address vasospasm’s pathophysiology and may cause tissue damage, making this instruction inappropriate compared to cold protection strategies.

Choice B reason: Wearing gloves when handling cold items prevents vasospasm in Raynaud’s, where cold triggers arteriolar constriction, causing ischemia and pain. Protecting extremities maintains blood flow, preventing episodes. This directly addresses the disease’s pathophysiological trigger, making it the most effective instruction for managing Raynaud’s symptoms.

Choice C reason: Knee-high support stockings improve venous return, relevant for venous insufficiency, not Raynaud’s arterial vasospasm. Stockings do not prevent cold-induced vasoconstriction, the primary trigger. Gloves for cold exposure directly mitigate vasospastic episodes, making this instruction less effective for Raynaud’s disease management.

Choice D reason: Regular walking improves overall circulation but does not prevent Raynaud’s vasospastic episodes, triggered by cold or stress. While exercise supports vascular health, avoiding cold exposure with gloves is more targeted, directly reducing arteriolar constriction and ischemic symptoms, making walking a secondary recommendation.

Choice A reason: Connecting to suction is inappropriate, as “coffee ground” drainage indicates upper GI bleeding, likely from an ulcer. Suction could worsen bleeding by traumatizing the site. Clamping and notifying the provider ensure assessment, preventing further hemorrhage or complications like perforation in this critical scenario.

Choice B reason: “Coffee ground” drainage suggests oxidized blood from upper GI bleeding (e.g., gastritis). Clamping prevents irritation or bleeding exacerbation, and contacting the provider ensures urgent evaluation, possibly via endoscopy or proton pump inhibitors, addressing the bleeding source to stabilize the client and prevent shock.

Choice C reason: Removing and reinserting the tube risks further trauma to the bleeding site, as “coffee ground” drainage indicates active hemorrhage. Repeated insertion may dislodge clots, worsening bleeding. Clamping and notifying the provider prioritize safety, allowing diagnostic and therapeutic interventions for the underlying cause.

Choice D reason: High continuous suction is contraindicated, as “coffee ground” drainage signals GI bleeding, and aggressive suction could dislodge clots, increasing hemorrhage. Clamping and contacting the provider ensure controlled management, preventing complications like hypovolemic shock, making this action harmful and inappropriate.