A nurse is collecting data from a client who has pneumonia and a prescription for cefazolin. Which of the following findings should the nurse report to the provider prior to administering the initial dose? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

A fecal occult blood test (FOBT) is used to detect hidden blood in the stool that may indicate gastrointestinal bleeding, polyps, or colorectal cancer. Proper specimen collection is essential because certain foods, medications, and conditions can affect test accuracy and lead to false-positive or false-negative results. Clients are taught to follow dietary and medication restrictions and to collect samples over multiple bowel movements. Correct technique improves the reliability of screening results.

Rationale:
A. Collecting samples when hemorrhoids are bleeding is incorrect because visible blood from hemorrhoids can cause a false-positive result. The test is designed to detect occult (hidden) blood, not overt bleeding. Active hemorrhoidal bleeding should be reported, and testing may need to be postponed until bleeding resolves.

B. Continuing to take aspirin daily is incorrect because aspirin can irritate the gastrointestinal mucosa and increase the risk of bleeding, leading to a false-positive test result. Clients are typically instructed to avoid aspirin and other NSAIDs before and during stool collection unless otherwise directed by the provider.

C. Continuing to eat red meat is incorrect because red meat contains heme iron, which can cause a false-positive result on fecal occult blood testing. Clients are usually instructed to avoid red meat prior to and during testing to ensure accurate results. Diet restrictions help improve test specificity.

D. Collecting samples from three separate bowel movements is correct because multiple specimens increase the accuracy and reliability of fecal occult blood testing. Since bleeding in the gastrointestinal tract may be intermittent, obtaining samples over different bowel movements improves the likelihood of detecting occult blood. This ensures more accurate screening results.

Management of a client with suspected ectopic pregnancy is based on clinical findings such as delayed menses, unilateral abdominal pain, vaginal spotting, and abnormal pregnancy hormone levels. Ectopic pregnancy occurs when implantation happens outside the uterine cavity, most commonly in the fallopian tube, and can lead to rupture and life-threatening hemorrhage. Management includes medical therapy (methotrexate), diagnostic confirmation, and close monitoring of hCG trends. Interventions that are appropriate for intrauterine pregnancy (such as cerclage) are contraindicated.

Rationale:

• Methotrexate is a folic acid antagonist used to medically manage ectopic pregnancy by stopping rapidly dividing trophoblastic tissue. It prevents further growth of the ectopic implantation and allows the body to reabsorb the tissue. The client’s stable vital signs and early diagnosis make them a candidate for medical management. This is a standard and expected treatment for non-ruptured ectopic pregnancy.

• Blood typing is essential in any suspected ectopic pregnancy because of the risk of hemorrhage and possible need for transfusion. Determining Rh status is also critical to guide administration of Rh immune globulin if the client is Rh-negative. Baseline blood typing ensures preparedness for emergency intervention. Therefore, this is a necessary diagnostic step.

• Transvaginal ultrasound is the primary diagnostic tool used to confirm the location of pregnancy and rule out intrauterine gestation. It helps identify ectopic implantation in the fallopian tube or other abnormal sites. This imaging is essential for confirming diagnosis and guiding treatment decisions.

• Serial β-hCG measurements are used to assess pregnancy viability and progression. In ectopic pregnancy, hCG levels often rise abnormally or plateau instead of doubling appropriately. Monitoring trends helps evaluate response to treatment such as methotrexate. Therefore, repeat testing is a critical component of ongoing management.

• Cervical cerclage is used to treat cervical insufficiency in cases of intrauterine pregnancy to prevent preterm birth. It is not indicated in ectopic pregnancy because the pregnancy is not located within the uterus. Performing cerclage in this case would be inappropriate and provide no benefit. Therefore, it is contraindicated.