A nurse is reinforcing client teaching about preventing stress injuries. Which of the following statements by the client indicates an understanding of teaching?

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.

Rationale:

A. "The client can revoke consent even after the procedure has begun.": Clients have the legal right to withdraw consent at any time, including during a procedure. Respecting this autonomy is essential, and healthcare providers must stop the procedure if the client revokes consent.

B. "The nurse is responsible for obtaining informed consent.": Obtaining informed consent is the responsibility of the provider performing the procedure, who must ensure the client understands the risks, benefits, and alternatives. Nurses typically witness and verify the signature but do not obtain consent.

C. "Consent must be obtained from a family member if a client has a mental illness.": Consent depends on the client’s decision-making capacity, not solely on the presence of mental illness. If the client is competent, they can provide consent; if not, a legally authorized representative may be involved.

D. "The charge nurse will explain the risks of the procedure to the client.": Explaining procedure risks is the responsibility of the healthcare provider performing the procedure, not the charge nurse. This ensures that the explanation is accurate and comprehensive.