An elderly client comes to the emergency department with his wife. He has a history of peptic ulcer disease (PUD), and is currently experiencing confusion and severe headaches. What does the best plan by the nurse include?
1. Ask the client if he has experienced any head injuries recently.
2. Obtain a complete blood count (CBC), chemistry profile, and urine drug screen.
3. Ask the client's wife for a list of medications that the client has taken.
4. Obtain a magnetic resonance imaging (MRI) exam to assess if the client has experienced a stroke.
Correct Answer: 3
Rationale 1: Since the client has PUD, it would be logical to ask about medication prior to asking about injury.
Rationale 2: A complete blood count (CBC), chemistry profile, and urine drug screen are worthwhile tests, but the first priority for a client with a history of peptic ulcer disease (PUD) should be to find out what medications he has been taking.
Rationale 3: There is a known correlation between H2-receptor antagonists and confusion and headaches in the elderly population; the nurse should ascertain what medications the client is taking.
Rationale 4: It is premature to obtain a magnetic resonance imaging (MRI) exam until other causes have been ruled out.
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