A male client is admitted for observation because he is reporting progressively increasing fatigue over the past month and a brief episode of dizziness that occurred today. He has a history of heartburn and indigestion that he self-treats with ibuprofen and antacids. Which assessment finding should the nurse report immediately to the healthcare provider?

Reference Ranges:
Hemoglobin (14 to 18 g/dL (8.7 to 11.2 mmol/L)]
Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]
Gastric pH [1.5 to 3.5]

Hematocrit 42% (0.42 volume fraction).

Hemoglobin 13 g/dL (8.07 mmol/L).

Positive guaiac of stool.

Gastric pH 2.0.

Answer and Explanation

The Correct Answer is C

A. Hematocrit 42% (0.42 volume fraction):
A hematocrit of 42% is within the normal reference range for males (42% to 52%). While it is important to monitor hematocrit levels, this finding alone does not indicate an immediate issue.

B. Hemoglobin 13 g/dL (8.07 mmol/L):
A hemoglobin level of 13 g/dL is slightly below the normal range for males (14 to 18 g/dL). However, it is not critically low and may not require immediate intervention without additional context or symptoms.

C. Positive guaiac of stool:
A positive guaiac test for stool indicates the presence of occult blood in the stool, which could suggest gastrointestinal bleeding. Given the client's history of heartburn, indigestion, and use of ibuprofen (a nonsteroidal anti-inflammatory drug that can cause gastrointestinal bleeding), this finding is concerning and should be reported immediately to the healthcare provider for further evaluation and management.

D. Gastric pH 2.0:
A gastric pH of 2.0 is within the normal range for gastric acid, as the normal pH of gastric acid typically ranges from 1.5 to 3.5. This finding is expected and does not indicate an immediate problem related to the client's symptoms.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Begin therapy 1 week before the next normal menstrual cycle:
Misoprostol is used to prevent NSAID-induced gastric ulcers and to induce labor or manage miscarriage. It is not specifically tied to the timing of the menstrual cycle. The client should start therapy according to the provider's instructions, which will not necessarily be related to the menstrual cycle.

B. Call the healthcare provider immediately if there is a chance of conception:
Misoprostol is contraindicated during pregnancy due to its potential to cause uterine contractions and possible abortion. This statement correctly highlights the need to inform the healthcare provider if there is a chance of conception, as the medication poses risks to pregnancy.

C. Use condoms and a backup method of birth control to prevent pregnancy:
This is an appropriate and necessary precaution when taking misoprostol due to its potential teratogenic effects and risks to pregnancy. Using effective contraception is important to prevent unintended pregnancy while on this medication.

D. Ensure a negative pregnancy test result 2 weeks before therapy:
This is a standard precaution to ensure that the client is not pregnant before starting misoprostol, which is crucial due to its potential effects on pregnancy. A negative pregnancy test is essential for safe use of the medication.

A. Provide a PRN NSAID for gum B. Complete a medication variance report. C. Review most recent coagulation lab values. D. Report findings to healthcare provider. E. Obtain a soft bristle toothbrush for client.

Correct Answer is ["B","C","D","E"]

Explanation

A) Provide a PRN NSAID for gum pain: Administering NSAIDs is not recommended as they can exacerbate bleeding risks in clients on anticoagulants. NSAIDs can interfere with platelet function and increase bleeding tendencies.

B) Complete a medication variance report: Documenting adverse effects and any discrepancies in medication administration is crucial for patient safety and quality control. A variance report helps track and address issues related to medication effects.

C) Review most recent coagulation lab values: Evaluating recent lab results is essential to determine if the anticoagulant dosage is appropriate and if there is an increased risk of bleeding. This information guides decisions about further interventions or adjustments to the medication regimen.

D) Report findings to healthcare provider: Immediate communication with the healthcare provider is necessary to address the client’s symptoms of bleeding and bruising. The provider can then evaluate the need for treatment modification or additional measures to manage bleeding risks.

E) Obtain a soft bristle toothbrush for client: A soft bristle toothbrush helps minimize gum irritation and bleeding, which is important for clients on anticoagulants to reduce the risk of oral bleeding and maintain oral health.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A female client with a history of peptic ulcer disease receives a prescription for misoprostol. Which information provided by the client indicates to the nurse a need for further teaching?

Correct Answer is A

Explanation

After receiving the third dose of a new oral anticoagulant prescription, an older adult client develops bleeding and tender gums and has many new bruises. Which actions should the nurse implement? Select all that apply.

Correct Answer is ["B","C","D","E"]

Explanation

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