It is most important for the practical nurse (PN) to observe for which complication when caring for a client who had a long bone fracture repaired yesterday?

Choice A reason: Hematemesis, or vomiting of blood, is a critical symptom to monitor in a client with esophageal varices. Esophageal varices are enlarged veins in the esophagus that can rupture and bleed due to increased pressure in the portal venous system, a common complication of cirrhosis. Hematemesis indicates a potentially life-threatening variceal bleed that requires immediate medical intervention. Reporting this finding promptly ensures that the healthcare team can take swift action to manage the bleeding and stabilize the client.
Choice B reason: Anorexia, or loss of appetite, is a common symptom in clients with chronic liver disease, including cirrhosis. While it is important to address nutritional concerns, anorexia does not directly indicate a life-threatening complication like variceal bleeding. Monitoring for anorexia is essential for overall health and nutritional support, but it is not the most immediate concern in this scenario.
Choice C reason: Clay-colored stools can indicate a lack of bile in the stool, which may occur due to biliary obstruction or impaired bile flow. While this finding is significant and requires attention, it is not as urgent as hematemesis in the context of esophageal varices. Clay-colored stools may suggest other complications related to liver function but do not indicate an immediate life-threatening situation.
Choice D reason: Brown, foamy urine may indicate the presence of blood or protein in the urine, which can occur in various kidney and urinary tract disorders. While this finding is important to monitor, it is not directly related to esophageal varices or their complications. The primary concern with esophageal varices is the risk of bleeding, which is best indicated by hematemesis.

Choice A reason: Commending the client for ensuring an adequate source of vitamin C in the diet is not the best response. While vitamin C is important for overall health, it does not directly impact bone density. The client's focus on orange juice may stem from a misunderstanding of the nutrients that are critical for bone health, such as calcium and vitamin D. A better approach would be to address the specific nutrients that support bone density and clarify any misconceptions.
Choice B reason: Advising the client of the need to remain NPO (nothing by mouth) until the test is completed is not necessary for a bone density test. Bone density tests, such as dual-energy X-ray absorptiometry (DEXA) scans, do not require the client to fast beforehand. Providing this advice would be incorrect and could cause unnecessary concern or confusion for the client.
Choice C reason: Determining if the client drinks orange juice that has been fortified with calcium is a helpful step, but it does not address the immediate need to correct the client's misunderstanding about the purpose of the bone density test. While calcium-fortified orange juice can be beneficial for bone health, the priority should be to ensure the client has accurate information about the test they are undergoing.
Choice D reason: Correcting the client's misunderstanding of the purpose of bone density testing is the most appropriate response. The primary goal of a bone density test is to measure the density of the bones and assess the risk of fractures, not to diagnose or confirm the presence of osteoporosis. By providing clear and accurate information about the test, the practical nurse can help the client understand its purpose and alleviate any misconceptions. This response also opens the door for further education on managing osteoporosis and ensuring the client is receiving the necessary nutrients for bone health.