A nurse is transcribing new medication prescriptions for a group of clients. For which of the following prescriptions should the nurse contact the provider for clarification?

Rationale:

A. Crohn’s disease typically presents with chronic diarrhea (often with blood or mucus), weight loss, fever, abdominal cramping (often in the right lower quadrant), and possible perianal disease. The client in this case reports epigastric pain that improves with eating, which is not characteristic of Crohn’s disease. Additionally, there is no mention of systemic inflammatory symptoms or chronic diarrhea.

B. A duodenal ulcer commonly presents with epigastric pain that improves with food intake and returns several hours after eating or during periods of fasting (e.g., at night). The client’s use of frequent ibuprofen (a nonsteroidal anti-inflammatory drug) is a major risk factor because NSAIDs reduce gastric prostaglandin protection, increasing acid damage to the duodenal lining. Additional findings such as bloating, hyperactive bowel sounds, and constipation (“pebble-like” stools) may also be associated with gastrointestinal irritation and altered motility.

C. GERD typically presents with heartburn, regurgitation, sour taste in the mouth, and symptoms that worsen after eating or when lying down. The client’s pain improves with eating, which is opposite of the expected GERD pattern.

D. Pancreatitis typically presents with severe epigastric pain that radiates to the back, nausea, vomiting, and pain that worsens after eating (especially fatty foods). The client does not report radiating pain, vomiting, or systemic signs consistent with pancreatitis.

Rationale:

A. The client’s heart rate is 98/min, which is within the upper normal range. It may reflect mild anxiety, medication effects, or mild dehydration, but it is not critically abnormal and does not require immediate provider notification.

B. The client is taking clozapine, an atypical antipsychotic associated with a serious adverse effect: agranulocytosis (severe neutropenia). A sore throat can be an early sign of infection due to a dangerously low white blood cell count. This symptom must be reported immediately so that a CBC with differential can be obtained and the medication potentially held to prevent life-threatening infection.

C. The blood pressure is 102/56 mm Hg, which is mildly low but can be expected in clients taking antipsychotic medications like clozapine due to orthostatic hypotension. The client reports dizziness on position change, which is consistent with this known side effect and is managed with safety teaching and monitoring rather than urgent provider notification.

D. The client ate 75% of breakfast, which indicates adequate oral intake. Mild nausea and dry mouth are common side effects of clozapine and do not, in isolation, require provider notification unless they significantly worsen or lead to poor intake or dehydration.