A nurse in a provider's office is caring for a client.

Select the 3 findings from the client's medical record that increase their risk for peptic ulcer disease (PUD).

Rationale:

A. Dyspepsia, or indigestion, is a common symptom in peptic ulcer disease (PUD), often described as burning, gnawing, or aching pain in the epigastric region. While it can significantly affect quality of life and may indicate ulcer activity, it is generally non-emergent and can be managed with medications such as proton pump inhibitors, H2 blockers, or antacids, along with lifestyle modifications. Dyspepsia does not pose an immediate threat to life.

B. Epigastric discomfort is a hallmark symptom of PUD and includes sensations such as fullness, bloating, or mild pain after meals. Like dyspepsia, it is important for monitoring disease progression and evaluating treatment effectiveness, but it is not an acute, life-threatening finding.

C. Hematemesis (vomiting blood) is the highest-priority finding in a client with PUD because it indicates active upper gastrointestinal bleeding, which is a medical emergency. Bleeding can be caused by erosion of the ulcer into a blood vessel, leading to rapid blood loss. Consequences include hypovolemic shock, anemia, and hemodynamic instability, which may necessitate IV fluid resuscitation, blood transfusion, and urgent surgical or endoscopic intervention. Immediate nursing actions include assessing vital signs, initiating two large-bore IV lines, monitoring intake and output, preparing for laboratory testing, and notifying the healthcare provider promptly.

D. Constipation may result from dietary factors, reduced activity, or certain medications but is not an urgent or life-threatening complication of PUD. It is a lower-priority concern compared to active bleeding.

Rationale:

A. Scheduling serological testing for Lyme disease may be part of the diagnostic process, but early testing is often unreliable because antibodies may not be detectable in the first few weeks after infection. Waiting for test results can delay treatment and increase the risk of complications.

B. Assessing for neurological involvement, such as facial palsy, is important in later stages of Lyme disease. While the nurse should monitor for these signs, it is not the immediate priority in a client with early localized disease and a characteristic rash.

C. Administering a prescribed dose of doxycycline is the most appropriate initial action. Early antibiotic treatment for Lyme disease, especially when a bull’s-eye rash (erythema migrans) is present, is critical to prevent progression to more serious systemic manifestations, including neurological, cardiac, or musculoskeletal complications. Prompt initiation of therapy is more important than waiting for confirmatory testing.

D. Initiating a discussion about safe hiking practices is valuable for health promotion and prevention, but it does not address the client’s immediate need for treatment. Education can be provided after initiating therapy.