The nurse has reviewed the Provider Prescriptions.

Exhibits

For each potential intervention, click to specify if the intervention is anticipated or contraindicated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Rationale:

A. Hemoglobin and hematocrit: The client’s hemoglobin (9.1 g/dL) and hematocrit (27%) are significantly below normal, indicating anemia, likely from gastrointestinal bleeding. This finding requires immediate follow-up to prevent further hemodynamic compromise and assess for ongoing blood loss.

B. Stool results: The client reports dark, tarry stool, which is indicative of melena and gastrointestinal bleeding. Positive hemoccult (if confirmed) further supports active bleeding. Prompt evaluation is necessary to identify the source and prevent severe anemia or shock.

C. Temperature: The client’s temperature is 37.5°C (99.5°F), which is mildly elevated but not critically high. It does not indicate an immediate life-threatening condition, though it should be monitored as part of ongoing assessment for infection.

D. WBC count: The WBC is 6,700/mm³, which is within normal limits. There is no indication of acute infection requiring immediate intervention at this time.

E. Respiratory rate: The respiratory rate of 18/min is within normal limits and does not require immediate follow-up.

F. Heart rate: The client’s heart rate is 118/min, which is tachycardic and may indicate hypovolemia from blood loss. Immediate monitoring and intervention are warranted to prevent cardiovascular compromise.

G. Blood pressure: The client’s blood pressure is 90/50 mm Hg, which is hypotensive. This may result from fluid loss due to bleeding and requires urgent assessment and stabilization to prevent shock.

H. Current medications: The client is taking high-dose ibuprofen (800 mg three times daily), a nonsteroidal anti-inflammatory drug (NSAID), which increases the risk of gastrointestinal bleeding and ulcer formation. This directly relates to the client’s presenting symptoms and requires immediate review and discontinuation.

Rationale:

A. Conversion: Conversion involves the expression of psychological stress through physical symptoms without an underlying medical cause. The client is describing real pain rather than expressing a psychological conflict as a physical symptom, so this does not match conversion.

B. Displacement: Displacement occurs when a person redirects emotions or feelings from the original source to a safer target. The client is addressing the nurse directly about pain management, not redirecting feelings onto another target, so this is not displacement.

C. Introjection: Introjection involves internalizing the beliefs or values of another person. The client is expressing frustration about pain management rather than adopting someone else’s values or attitudes, so introjection does not apply here.

D. Projection: Projection occurs when a person attributes their own feelings, motives, or thoughts onto someone else. In this case, the client is suggesting that the nurse does not believe them, which reflects the client projecting their feelings of frustration and mistrust onto the nurse.