A nurse on a medical-surgical unit is caring for four patients who are 24 to 36 hours postoperative. Which of the following surgical procedures places the patient at risk for deep-vein thrombosis?

Choice A rationale
If a client reports chills and back pain during a blood transfusion, and their blood pressure is 80/64 mm Hg, the nurse’s first action should be to stop the infusion of blood. These symptoms could indicate an acute intravascular hemolytic transfusion reaction, and the greatest risk to the client is injury from receiving additional blood.

Choice B rationale
Notifying the laboratory is an important step in managing a transfusion reaction, but it is not the first action that should be taken.
Choice C rationale
Obtaining a urine specimen could be part of the overall assessment of the client’s condition, but it is not the first action that should be taken when a client is experiencing a potential transfusion reaction.
Choice D rationale
Informing the provider is an important step when a client is experiencing a reaction to a blood transfusion, but it is not the first action that should be taken.

Choice A rationale
While liver issues can be a concern with certain medications or diseases, they are not typically associated with GERD. GERD is a digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach. Therefore, monitoring for liver issues would not be directly relevant to a patient with GERD.
Choice B rationale
Pancreatic cancer is a serious condition, but it is not directly related to GERD. GERD is primarily an issue of the esophagus and stomach, not the pancreas. While it’s always important to be vigilant about potential health issues, there is no specific reason for a patient with GERD to watch for manifestations of pancreatic cancer.
Choice C rationale
While diabetes is a significant health concern, it is not directly linked to GERD. GERD does not increase the risk for diabetes. An endocrinologist specializes in hormonal disorders, including

diabetes, but would not typically be involved in the management of GERD unless there were other co-existing endocrine issues.
Choice D rationale
This is the correct answer. Barrett’s esophagus is a condition that can develop in people who have long-term GERD. It changes the color and composition of the esophagus lining, which can increase the risk of esophageal cancer. Therefore, it is important for patients with long-term GERD symptoms to follow up with a GI specialist for recommended surveillance for Barrett’s esophagus.