A client is admitted to the hospital with serious, practically painless gastrointestinal bleeding requiring emergency upper GI endoscopy and blood transfusions. A large peptic ulcer is found in the duodenum

Question

Which of the following details of the client's history is likely the cause? 1. The client is allergic to penicillin and morphine sulfate.
2. The client has been taking ibuprofen for bursitis for the past month and is also being treated with warfarin (Coumadin) for chronic atrial fibrillation.
3. The client has a 2-year history of chronic atrial fibrillation.
4. The client underwent outpatient cataract extraction with lens implant 6 weeks earlier.

Answer 1

2. The client has been taking ibuprofen for bursitis for the past month and is also being treated with warfarin (Coumadin) for chronic atrial fibrillation.

Rationale:
Clients who are taking high doses of NSAIDs, such as ibuprofen, and anticoagulants, such as warfarin, are predisposed to developing large ulcers that do not cause pain. The first symptom the client often experiences is a significant bleeding episode. Concurrent use of NSAIDs and anticoagulants should be avoided. The allergy to penicillin and morphine sulfate, history of atrial fibrillation, and recent eye surgery are not relevant to the client's bleeding incident.