A client was admitted to the hospital with cholelithiasis the previous day. Which of the following new assessment findings indicates to the nurse that the stone has probably obstructed the common bile duct?
1. Nausea
2. Elevated cholesterol level
3. Right upper quadrant (RUQ) pain
4. Jaundice
4. Jaundice
Rationale:
Nausea and RUQ pain occur in cystic duct disease, but obstruction of the common bile duct results in reflux of bile into the liver, which produces jaundice. Alkaline phosphatase increases with biliary obstruction, but cholesterol level does not increase.
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Which actions violate the civil rights of a psychiatric patient? The nurse: You may select more than one answer
a. performs mouth checks after overhearing a patient say, "I've been spitting out my medication." b. begins suicide precautions before a patient is assessed by the health care provider. c. opens and reads a letter a patient left at the nurse's station to be mailed. d. places a patient's expensive watch in the hospital business office safe. e. restrains a patient who uses profanity when speaking to the nurse.
Which statement shows a nurse has empathy for a patient who made a suicide attempt?
a. "You must have been very upset to do what you did today." b. "It makes me sad to see you going through such a difficult experience." c. "If you tell me what is troubling you, I can help you solve your problems." d. "Suicide is a drastic solution to a problem that may not be such a serious matter."
Nursing students are in the laboratory practicing palpation. What would they learn about the best depth for moderate palpation?
A) ½ to 1 cm B) 1 to 2 cm C) 1 to 2½ cm D) 2 to 3 cm
Which statement best indicates use and abuse of power in a violent family situation?
a. "I admit I was mad and yelling and swinging my fists in the air, but I wasn't trying to hit our child. I was letting off some steam. My spouse just overreacted.". b. "When she found out I watched television instead of taking the kids to the park, she starting yelling about how I don't care about the kids. She has no right to get mad at me. I should have some time to myself.". c. "I thought he would like this new recipe. I should have known better. I will not do that again. He was right. He works all day and should come home to a good meal that he can enjoy. It's not too much to ask of a wife.". d. "All I did was tell him I need some money. I can't understand why he can't just give me what I need. I stay home and take care of his house and kids, and I have to almost beg before he gives me money to spend on myself.".