A nurse is caring for a client in an outpatient clinic. Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again. Nurses' Notes 12 weeks ago: Client presents to the provider's office with reports of epigastric discomfort. Client states discomfort usually goes away after eating. Abdomen round. distended. Client reports feelings of fullness. Bowel sounds hyperactive. Client reports bowel movement was 3 days ago, described as "round pebbles". Heart sounds regular, S1, S2. Skin turgor elastic. Client reports pain as 5 on the scale of 0 to 10. Vital Signs 12 weeks ago: Temperature 36.7° C (98.1° F) Heart rate 94/min Respiratory rate 20/min Blood pressure 106/72 mm Hg Oxygen saturation 98% on room air
Explanation & Rationale
Rationale for Correct Answers: Discomfort usually goes away after eating: This is a classic symptom of a duodenal ulcer. While eating temporarily buffers stomach acid, the discomfort returning later suggests a peptic ulcer issue, especially given the family history and frequent ibuprofen use. Client reports feelings of fullness: Combined with a distended abdomen, "fullness" (bloating) can indicate gastric outlet obstruction or significant inflammation related to H. pylori or ulcer disease. Bowel movement was 3 days ago, described as "round pebbles": This indicates constipation. In the context of epigastric pain, it is important to monitor for potential complications or to determine if the client's iron intake or medication use is affecting motility. Reports pain as 5 on the scale of 0 to 10: Any pain reported at a mid-to-high level (5/10) is a significant finding that requires a pain management plan and diagnostic workup to identify the underlying cause. Rationale for Incorrect Answers: Skin turgor elastic: This is a normal finding indicating adequate hydration. Temperature 36.7° C (98.1° F): This is within the normal range (afebrile). Heart rate 94/min: While on the higher end of normal (60–100 bpm), it is a stable finding in a client experiencing moderate pain. Blood pressure 106/72 mm Hg: This is a stable, normal blood pressure reading.