A nurse is assisting in the care of a client who has preeclampsia. Which of the following findings should the nurse report to an RN immediately?

Rationale:

A. "The client's partner visited earlier today for 2 hours.": While documenting visitors can be relevant in certain psychosocial or safety contexts, this detail is not critical to clinical decision-making or continuity of care during shift handoff.

B. "The client received the prescribed antibiotic every 8 hours.": Routine administration of scheduled medications does not need to be reported unless there are concerns like adverse reactions, missed doses, or changes in therapy. Simply stating adherence to the schedule adds little value to clinical communication.

C. "The client's mother died 4 years ago from breast cancer.": Past family history may be relevant to the medical record, but it does not impact immediate clinical care or require prioritization during a shift change report unless it is directly influencing current treatment decisions.

D. "The client reports pain is reduced when he is positioned on his side.”: This is current, subjective, and actionable information that informs the incoming nurse about effective pain management strategies and contributes to patient comfort and care planning.

Rationale:

 • An endoscopy is necessary to visualize the upper gastrointestinal tract for potential ulcers or bleeding sites, especially given the client’s positive fecal occult blood and anemia. This procedure will help identify active bleeding and confirm a diagnosis of peptic ulcer disease.

 • An antifungal prescription is inappropriate because there is no evidence of fungal infection such as thrush or candidiasis. The client’s symptoms and diagnostic findings are more consistent with a gastrointestinal disorder, particularly peptic ulcer disease.

 • Oxygen via nonrebreather mask is not indicated because the client's oxygen saturation is normal at 98% on room air. There are no respiratory symptoms or signs of hypoxia that would necessitate supplemental oxygen at this level of intensity.

 • Low hemoglobin and hematocrit indicate a state of anemia, which is likely due to chronic gastrointestinal bleeding. The client’s history of dark, tarry stools (melena) further supports ongoing blood loss from the upper GI tract, necessitating diagnostic evaluation.

 • History of gnawing epigastric pain is suggestive of peptic ulcer disease but does not on its own justify urgent endoscopy. This history becomes more significant when paired with other alarming signs like bleeding or anemia, but alone it is not a definitive indicator.

 • Stool test results showing a positive hemoccult test confirm the presence of gastrointestinal bleeding. Combined with anemia and pain, this is a key indicator for immediate endoscopic evaluation to locate and treat the bleeding source.

 • H. pylori results support a peptic ulcer etiology, but the infection alone does not require urgent visualization unless there are complications like bleeding, anemia, or severe symptoms, which would necessitate further diagnostic action.

 • Presence of epigastric tenderness is a non-specific physical finding that could result from many conditions and is not sufficient to determine the need for endoscopy without other supportive clinical evidence pointing toward bleeding or ulceration.

 • Smoking and alcohol intake history increase the risk for peptic ulcer disease but are not acute indicators for endoscopy. They contribute to the etiology and chronic risk but do not demonstrate the immediate need for invasive diagnostics.