A patient admitted to the unit for dehydration tells the nurse that he has not had a bowel movement in 5 days, and he typically has one daily. The nurse administers psyllium (Metamucil) as ordered and should monitor the patient for
a. bright red stools.
b. black, tarry stools.
c. pale, clay-colored stools.
d. intestinal obstruction.
D
Bulk-forming laxatives can cause an intestinal obstruction or impaction if not enough water is consumed. The patient needs concurrent rehydration to prevent this.
Bright red stools would not be anticipated unless the patient has hemorrhoids, and there is no indication of this.
Black, tarry stools typically are seen if blood is present in the stool, no information suggests that the patient has gastrointestinal bleeding.
Pale, clay-colored stools may be apparent if the patient has a hepatic disorder, but no information suggests this.
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A client has been treated with a cardiac glycoside and diuretics for congestive heart failure (CHF). The nurse determines that the treatment has been successful when the client experiences:
1. An increase in energy level. 2. Clear lung sounds. 3. Improved level of consciousness. 4. Weight loss.
One purpose of "Nurse Retention, Transfer, and Migration," the position statement by the International Council of Nurses, was to address nurses' ____
a. Benefits b. Rights c. Salaries d. Working hours
A nurse is preparing to discharge a postpartum client. The nurse notes on her chart that she is nonimmune to rubella. The nurse:
1. Administers a rubella vaccine prior to discharge. 2. Instructs the client to obtain a rubella vaccine after 1 month has elapsed. 3. Charts this information in the discharge summary notes. 4. Takes no action because none is needed.
The most helpful finding in determining left-sided heart failure is:
a. dyspnea. b. orthopnea. c. jugular vein distention. d. an S3 heart sound.