A patient has a blocked bile duct from a tumor. The nurse can expect the patient's urine to be:
A) Dark amber and concentrated
B) Orange and foamy
C) Rust colored and concentrated
D) Pale yellow and dilute
Ans: B
Feedback: If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy.
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When a central nervous system stimulant such as Adderall is prescribed for a client who has attention-deficit hyperactivity disorder (ADHD), the nurse must instruct the client's parents to assess the medication's immediate effectiveness by
looking for: a. a paradoxical reaction b. improved grades at school c. increased activity level d. increased insomnia and decreased appetite
A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately?
A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention
In assessing a patient with a history of poliomyelitis, the nurse suspects the right leg muscles are smaller than the left leg. What is the best approach for the nurse to confirm or reject this suspicion?
a. Palpating both legs using the pads of the thumb and index fingers and comparing one side with another b. Using a tape to measure each leg's circumference at the same location, above or below the nearest joint c. Using a goniometer to measure the upper and lower legs with the patient in supine and standing positions d. Palpating the legs using the tips of the thumb and index fingers, and comparing the findings with the Lovett scale
During a home safety assessment, the nurse identifies a number of hazards. Of the following hazards that are noted by the nurse, which one represents the greatest risk for the patient with diabetic peripheral neuropathy?
a. Improper water heater settings b. Absence of smoke detectors c. Cluttered walkways d. Lack of bathroom grab bars