A nurse is assessing a patient who has systemic lupus erythematosus (SLE). Which of the following findings is the highest priority for the nurse to report to the provider?

Choice A rationale

While weight loss is generally healthy for obese individuals, this statement dismisses a potential link between obesity and reflux, which may not be entirely accurate. Increased intra-abdominal pressure due to excess weight is a known contributing factor to gastroesophageal reflux.

Choice B rationale

Excess abdominal adipose tissue increases pressure on the stomach. This elevated pressure can overcome the lower esophageal sphincter's (LES) barrier function, allowing stomach acid and contents to reflux into the esophagus, causing the symptoms of gastroesophageal reflux disease (GERD).

Choice C rationale

While a high-fat diet can contribute to reflux by delaying gastric emptying and relaxing the LES, this statement generalizes that all obese people eat more high-fat food. Obesity itself, regardless of dietary habits, can increase intra-abdominal pressure.

Choice D rationale

This statement is a generalization about the eating habits of obese individuals and does not directly explain the physiological mechanism by which obesity can cause reflux. While larger or more frequent meals can increase stomach distension and potentially reflux, the primary link related to obesity is the increased abdominal pressure.

· Initiate IV fluids – Contraindicated: While IV fluids might be helpful in some cases, excessive fluid administration could exacerbate certain conditions like heart failure or fluid overload. It would depend on the underlying cause of his symptoms.

· Administer aspirin for abdominal pain – Contraindicated: Aspirin can worsen gastrointestinal conditions, especially in someone with GERD. It can increase the risk of gastric irritation or even bleeding.

· Insert a nasogastric tube, attach to low suction – Contraindicated: While NG tube placement can be used for gastric decompression, it is generally not the first step in managing GERD or non-obstructive epigastric pain. This should only be considered if there is suspicion of an obstructive process.

· Initiate continuous ECG monitoring – Anticipated: Given his tachycardia, elevated blood pressure, and history of anxiety, monitoring his cardiac status would be appropriate to rule out cardiac involvement.

· Test stools for occult blood – Anticipated: Considering his long history of smoking and GERD, there is a risk of gastrointestinal bleeding, so checking for occult blood would be a reasonable precaution.