A nurse is obtaining a client's vital signs. Which of the following findings should the nurse report to the charge nurse?

• 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. Open curtains between clients in semiprivate rooms. Keeping curtains closed between clients helps reduce noise, light, and distractions, promoting a more restful environment. Open curtains can increase disturbances and compromise privacy.
B. Wear shoes with rubber soles. Rubber-soled shoes help minimize noise from footsteps, reducing disruptions to clients' sleep. Hard-soled shoes can create unnecessary noise, contributing to environmental stressors in an acute care setting.
C. Conduct change-of-shift report near the clients' rooms. Shift reports should be conducted away from client rooms to limit noise exposure. Conversations near sleeping clients can be disruptive, reducing sleep quality and contributing to stress.
D. Turn on overhead lights briefly when checking IV lines. Bright overhead lighting can disturb clients' sleep. Using a flashlight or dim bedside lighting is a better approach to minimize disruptions while ensuring safe IV checks.