A nurse is caring for a client who has a gastrointestinal (GI) bleed. Which of the following findings is the priority for the nurse to report to the provider?

Urine output of 50 mL in 2 hr

BUN 21 mg/dL

Positive fecal occult blood test

75 mL coffee ground emesis

Answer and Explanation

The Correct Answer is A

A. Urine output of 50 mL in 2 hr: This indicates possible hypovolemia or early shock from blood loss. Low urine output is a sign of impaired perfusion and requires immediate intervention to prevent organ failure.

B. BUN 21 mg/Dl: Elevated BUN can indicate dehydration or GI bleeding, but it is not as immediately critical as a clinical sign of shock. Monitoring trends is important, but it is not the first priority.

C. Positive fecal occult blood test: This confirms the presence of blood in the stool but is not an acute change; it is diagnostic rather than an emergency sign.

D. 75 mL coffee ground emesis: Indicates slow upper GI bleeding; while concerning, hemodynamic instability (like low urine output) takes priority over volume or appearance of vomitus.

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Correct Answer is A

Explanation

A. Use of NSAIDs for arthritic pain: NSAIDs inhibit prostaglandin synthesis, which reduces the protective mucus layer of the stomach and increases the risk of PUD. Clients with chronic NSAID use are at significantly higher risk for gastric ulcers.

B. Smoking history for 10 years: Smoking can delay healing of ulcers and contribute to recurrence, but it is not as direct a risk factor for developing PUD as NSAID use.

C. History of rheumatoid arthritis:RA itself does not directly cause PUD. However, clients with RA may take NSAIDs, which increases risk; the condition alone is not a primary risk factor.

D. Family history of peptic ulcer disease:While genetic predisposition may play a minor role, family history alone is not as significant as active NSAID use or other direct risk factors in increasing suspicion for PUD.

A. Weight loss of 2 lb (0.91 kg) from baseline B. Dyspepsia C. Reports being thirsty D. Abdominal pain radiating to the shoulder

Correct Answer is D

Explanation

A. Weight loss of 2 lb (0.91 kg) from baseline:Unintentional weight loss can indicate chronic illness or poor intake, but a 2-lb loss is relatively small and not an immediate sign of complication.

B. Dyspepsia:Dyspepsia (indigestion) is a common symptom of gastric ulcers and while important to manage, it is not an acute red flag requiring immediate notification.

C. Reports being thirsty:Thirst suggests dehydration or inadequate fluid intake; it is addressable and not a specific sign of a life-threatening ulcer complication.

D. Abdominal pain radiating to the shoulder:Shoulder pain with abdominal pathology suggests diaphragmatic irritation from perforation or intra-abdominal hemorrhage (referred pain via phrenic nerve) - this can indicate a surgical emergency and must be reported immediately.

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A nurse is caring for a client who has a gastrointestinal (GI) bleed. Which of the following findings is the priority for the nurse to report to the provider?

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Naxlex Comprehensive Predictor Exams

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