An older adult client is admitted to the medical unit because of a loss of appetite and generalized malaise. To analyze the client's general nutritional status, which laboratory value is most important for the nurse to review?

Rationale:
A. Apex of the heart at left fifth intercostal space at the midclavicular line: The apex of the heart is the best site for auscultating the mitral valve and detecting abnormal heart sounds such as murmurs or extra beats. Palpitations described when lying on the left side suggest that subtle cardiac abnormalities might be most prominent at the apex.

B. Base of the heart at second intercostal space, right of the sternal border: This area is used to auscultate the aortic valve. While important in cardiac assessment, it is less likely to reveal abnormalities related to palpitations originating from left-sided cardiac activity.

C. Left third intercostal space, left lateral sternal border: This location is the best for auscultating the tricuspid valve and certain murmurs, but for palpitations described in the left lateral position, the apex is a more targeted and sensitive site for assessment.

D. Second intercostal space, left of the sternal border: This site is used to auscultate the pulmonic valve. It does not best capture mitral valve or left ventricular activity, which are more likely sources of palpitations when lying on the left side.

Rationale:
A. Heartburn occurs when lying down at night: Lying flat increases intra-abdominal pressure and reduces gravity’s assistance in keeping stomach contents from refluxing into the esophagus. Nighttime heartburn is a classic symptom of gastroesophageal reflux disease (GERD) and is important for the nurse to further assess when evaluating the client’s condition.

B. Small frequent meals cause heartburn to worsen: Small, frequent meals are generally recommended for clients with GERD to reduce gastric distention and minimize reflux episodes. Worsening heartburn after small meals would not be typical and suggests another gastrointestinal issue rather than straightforward reflux.

C. Hyperactive bowel sounds are present in all quadrants: Hyperactive bowel sounds are more commonly associated with gastrointestinal disorders like diarrhea or early bowel obstruction, not GERD. GERD primarily affects the esophagus and upper gastric system without typically altering bowel sound patterns.

D. Bowel movements are light grey and chalky: Light grey or chalky stools indicate possible biliary obstruction or liver dysfunction, not gastroesophageal reflux. GERD symptoms are primarily upper gastrointestinal in nature and do not typically affect the color or characteristics of bowel movements.