A nurse is assisting with the care of a client.

Exhibits

The nurse is collecting data from the client.

Drag words from the choices below to fill in each blank in the following sentence.

The nurse should identify that

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indicate manifestations of borderline personality disorder.

• Endoscopy is the most appropriate diagnostic tool to visualize the gastrointestinal tract directly when gastrointestinal bleeding is suspected. Given the client’s symptoms of gnawing abdominal pain, radiation of pain to the back, and a positive Hemoccult stool test Endoscopy will help confirm this diagnosis and allow for appropriate treatment.
• Positive Hemoccult stool indicates the presence of occult blood, which is a hallmark sign of gastrointestinal bleeding. In this case, the presence of blood in the stool aligns with the client’s symptoms of abdominal pain and possible peptic ulcer disease, often linked with H. pylori infection. The positive Hemoccult stool test justifies the need for endoscopy to identify the source of bleeding and guide further management.

• Barium swallow. A barium swallow can detect structural abnormalities like strictures, tumors, or achalasia in the esophagus but is not as effective as endoscopy in diagnosing peptic ulcers or evaluating gastrointestinal bleeding. In this case, endoscopy is the preferred diagnostic method as it provides direct visualization of ulcers or other lesions in the stomach or duodenum.
• CT scan. While a CT scan can be helpful in assessing for abdominal issues like perforation or obstruction, it is not the first choice for diagnosing peptic ulcers or gastrointestinal bleeding. Endoscopy provides a more targeted and effective approach for visualizing the gastrointestinal tract and identifying the source of the bleeding.
• Surgical intervention.Surgical intervention is typically reserved for severe cases where there is gastrointestinal perforation or uncontrollable bleeding. In this case, the client has not yet shown signs of perforation or hemorrhagic shock that would require immediate surgery. Initial diagnostic tests, such as endoscopy, are needed before surgical consideration.

• WBC count of 6,700/mm³. The client’s WBC count is within the normal range (5,000 to 10,000/mm³), suggesting no current acute infection. While inflammation could be indicated in cases of ulcers or gastritis, the normal WBC count in this case does not raise immediate concern for infection. It is unlikely to directly influence the need for endoscopy, which is guided primarily by the clinical presentation and positive Hemoccult stool result.

• Hemoglobin of 9.1 g/dL, Hematocrit of 27%. The low hemoglobin and hematocrit levels indicate anemia, which is often caused by chronic blood loss. This aligns with the positive Hemoccult stool test, which suggests that the client is losing blood through the gastrointestinal tract, possibly due to a peptic ulcer. This finding supports the need for endoscopy to investigate the cause of the bleeding and assess the need for treatment such as blood transfusions or iron supplementation.

A. Offer the client several choices at mealtimes. Clients with delirium often experience confusion and difficulty processing information. Providing too many choices can increase anxiety and agitation. Instead, offering simple and limited options helps reduce cognitive overload.
B. Alternate daily caregivers. Consistency in caregivers is important for clients with delirium to minimize confusion and distress. Frequent changes in caregivers can contribute to disorientation and make it more difficult for the client to feel secure.
C. Remind the client of the day and time often. Delirium is characterized by fluctuating levels of consciousness and confusion. Frequent orientation to time, place, and situation helps reduce anxiety and supports cognitive function. Using clocks, calendars, and familiar objects in the environment can reinforce orientation.
D. Avoid discussing the client's fears. Clients with delirium may have distressing thoughts or fears that should be acknowledged and addressed. Providing reassurance and a calm, supportive environment can help alleviate anxiety and improve the client's well-being.