A nurse is collecting data from a client who has hypocalcemia. Which of the following findings should the nurse expect?

(A) Increased bowel sounds
At the end of life, decreased bowel sounds or even absent bowel sounds are more common due to reduced gastrointestinal activity as the body begins to shut down. Increased bowel sounds are not typically expected.

(B) Hypertension
Hypertension is not typically expected at the end of life. Instead, hypotension (low blood pressure) is more common as the heart and other systems begin to fail.

(C) Moist mucous membranes
At the end of life, mucous membranes are often dry due to decreased fluid intake and systemic dehydration. Moist mucous membranes would not be an expected finding.

(D) Mottled skin
Mottled skin is a common and expected finding at the end of life. It occurs as circulation diminishes and the skin takes on a blotchy, purplish appearance, typically starting in the extremities and moving centrally. This is a sign that the body is shutting down and approaching death.

(A) Determine the client’s blood pressure 1 min after each position change: While it’s important to check the client’s blood pressure after each position change when assessing for orthostatic hypotension, this is not the first step. The nurse should first establish a baseline blood pressure reading with the client in a supine position.

(B) Place the client in a sitting position: Although the nurse will eventually need to check the client’s blood pressure in a sitting position, the first step is to get a baseline reading with the client in a supine position.

(C) Assist the client into a standing position: The nurse will eventually assist the client into a standing position to check for changes in blood pressure, but this is not the first step. The initial step is to get a baseline reading with the client in a supine position.

(D) Check the blood pressure with the client in a supine position: This is the most appropriate first step. When checking for orthostatic hypotension, the nurse should first check the client’s blood pressure while they are lying flat (supine). This provides a baseline reading against which subsequent readings (taken when the client is sitting and standing) can be compared. If there’s a significant drop in blood pressure upon standing, this could indicate orthostatic hypotension.