A nurse is reviewing the laboratory report of a client who is at 6 weeks of gestation. Which of the following laboratory results should the nurse report to the provider?

Rationale for correct choices

• an endoscopy: The client reports a 3-week history of gnawing, burning epigastric pain that radiates to the back, worsens after meals, and is accompanied by one episode of dark, tarry stool. These symptoms suggest a possible peptic ulcer or gastrointestinal bleeding. An endoscopy is the definitive diagnostic procedure to visualize the gastric mucosa, identify ulcers, and assess for bleeding.

• stool test results: The presence of a dark, tarry stool indicates possible gastrointestinal bleeding (melena). Stool testing, such as a fecal occult blood test, provides objective evidence of bleeding and guides the urgency and necessity of endoscopy. This finding is a key indicator for further gastrointestinal evaluation.

Rationale for incorrect choices

• oxygen via nonrebreather mask: The client’s respiratory assessment shows bilateral clear breath sounds and no signs of hypoxia. Oxygen therapy is not indicated based on current findings, as there is no respiratory compromise.

• an antifungal prescription: There is no evidence of fungal infection. The client’s symptoms are consistent with gastrointestinal pathology, not a fungal etiology. Prescribing an antifungal would be inappropriate without clinical or laboratory indications.

• respiratory rate: The respiratory rate is normal and does not correlate with the presenting gastrointestinal symptoms. It is not a primary indicator for diagnostic intervention in this case.

• temperature: The client does not report fever or signs of infection at this time. While monitoring temperature is standard, it is not a primary indicator for diagnosing peptic ulcer disease or gastrointestinal bleeding in this scenario.

Rationale:

A. Remind the client to eat scheduled meals daily.: As clients near the end of life, appetite naturally decreases due to metabolic changes and reduced physiologic demand. Encouraging scheduled meals can create discomfort or distress and does not improve outcomes. Supportive care focuses on comfort rather than forcing nutritional intake.

B. Place the client in a supine position.: A supine position can worsen respiratory effort, increase the sensation of breathlessness, and promote secretion pooling. Terminal clients often breathe more comfortably in semi-Fowler’s or side-lying positions, which help ease ventilation and support comfort-based care.

C. Offer the client a blanket to keep warm.: Clients at the end of life commonly experience decreased body temperature due to reduced circulation and metabolic slowing. Gently providing a blanket supports comfort without invasive measures. Maintaining warmth helps ease physical distress and aligns with palliative goals focused on dignity and relief.

D. Speak in a loud tone when addressing the client.: Hearing is often the last sense to diminish, so speaking loudly is unnecessary and may startle or distress the client. A calm, soft voice preserves a peaceful environment and promotes emotional comfort, supporting both the client and family during end-of-life care.