A nurse in a clinic is reviewing the home medications of client who has a history of asthma, and who is at the clinic to have a routine annual physical. Which statement made by the patient would indicate a need for further action by the nurse?

A. Casts in the urine are typically associated with kidney problems, such as glomerulonephritis or kidney infections, rather than biliary obstruction. Casts are formed from proteins or cells in the renal tubules and are not related to bile duct obstruction or cholelithiasis.
B. Dark, tarry stools are indicative of upper gastrointestinal bleeding and the presence of digested blood in the stool. This condition, known as melena, is not typically associated with obstruction of the common bile duct due to cholelithiasis.
C. Jaundice is a common and significant finding in cases of obstruction of the common bile duct due to cholelithiasis. When the bile duct is obstructed, bilirubin, which is a component of bile, accumulates in the bloodstream because it cannot be properly excreted into the intestine.
D. Pain from cholelithiasis (gallstones) typically occurs in the right upper quadrant, not the left. The right upper quadrant pain is often associated with gallbladder inflammation or bile duct obstruction.

A. Automatically switching to liquid nutrition without assessing the client’s tolerance and needs may not be the most appropriate first step. It’s important to consider the client’s preferences, nutritional requirements, and overall ability to tolerate different types of food.
B. This is a highly appropriate and commonly recommended intervention for clients experiencing nausea and weight loss due to chemotherapy. Small, frequent meals can help manage nausea better than large meals and ensure a more consistent intake of calories and nutrients.
C. Eating one large meal per day is generally not advisable for clients with nausea, as it can exacerbate feelings of fullness and discomfort. Large meals may increase nausea and make it more difficult for the client to consume adequate nutrients. Small, frequent meals are generally better tolerated and more effective for managing nausea and ensuring consistent nutrient intake.
D. Inserting a nasogastric (NG) tube and administering tube feedings is a more invasive measure and is usually considered only if oral intake is severely compromised and other interventions have been ineffective. Tube feedings are appropriate for clients who cannot meet their nutritional needs through oral intake due to severe nausea, vomiting, or other conditions.