Which of the following are critical steps a nurse should take when setting up a PCA pump for a postoperative patient? (Select all that apply.)

Choice A reason: Dyspepsia, or indigestion, is a common symptom of peptic ulcer disease. It reflects irritation of the gastric mucosa but is not life-threatening. While it contributes to discomfort and may guide diagnosis, it does not indicate an acute complication requiring immediate intervention.

Choice B reason: Epigastric discomfort is a hallmark symptom of peptic ulcer disease and often prompts clinical evaluation. However, it is a subjective symptom and not necessarily indicative of a complication. It lacks the urgency associated with signs of active bleeding or perforation.

Choice C reason: Hematemesis, or vomiting blood, is a sign of gastrointestinal bleeding and represents a potentially life-threatening complication of peptic ulcer disease. It requires immediate intervention to stabilize the patient, assess hemodynamic status, and initiate diagnostic and therapeutic procedures such as endoscopy. This finding takes priority due to the risk of hypovolemic shock and further deterioration.

Choice D reason: Constipation is not typically associated with peptic ulcer disease and may be related to other factors such as diet, medications, or decreased mobility. It does not represent a priority concern in the context of ulcer complications.

Choice A reason: Having a pacemaker is not a contraindication for kidney transplantation. Many transplant candidates have cardiac devices due to comorbid conditions. As long as cardiac function is stable and the patient meets other criteria, they may be eligible for transplant.

Choice B reason: Age alone is not a contraindication. While older age may increase surgical risk and affect recovery, many transplant centers evaluate candidates based on overall health, functional status, and comorbidities rather than age alone. A 65-year-old can be a viable candidate if otherwise healthy.

Choice C reason: Active alcohol use disorder is a contraindication for kidney transplantation. Substance abuse can impair adherence to post-transplant immunosuppressive therapy, increase risk of complications, and affect long-term outcomes. Candidates must demonstrate sustained sobriety and commitment to treatment protocols.

Choice D reason: A history of breast cancer with a 9-year disease-free interval is not a contraindication. Most transplant programs require a cancer-free period (often 2–5 years) before listing. A 9-year remission suggests low recurrence risk and acceptable transplant candidacy.