A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
A. Yellow sclera
B. Light amber urine
C. Circumoral pallor
D. Black, tarry stools
Correct Answer: A. Yellow sclera
Yellow sclera may be the first sign of jaundice, which occurs when the common bile duct is obstructed. Jaundice can be a sign of a common bile duct obstruction from an entrapped gallstone. In the presence of jaundice and abdominal pain, often, a procedure is an indication to go and retrieve the stone to prevent further sequelae.
Option B: Urine normally is light amber. Usually, patients with symptoms from gallstones present with right upper abdominal pain after eating greasy or spicy foods. There is often nausea and vomiting. Pain can also be present in the epigastric area that radiates to the right scapula or mid-back.
Option C: Circumoral pallor doesn’t occur in common bile duct obstruction; it is a sign of hypoxia, respectively. The classic physical exam finding is a positive Murphy’s sign, where the pain is elicited on deep palpation to the right upper quadrant underneath the rib cage upon deep inspiration.
Option D: Black, tarry stools don’t occur in common bile duct obstruction; they are signs of GI bleeding. Progression of this condition is indicated by neurologic changes and hypotension (Reynold’s pentad). Other sequelae are acute pancreatitis with symptoms of midepigastric pain and intractable vomiting.
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