A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate. The client reports that she is experiencing difficulty breathing. Which of the following actions should the nurse take first?

A. Patient-centered care: This competency focuses on respecting client preferences, values, and needs while involving them in care decisions. Completing an incident report does not directly address individualized client care.

B. Evidence-based practice: Evidence-based practice involves integrating the best current research evidence with clinical expertise and patient values. Documenting an incident report is not based on reviewing or applying research evidence.

C. Informatics: Informatics involves using information technology to communicate, manage knowledge, and support decision-making. While an incident report may use electronic systems, the primary purpose is not focused on informatics competency.

D. Quality improvement: Completing an incident report identifies errors, near misses, or adverse events, which helps the healthcare team analyze processes and implement changes to improve patient safety. This reflects the quality improvement competency by contributing to safer care systems.

Rationale for correct choices:

• Endoscopy: The client presents with a history of gnawing epigastric pain, one episode of dark, tarry stool, hypotension, tachycardia, and significant anemia. These findings suggest possible upper gastrointestinal bleeding or peptic ulcer disease. Endoscopy is the definitive diagnostic procedure to identify the source of bleeding and assess ulcer severity.
• Stool test results: The positive hemoccult (tarry stool) indicates gastrointestinal bleeding. This abnormal finding provides objective evidence that warrants further diagnostic evaluation through endoscopy to prevent further blood loss and complications.

Rationale for incorrect choices:

• Antibiotic prescription: While H. pylori infection can require antibiotics, this client’s immediate concern is gastrointestinal bleeding, not infection control. Antibiotics would not address the urgent need to identify and manage the bleeding source.
• Proton pump inhibitor therapy: Proton pump inhibitors help reduce gastric acid and promote ulcer healing, but initiating therapy alone does not evaluate or stop potential active bleeding. Endoscopy is needed first for diagnostic and possible therapeutic intervention.
• Hypotension: Although hypotension is present, it is a clinical sign of potential blood loss rather than a direct diagnostic criterion. It supports the urgency for endoscopy but is not the primary evidence for the procedure.
• Positive H. pylori test: While H. pylori infection contributes to ulcer formation, the acute presentation of bleeding evidenced by positive hemoccult stool makes the stool test a more immediate indicator for endoscopy.