A client reports to the healthcare provider's (HCP) office for a routine postsurgical evaluation six weeks after a hysterectomy.
Which history-taking approach should the nurse use to gather the needed information?

Choice A rationale

Obtaining a pulse oximeter reading from two extremities assesses peripheral perfusion and oxygen saturation, providing data on systemic oxygen delivery. This action is unrelated to identifying an extra heart sound, which originates from cardiac mechanics and blood flow dynamics within the heart's chambers and valves.

Choice B rationale

The bell of the stethoscope is designed to optimally transmit low-frequency sounds due to its larger surface area and lighter pressure application. Extra heart sounds, such as S3 or S4 gallops or certain murmurs, are typically low-pitched and therefore best appreciated with the bell, allowing for clearer differentiation from normal heart sounds.

Choice C rationale

Auscultating for one minute with the diaphragm primarily transmits high-frequency sounds due to its taut membrane and firm application. While useful for normal heart sounds (S1, S2) and high-pitched murmurs, it may obscure or poorly transmit the low-frequency characteristics of most extra heart sounds, leading to their non-detection.

Choice D rationale

Using a Doppler ultrasound primarily detects blood flow and its direction, often used to assess peripheral pulses or vascular patency. While it can detect cardiac motion, it does not provide the nuanced auditory information necessary to differentiate and characterize specific extra heart sounds based on their timing, pitch, and quality within the cardiac cycle.

Choice A rationale

A decrease in Hemoglobin A1C from 10% to 8% indicates improved glycemic control over the past 2-3 months, as A1C reflects average blood glucose levels. This lab value is not directly indicative of acute or ongoing gastrointestinal bleeding resolution. Normal HbA1C is typically below 5.7%.

Choice B rationale

An increase in Prothrombin Time (PT) from 12 seconds (normal range 11-13.5 seconds) to 18 seconds indicates impaired clotting, which could be related to severe liver dysfunction or anticoagulant therapy, but it does not directly confirm ongoing GI bleeding. While bleeding may worsen with prolonged PT, it doesn't indicate active bleeding as the primary finding.

Choice C rationale

A change in Guaiac test from positive to negative indicates that occult blood is no longer detected in the stool, suggesting resolution of gastrointestinal bleeding. The guaiac test detects the peroxidase activity of hemoglobin; a negative result implies cessation of blood loss into the GI tract.

Choice D rationale

A decrease in Hematocrit (Hct) from 36% (normal range for adult males typically 40-54%) to 32% suggests ongoing blood loss or hemodilution. Hematocrit represents the percentage of red blood cells in blood volume. A continued drop indicates unresolved bleeding, as red blood cells are being lost from the circulatory system.