A nurse in a provider's office is caring for a client who has a medical history of rheumatoid arthritis and psoriasis, and a family history of heart disease and arthritis. The client has a 60-year smoking history and denies alcohol or other substance use. They are positive for Helicobacter pylori and are on medication for peptic ulcer disease (PUD). Which three findings from the client's medical record increase their risk for peptic ulcer disease?

Choice A rationale
Jaundice of the sclera is indicative of hyperbilirubinemia, which can occur in various liver diseases but is not specifically associated with Grey Turner's sign or pancreatitis.

Choice B rationale
Bluish discoloration of the periumbilical area, known as Cullen's sign, is another indicator of severe pancreatitis but is distinct from Grey Turner's sign, which specifically refers to the flank area.

Choice C rationale
Left abdominal pain that occurs with movement may be a symptom experienced by patients with pancreatitis, but it is not referred to as Grey Turner's sign, which is a physical finding rather than a symptom.

Choice D rationale
Grey Turner's sign is characterized by bluish discoloration of the flank area. It is a sign of retroperitoneal hemorrhage, which can occur in severe cases of pancreatitis due to the spread of pancreatic enzymes to surrounding tissues, leading to localized bleeding.

Choice A rationale
Storing the medication at room temperature is a practical instruction but does not explain the therapeutic purpose of the medication, which is essential for patient understanding.

Choice B rationale
Epoetin alfa (Procrit) is used to treat anemia associated with chronic kidney disease by supplementing erythropoietin, a hormone the damaged kidneys can no longer produce effectively. This is the most informative statement for the patient's understanding of the medication's purpose.

Choice C rationale
While epoetin alfa can improve anemia and potentially improve quality of life, it does not directly delay the need for dialysis, which is determined by overall kidney function and not solely by the presence of anemia.

Choice D rationale
Epoetin alfa does not have a role in preventing AV fistula clotting. It is specifically used to stimulate red blood cell production and has no direct effect on clotting mechanisms.