Biliary Disorders

A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the BEST answer the nurse can give? A) 3-5 months B) 6-12 months C) 1-2 months D) 6-8 months

B) 6-12 months

The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator? A) Serum calcium B) Serum lipase C) Serum bilirubin D) Serum amylase

B) Serum lipase

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A) Appendicitis B) Peptic ulcer C) Pancreatitis D) Cholecystitis

C) Pancreatitis

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? A) Muscle pain related to referred pain manifestations B) Tetany related to hypercalcemia C) Tetany related to hypocalcemia D) Muscle spasm related to hypokalemia

C) Tetany related to hypocalcemia

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is MOST common in the client with chronic pancreatitis? A) Diarrhea B) Fatigue C) Weight loss D) Hypertension

C) Weight loss

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A) Black, tarry stools B) Circumoral pallor C) Yellow sclerae D) Light amber urine

C) Yellow sclerae

T or F: Gallstones, composed predominantly of pigment, account for 75% of all cases of gallbladder diseases in the United States.

False

Pancreatic enzymes include amylase, which aids in the digestion of carbohydrates; _____, which aids in the digestion of proteins; and lipase, which aids in the digestion of fats.

Trypsin

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is MOST appropriate for a client with this diagnosis? A) Withholding all oral intake, as ordered, to decrease pancreatic secretions B) Administering meperidine, as ordered, to relieve severe pain C) Limiting I.V. fluids, as ordered, to decrease cardiac workload D) Keeping the client supine to increase comfort

A) Withholding all oral intake, as ordered, to decrease pancreatic secretions

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? A) Tetany B) Pancreatic necrosis C) Shock D) MODS

B) Pancreatic necrosis

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? A) Potassium B) Oral bile acids C) Vitamin K D) Vitamin B

C) Vitamin K

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? A) Disturbed body image B) Nausea C) Anxiety D) Impaired nutrition: less than body requirements

D) Impaired nutrition: less than body requirements

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? A) Measure abdominal girth every shift B) Monitor for reports of nausea and vomiting C) Auscultate the abdomen for bowel sounds every 4 hours D) Measure blood glucose concentration every 4 to 6 hours

D) Measure blood glucose concentration every 4 to 6 hours

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A) Gastric ulcer B) Cholecystitis C) Appendicitis D) Pancreatitis

D) Pancreatitis

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? A) Encourage the client to deep breathe and cough. B) Encourage the client to ambulate frequently. C) Instruct the client on the proper use of an incentive spirometer. D) Place the client in semi-Fowler's position.

D) Place the client in semi-Fowler's position.

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for? A) Ultrasonography B) Oral cholecystography C) Cholecystography D) Xray

A) Ultrasonography

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? A) Maintaining nothing-by-mouth (NPO) status B) Administering morphine I.V. as ordered C) Providing mouth care D) Placing the client in a semi-Fowler's position

B) Administering morphine I.V. as ordered

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? A) Protein digestion B) Carbohydrate digestion C) Protein synthesis D) Fat digestion

B) Carbohydrate digestion

Clinical manifestations of common bile duct obstruction include all of the following except: A) Clay-colored feces B) Pruritis C) Light-colored urine D) Jaundice

C) Light-colored urine

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? A) Weight loss B) Hypertension C) Warm, dry skin D) Bile-stained vomiting

D) Bile-stained vomiting

A client with calculi in the gallbladder is said to have: A) Choledocholithiasis B) Cholecystitis C) Choledochotomy D) Cholelithiasis

D) Cholelithiasis

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? A) Ingestion of foods high in sugar B) Inability for the liver to reabsorb serum glucose C) Renal failure D) Dysfunction of the pancreatic islet cells

D) Dysfunction of the pancreatic islet cells

The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: A) Serum amylase B) Serum bilirubin C) Serum calcium D) Serum lipase

D) Serum lipase

The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is: A) Severe abdominal pain B) Mental agitation C) Jaundice D) Fever

A) Severe abdominal pain

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? A) Serum bilirubin B) Serum calcium C) Serum amylase D) Serum potassium

C) Serum amylase

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? A) To reduce gastric and pancreatic secretions B) To decrease metabolism C) To relieve nausea and vomiting D) To depress the central nervous system and increase the pain threshold

A) To reduce gastric and pancreatic secretions

Which is a clinical manifestation of cholelithiasis? A) Epigastric distress before a meal B) Abdominal pain in the upper left quadrant C) Clay-colored stools D) Nonpalpable abdominal mass

C) Clay-colored stools

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? A) Self-digestion of the pancreas by its own proteolytic enzymes B) Use of loop diuretics to increase the incidence of pancreatitis C) Calcification of the pancreatic duct, leading to its blockage D) Fibrosis and atrophy of the pancreatic gland

A) Self-digestion of the pancreas by its own proteolytic enzymes

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? A) Performing range-of-motion (ROM) leg exercises hourly while the client is awake B) Assisting the client to turn, cough, and deep breathe every 2 hours C) Assisting the client to ambulate the evening of the operative day D) Teaching the client to choose low-fat foods from the menu

B) Assisting the client to turn, cough, and deep breathe every 2 hours

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? A) Decreased WBC count B) Elevated urine amylase levels C) Increased serum calcium levels D) Decreased liver enzyme levels

B) Elevated urine amylase levels

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? A) Placing the patient in the prone position B) Frequent changes of positions C) Perform chest physiotherapy D) Suction the patient every 4 hours

B) Frequent changes of positions

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: A) Cystic duct B) Gallbladder C) Duodenum D) Common bile duct

B) Gallbladder

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? A) Monitor pulse oximetry every hour. B) Reposition the client every 2 hours. C) Withhold oral feedings for the client. D) Instruct the client to avoid coughing.

B) Reposition the client every 2 hours.

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? A) CT B) US C) MRI D) ERCP

D) ERCP

A nurse is caring for a client in the emergency department who is reporting severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value indicates further investigation? A) Elevated serum glucose level B) Decreased calcium C) Elevated WBC count D) Elevated troponin

D) Elevated troponin

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the HIGHEST priority? A) Developing no acute complications from the pancreatitis B) Maintaining normal respiratory function C) Achieving adequate fluid and electrolyte balance D) Maintaining satisfactory pain control

B) Maintaining normal respiratory function

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? A) Increases in the rate of pancreatic secretion B) Increases in the bicarbonate output by the kidneys C) Decreases in the physiologic function of major organs D) Development of local complications

C) Decreases in the physiologic function of major organs

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? A) Excess fluid volume B) Ineffective gastrointestinal tissue perfusion C) Deficient fluid volume D) Decreased cardiac output

C) Deficient fluid volume

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? A) "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." B) "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." C) "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." D) "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use."

A) "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? A) Pancreatitis can elevate the diaphragm and alter the breathing pattern. B) Pancreatitis causes alterations to hemoglobin, impairing oxygenation. C) Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. D) Pancreatitis can atrophy the diaphragm and alter the breathing pattern.

A) Pancreatitis can elevate the diaphragm and alter the breathing pattern.

A client recovers from an episode of gallbladder inflammation and the client's diet is advanced from a low-fat liquid diet. Which meals will the nurse recommend to the client? (Select all that apply.) A) Egg salad sandwich with low fat mayonnaise and a side salad with ranch dressing. B) Marinated lean steak, steamed rice, and roasted zucchini. C) Roasted chicken, mashed potatoes, and green beans. D) Oatmeal with a cooked fruit compote and hot tea. E) Vegetable lasagna, bread sticks, and steamed broccoli.

B) Marinated lean steak, steamed rice, and roasted zucchini. C) Roasted chicken, mashed potatoes, and green beans. D) Oatmeal with a cooked fruit compote and hot tea.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? A) Administering an analgesic once per shift, as ordered, to prevent drug addiction B) Positioning the client on the side with the knees flexed C) Administering frequent oral feedings D) Encouraging frequent visits from family and friends

B) Positioning the client on the side with the knees flexed

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? A) Maintaining adequate nutritional status B) Relieving abdominal pain C) Preventing fluid volume overload D) Teaching about the disease and its treatment

B) Relieving abdominal pain

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? A) Low-carbohydrate, high-potassium diet B) High-carbohydrate, high-protein, low-fat diet C) High-carbohydrate, low-protein, low-fat diet D) Low-sodium, high-potassium, low-fat diet

C) High-carbohydrate, low-protein, low-fat diet

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? A) Maintaining a high-Fowler's position B) Administering oral analgesics around the clock C) Provide intensive insulin therapy D) Allowing a clear liquid diet during the acute phase

C) Provide intensive insulin therapy

A client who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25-pound weight loss in the past year. The nurse attributes which factor as the most likely cause of this weight loss? A) Vomiting after heavy meals B) Ingesting a low-fat diet to prevent abdominal pain C) Skipping meals out of fear of painful attacks D) Malabsorption

C) Skipping meals out of fear of painful attacks

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient? A) The patient is developing a paralytic ileus. B) The patient has developed renal failure. C) The patient has developed peritonitis. D) The patient requires more pain medication.

C) The patient has developed peritonitis.

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? A) To prevent the occurrence of fibrosis B) To aid opening up of pancreatic duct C) To avoid inflammation of the pancreas D) To drain the pancreatic bed

C) To avoid inflammation of the pancreas

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the MAJOR causes of chronic pancreatitis? A) Alcohol consumption and smoking B) Acute hepatitis and alcohol consumption C) Malnutrition and acute pancreatitis D) Caffeine consumption and acute pancreatitis

A) Alcohol consumption and smoking

Which foods should be avoided following acute gallbladder inflammation? A) Cheese B) Cooked fruits C) Mashed potatoes D) Coffee

A) Cheese

The nurse cares for a client with gallstones that need to be removed but is not a surgical candidate or endoscopic candidate. What procedure does the nurse recognize as being a possible treatment option for the client? A) ESWL B) T-tube insertion C) ERCP D) Transnasal biliary catheter insertion

A) ESWL

Severe _____ pain is the major symptom of pancreatitis that causes the patient to seek medical care.

Abdominal

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? A) 70 mg/dL B) 30 mg/dL C) 90 mg/dL D) 50 mg/dL

B) 30 mg/dL

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? A) Pleural effusion B) Disseminated intravascular coagulopathy C) Edema and inflammation D) Sepsis

C) Edema and inflammation

A laparoscopic _____ is the standard therapy for symptomatic gallstones.

Cholecystectomy

The major stimulus for digestive enzyme secretion is the hormone _____, which acts by stimulating the gallbladder to contract.

Cholecystokinin

The nurse knows that the serum amylase concentration returns to normal within which time frame? A) 12 hr B) 24 hr C) 36 hr D) 48 hr

D) 48 hr

Which enzyme aids in the digestion of fats? A) Trypsin B) Amylase C) Secretin D) Lipase

D) Lipase

The patient with chronic pancreatitis often has frequent, frothy, foul smelling stools, a condition known as _____.

Steatorrhea

T or F: Acute pancreatitis presents with fever, jaundice, confusion, agitation, and abdominal guarding.

True

T or F: The endocrine functions of the pancreas include secretion of insulin, glucagon, and somatostatin directly into the bloodstream.

True

T or F: Zollinger-Ellison is characterized by tumors of the islets of Langerhans that result in hypersecretion of gastric acid.

True

Which is a gerontological consideration associated with the pancreas? A) Increased amount of fibrous material B) Increased calcium absorption C) Increased rate of pancreatic secretion D) Increased bicarbonate output

A) Increased amount of fibrous material

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? A) Muscle twitching and finger numbness B) Hypotension C) Paralytic ileus and abdominal distention D) Elevated blood glucose concentration

A) Muscle twitching and finger numbness

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? A) 6-12 B) 1-2 C) 3-5 D) 13-18

A) 6-12

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? A) Acute pain related to biliary spasms B) Deficient knowledge related to prevention of disease recurrence C) Imbalanced nutrition: Less than body requirements related to biliary inflammation D) Anxiety related to unknown outcome of hospitalization

A) Acute pain related to biliary spasms

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? A) Frequent vomiting, leading to loss of fluid volume B) High glucose concentration in the blood C) Dry mouth, which makes the client thirsty D) Acetone in the urine

A) Frequent vomiting, leading to loss of fluid volume

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? A) Pain with abdominal distention and hypotension B) Presence of blood in the client's stool and recent hypertension C) Adventitious breath sounds and hypertension D) Presence of easy bruising and bradycardia

A) Pain with abdominal distention and hypotension

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? A) Reserving an antecubital site for a peripherally inserted central catheter (PICC) B) Providing the client with plenty of P.O. fluids C) Providing generous servings at mealtime D) Limiting I.V. fluid intake according to the physician's order

A) Reserving an antecubital site for a peripherally inserted central catheter (PICC)

What is a major concern for the nurse when caring for a patient with chronic pancreatitis? A) Pain B) Weight loss C) Nausea D) Mental status change

B) Weight loss

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because they: A) Can digest high-fat foods. B) Cannot tolerate a high glucose concentration. C) Are at risk for hepatic encephalopathy. D) Are at risk for gallbladder contraction.

B) Cannot tolerate a high glucose concentration.

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? A) 1-4 months B) 4-6 months C) 6-12 months D) Over 1 year

C) 6-12 months

A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply). A) Elevated lipase level B) Hypoglycemia C) An abnormal glucose tolerance D) Hyperglycemia E) Glucosuria

C) An abnormal glucose tolerance D) Hyperglycemia E) Glucosuria

T or F: Pancreatic carcinoma has only a 5% survival rate at 5 years regardless of the stage of the disease at diagnosis or treatment.

False

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? A) "The tube provides relief from nausea and vomiting." B) "The tube helps control fluid and electrolyte imbalance." C) "The tube allows toxins to be removed." D) "The tube allows the gastrointestinal tract to rest."

D) "The tube allows the gastrointestinal tract to rest."