The practical nurse shines a pen light over a client's pupil and observes the pupil constrict briskly. Which action should the PN take next?

Rationale:

A. Hemoglobin: Melena indicates upper gastrointestinal bleeding, which can result in significant blood loss. Monitoring hemoglobin levels allows the nurse to detect anemia and quantify the impact of blood loss on the client’s oxygen-carrying capacity. Decreasing hemoglobin is a critical marker for assessing the severity of bleeding and guiding interventions such as transfusion.

B. Blood urea nitrogen (BUN): While BUN can rise with gastrointestinal bleeding due to the digestion of hemoglobin, it is not as specific or immediate an indicator as hemoglobin. BUN elevation may provide supporting information but does not replace direct monitoring of hemoglobin for safety and treatment decisions.

C. White blood cells (WBC): WBC count reflects infection or inflammation but is not directly influenced by gastrointestinal bleeding. Monitoring WBC does not provide relevant information for assessing the acute consequences of melena.

D. Glucose: Blood glucose levels are unrelated to melena or gastrointestinal bleeding. Glucose monitoring is not indicated in this context unless the client has a comorbid condition such as diabetes that requires routine assessment.

Rationale:

A. Inspect the urethral meatus for discharge: Examining the urethral meatus is primarily indicated when infection or inflammation, such as urethritis, is suspected. While discharge could indicate a problem, the client’s main concern involves urinary hesitancy and nocturia, making this assessment less directly relevant.

B. Observe the scrotum for swelling: Scrotal inspection is important for conditions such as hydrocele or testicular masses. These findings are not typically associated with nocturia or difficulty initiating urination in older males, so this assessment would not provide focused information for the client’s current urinary symptoms.

C. Palpate the inguinal area for a bulge: Assessing the inguinal area can detect hernias, which may cause discomfort or urinary issues indirectly, but it does not address the primary complaints of urinary hesitancy and frequency, and is therefore not the most pertinent assessment.

D. Question client about urinary dribbling and frequency: Asking about urinary dribbling, frequency, and stream characteristics directly evaluates symptoms associated with benign prostatic hyperplasia or lower urinary tract obstruction. This focused history provides critical information to guide further assessment and intervention for the client’s nocturia and difficulty initiating urination.