The nurse is assessing a client for goiter and is unable to observe the thyroid gland. Which action should the nurse take?

A. Auscultation of the abdomen involves listening to bowel sounds and can provide information about the gastrointestinal system's activity, such as whether there is increased or decreased motility. While important for assessing general bowel function, auscultation is not specific for confirming steatorrhea. It does not provide direct information about the presence of fat in the stool.
B. Inspecting the area around the umbilicus may help in identifying other abdominal conditions, such as hernias or signs of ascites. However, it does not provide information about stool characteristics or fat content, so it is not the most appropriate action for confirming steatorrhea.
C. Light palpation of areas of abdominal protuberance can help assess for abdominal masses or tenderness. While palpation can provide useful information about the abdominal organs and possible fluid accumulation, it does not give information about stool fat content.

D. Observing the appearance of the client’s stool is the most direct method to confirm steatorrhea. Stool that is greasy, foul-smelling, and floats is characteristic of steatorrhea, indicating the presence of undigested fat. This observation directly assesses the presence of fat in the stool, making it the best action to confirm steatorrhea.

A. Hyperactive bowel sounds are not typically associated with gastroesophageal reflux disease (GERD). They are more indicative of gastrointestinal disturbances such as increased bowel activity or a bowel obstruction. Since the client's symptoms are related to heartburn, assessing bowel sounds is less relevant to GERD. This choice does not provide useful information for diagnosing or managing GERD.
B. This option is not commonly associated with GERD. In fact, small frequent meals are often recommended as a management strategy for GERD to reduce the occurrence of heartburn, as large meals can exacerbate symptoms by increasing stomach pressure. This choice does not align with typical GERD management strategies and may not be a useful symptom to assess in this context.
C. This finding is highly relevant for GERD. Heartburn that occurs or worsens when lying down, especially at night, is a classic symptom of gastroesophageal reflux disease. When a person lies flat, stomach acid can more easily flow back into the esophagus due to decreased gravitational pressure, leading to heartburn. Identifying this symptom helps confirm GERD and guides management strategies, such as elevating the head while sleeping or avoiding late meals.
D. Light grey and chalky stools are indicative of issues related to bile production and could suggest a problem with the liver or biliary system rather than GERD. This symptom is not associated with GERD and would be more relevant in assessing conditions such as biliary obstruction or liver disease.