A client with peptic ulcer disease is at risk of developing a gastrointestinal bleed. The nurse should assess the client for which of the following early signs of bleeding?

Choice A reason:

Elevated white blood cell count may indicate inflammation or infection, but it is not directly related to jaundice and dark-colored urine, which are characteristic of increased bilirubin levels.

Choice B reason:

Impaired blood clotting is not directly related to jaundice and dark-colored urine. It may be a concern in liver disease but does not explain the specific manifestations mentioned in the question.

Choice C reason:

This statement is correct. Jaundice and dark-colored urine are indicative of increased bilirubin levels in the blood, which can occur in cholecystitis due to obstruction of the bile ducts.

Choice D reason:

Elevated serum amylase is more associated with pancreatitis rather than cholecystitis. It is not directly related to the clinical manifestations described.

Choice A reason:

Nausea and vomiting after meals are common symptoms in acute cholecystitis, but they do not indicate a severe complication. They are typical manifestations of gallbladder inflammation.

Choice B reason:

Mild right upper quadrant pain may be present in acute cholecystitis, but it does not suggest a severe complication.

Choice C reason:

Referred pain to the left shoulder (Kehr's sign) is a classic symptom of splenic rupture or other conditions involving the spleen, not directly related to cholecystitis.

Choice D reason:

This statement is correct. High fever and chills may indicate the presence of infection and sepsis, which can be severe complications of acute cholecystitis.