A nurse is caring for a client who has an acute exacerbation of chronic pain. Which of the following medications should the nurse anticipate administering for the client?

Rationale:

A. Wash hands with an alcohol-based cleaner: Alcohol-based hand sanitizers are not effective against Clostridium difficile spores. Handwashing with soap and water is necessary to physically remove spores and reduce transmission.

B. Wear a gown when providing care: Contact precautions, including wearing a gown, are essential to prevent the spread of C. difficile through contaminated clothing and surfaces. Gowns help protect the nurse and other clients from infection.

C. Remove the thermometer from client's room for use on another client: Using equipment on multiple clients without proper disinfection can spread C. difficile. Disposable or dedicated equipment should be used, or the thermometer must be disinfected before reuse.

D. Wear an N95 respirator when providing care: C. difficile is transmitted via the fecal-oral route, not airborne. An N95 respirator is not required; standard surgical masks are sufficient if needed for droplet precautions.

E. Change gloves after contact with infectious material: Proper glove use and changing gloves after contact with fecal material or contaminated surfaces prevent cross-contamination and reduce the risk of spreading C. difficile to other clients or surfaces.

Rationale for correct choices

• an endoscopy: The client reports a 3-week history of gnawing, burning epigastric pain that radiates to the back, worsens after meals, and is accompanied by one episode of dark, tarry stool. These symptoms suggest a possible peptic ulcer or gastrointestinal bleeding. An endoscopy is the definitive diagnostic procedure to visualize the gastric mucosa, identify ulcers, and assess for bleeding.

• stool test results: The presence of a dark, tarry stool indicates possible gastrointestinal bleeding (melena). Stool testing, such as a fecal occult blood test, provides objective evidence of bleeding and guides the urgency and necessity of endoscopy. This finding is a key indicator for further gastrointestinal evaluation.

Rationale for incorrect choices

• oxygen via nonrebreather mask: The client’s respiratory assessment shows bilateral clear breath sounds and no signs of hypoxia. Oxygen therapy is not indicated based on current findings, as there is no respiratory compromise.

• an antifungal prescription: There is no evidence of fungal infection. The client’s symptoms are consistent with gastrointestinal pathology, not a fungal etiology. Prescribing an antifungal would be inappropriate without clinical or laboratory indications.

• respiratory rate: The respiratory rate is normal and does not correlate with the presenting gastrointestinal symptoms. It is not a primary indicator for diagnostic intervention in this case.

• temperature: The client does not report fever or signs of infection at this time. While monitoring temperature is standard, it is not a primary indicator for diagnosing peptic ulcer disease or gastrointestinal bleeding in this scenario.