CH 54

When caring for a patient diagnosed with pancreatic cancer, the nurse understands that the course of treatment will be guided by which of the following? A. Physician preference B. Biopsy results C. The degree of metastasis D. Analgesia for pain control

B

Which complication in a client with acute necrotizing pancreatitis who develops a temperature spike to 104°F (40°C) will the nurse suspect? A. Pancreatic pseudocyst B. Pancreatic abscess C. Chronic pancreatitis D. Pancreatic cancer

B

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to immediately contact the primary health care provider? a. Drainage from a fistula b. Diminished bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

A

For which of the following patients would the nurse anticipate extracorporeal shock wave lithotripsy for removal of gallstones? A. A client with a history of cholesterol based gallstones B. A morbidly obese client C. A client with minimal ejection on HIDA scan D. A client with acalculous cholecystitis

A

In which position will the nurse place a client after an open Whipple procedure for treatment of pancreatic cancer? A. Semi-Fowler position to reduce tension on the suture line B. Prone position to prevent acute respiratory distress syndrome C. Left lateral Sims' position with knees drawn up to the chest to reduce pain D. Right lateral Sims' position with knees drawn up to the chest to reduce pain

A

The nurse is caring for a client who had a Whipple surgical procedure yesterday. For what serum laboratory test results would the nurse want to monitor frequently and carefully? A. Blood glucose B. Blood urea nitrogen C. Phosphorus D. Platelet count

A

The nurse is caring for a client who states that her mother had "gallbladder problems" and wonders if she is at risk for this disorder. What major risk factor places women most at risk for gallbladder disease? A. Obesity B. Birth control pills C. Infertility D. Advanced age

A

The preceptor asks the nursing student why Morphine is prescribed for the patient undergoing HIDA scan. What is the student's best response? A. To increase gallbladder visualization B. To control acute abdominal pain C. To improve pulmonary perfusion D. To slow the patient's respiratory rate

A

What is the nurse's priority action when caring for a client with acute cholecystitis who now has severe abdominal pain, diaphoresis, heart rate of 118 beats/min, BP 95/70, respirations 32 breaths/min, and temperature 101°F (38.3°C)? A. Initiating the Rapid Response Team B. Assisting the client to a semi-Fowler position C. Administering the prescribed opioid analgesic D. Auscultating the client's abdomen in all four quadrants

A

Which action will the nurse take first when an 80-year-old client with acute pancreatitis has no breath sounds in the left lower lung lobe? A. Apply oxygen. B. Assess the breath sounds on the right. C. Notify the primary health care provider. D. Document the finding as the only action.

A

Which actions and precautions will the nurse educate a client with chronic pancreatitis about when starting pancreatic enzyme replacement therapy (PERT)? Select all that apply. A. Do not crush or chew the capsules. B. Take these drugs with all meals and snacks. C. Sit in an upright position for at least 30 minutes after taking the drug. D. Wear sunscreen and protective clothing outdoors to prevent severe sunburn. E. Check your stools for amount and presence of fat to assess whether the drugs are working. F. If you are too nauseated to eat or to take the drug, go to an emergency department for an injectable form of the drug.

ABE

The nurse is caring for a female patient with acute cholecystitis. Which statement by the patient indicates an urgent need for further teaching? A. "The pain is a symptom of the bile from my liver being obstructed by stones." B. "I'm not concerned. Gallbladder attacks happen everyday to someone. It's not like it can hurt me." C. "I have been on a high fiber, low fat diet, and drink plenty of water." D. "I understand I can have my gallbladder removed with no visible scars at all."

B

The nurse is preparing and SBAR report to alert the provider of suspected pancreatitis. Which of the following is a symptom associated with acute pancreatitis? A. Intermittent epigastric pain that improves when lying flat. B. constant gnawing mid-abdomen pain that is worse while lying supine C. Right upper quadrant pain accompanied by severe nausea D. Retro peritoneal pain in the lower back and flanks

B

Which fluid and electrolyte balance assessment action will the nurse perform most often for a client with pancreatic cancer after surgery with a traditional Whipple procedure? A. Using a reflex hammer to check deep tendon reflexes B. Pinching up skin over the sternum and checking for tenting C. Applying a blood pressure cuff and assessing for a Trousseau sign D. Asking the client whether he or she has noticed tingling or numbness around the mouth

B

The nurse is teaching a preoperative client who is scheduled for a laparoscopic cholecystectomy ("lap chole"). What statement by the client indicates a need for further teaching? A. "I will likely need oral pain medications for the first few days after my surgery." B. "I should only be hospitalized for 2 to 3 days after my surgery." C. "I will probably not be at risk for complications from this surgery." D. "I should be able to go back to work in the next week or so."

B

A client has an external percutaneous transhepatic biliary catheter inserted for a biliary obstruction. What health teaching about catheter care would the nurse provide for the client? a. "Cap the catheter drain at night to prevent leakage and skin damage." b. "Position the drainage bag lower than the catheter insertion site." c. "Irrigate the catheter with an ounce of saline every night." d. "Pierce a hole in the top of the drainage bag to get rid of odors."

B

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

B

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Assist the client to assume a position of comfort. B. Administer opioid analgesic medication. C. Do not administer food or fluids by mouth. D. Measure intake and output every shift.

B

Which nursing assessment has the highest priority for the nurse to perform on a client admitted in severe pain with acute pancreatitis? A. Asking the client to rate the level of pain B. Measuring heart rate, blood pressure, and oxygen saturation C. Auscultating bowel sounds in all four abdominal quadrants D. Determining the amount of alcoholic beverages the client consumes daily

B

Which of the following anastomosis is not included in the Whipple procedure? A.Choledochojejunostomy B. Hepaticojejunostomy C. Pancreatojejunostomy D. Gastrojejunostomy

B

While reading a physician's note, the nurse understands that the patient grimaced on palpation of the right upper abdomen during inspiration. Which of the following terms describe this impression? A. (+) Ker's sign B. (+) Murphy's sign C. (+) Cullen's sign D. (+) Blumberg's sign

B

Which clients will the nurse recognize as having a higher risk for development of acute pancreatitis? Select all that apply. A. 26-year-old woman who is a marathon runner B. 34-year-old man with Stage II HIV disease C. 40-year-old woman who has had cholelithiasis for 3 years D. 56-year-old man who drinks alcohol heavily and is underweight E. 62-year-old woman with gastroesophageal reflux disease F. 70-year-old man who has type 2 diabetes

BCD

A nurse assesses a client who is recovering from an open traditional Whipple surgical procedure. Which assessment finding(s) alert(s) the nurse to a complication from this surgery? (Select all that apply.) a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

BCDE

A client is preparing to have a hepatobiliary scan (HIDA scan). What health teaching would the nurse include about what the client can expect during the test? A. "This test measures how inflamed your gallbladder and liver may be." B. "You may eat and drink as much as you'd like before you have this test." C. "You will have to lie still for some time while the camera is very close to your body." D. "I need to know if you are allergic to shellfish because the contrast will be iodine-based."

C

A client who had a Whipple surgical procedure develops an internal fistula between the pancreas and stomach. For which complication would the nurse monitor? A. Peptic ulcer disease B. Cirrhosis C. Peritonitis D. Chronic pancreatitis

C

A nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy sign c. Clay-colored stools d. Upper abdominal pain after eating

C

A nurse is assessing a patient suspected of having acute cholecystitis. Which information about the last meal would best align with this diagnosis? A. A clear liquid diet for 18 hours B. NPO due to chronic nausea C. A large fatty meal an hour before onset of pain D. A low fat consistent carb diet

C

A nurse recognizes that an 80 year old female patient who takes solumedrol for an acute exacerbation of COPD, HCTZ for hypertension, and Lasix for symptoms associated with heart failure has how many risk factors for Drug Induced Pancreatitis? A. 2 B. 3 C. 5 D. 6

C

A patient presents in the fetal position and is suspected of having acute pancreatitis. Knowing the patient will be in the supine position for a CT, which intervention does the nurse prioritize? A. Application of oxygen B. Auscultation of lung sounds C. Administration of IV hydromorphone D. Placing an NG tube to prevent vomiting

C

The nurse documents the vital signs of a client diagnosed with acute pancreatitis: Apical pulse = 116 beats/min Respirations = 28 breaths/min Blood pressure = 92/50 What complication of acute pancreatitis would the nurse suspect that the client might have? a. Electrolyte imbalance b. Pleural effusion c. Internal bleeding d. Pancreatic pseudocyst

C

The nurse is caring for a patient awaiting a gallbladder ultrasound. When asked why the patient must be NPO for the study, what is the nurse's best response? A. To prevent vomiting associated with gallbladder disease B. To decrease risk of aspiration during the procedure C. Stomach contents can interfere with imaging D. Your doctor must order a diet

C

The nurse is teaching a client with gallbladder disease about diet modification. Which meal would the nurse suggest to the client? A. Sausage and scrambled eggs B. Steak and french fries C. Turkey sandwich on wheat bread D. Fried chicken and mashed potatoes

C

What action will the nurse take when, 12 hours after a traditional cholecystectomy, a client's Jackson-Pratt (JP) drain shows serosanguineous drainage stained with bile? A. Placing the client to the left lateral Sims' position B. Clamping the drain intermittently for 30 minutes every hour C. Measuring the drainage and documenting the findings D. Disconnecting the suction device and gently irrigating the drain with sterile saline

C

Which change in electrolyte values will the nurse expect in a client with acute pancreatitis who reports numbness around the mouth and leg muscle twitching? A. Hyponatremia B. Hypokalemia C. Hypocalcemia D. Hypochloremia

C

Which client will the nurse recognize as having the most risk factors for cholelithiasis? A. 25-year-old white female athlete who is 10 lb (4.5 kg) underweight and had an appendicitis 2 months ago B. 35-year-old African-American male who is 10 lb (4.5 kg) overweight and is hypertensive C. 50-year-old Mexican-American female who has three children and takes hormone replacement therapy D. 60-year-old Asian-American male who had coronary artery bypass graft surgery 4 weeks ago

C

Which statements about eating habits and diet therapy indicate to the nurse that the client recovering from acute pancreatitis understands the recommendations made in collaboration with the registered dietitian nutritionist? Select all that apply. A. "Now I can go back to my usual three meals a day." B. "Replacing carbohydrates with protein will speed my recovery." C. "Although they do not contain fat, I will avoid chocolate and caffeine." D. "If vomiting or diarrhea occur, I will call my primary health care provider." E. "I can't wait to have some good, spicy Mexican food after all this hospital food." F. "I am planning on joining Alcoholics Anonymous and giving up drinking altogether."

CDE

A client had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess? a. Urinary tract infection b. Chronic kidney disease c. Heart failure d. Fluid and electrolyte imbalances

D

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. High fat B. High fiber C. Carbohydrates D. Protein

D

The nurse is caring for a patient diagnosed with acalculous cholecystitis. Which of the following can be omitted from the teaching plan for this patient? A. Cardiovascular risk factors B. Effects of biliary stasis C. Signs and symptoms of infection D. Treatments for cholelithiasis

D

The nurse is caring for a patient diagnosed with acute pancreatitis. Which of the following would be called to the provider? A. Serum potassium 3.7mmOl/L B. Serum sodium 144 mEq/L C. WBC 10,000/ microliter D. Serum Calcium 6.6 mg/dl

D

The patient admitted with cholecystitis due to cholelithiasis asks, "Why is my poop so white?" Which is the nurse's appropriate response? A. "The color of stool varies based on diet and is insignificant." B. "The disease is limiting the amount of bile your gallbladder produces." C. "The high fiber carbohydrate, low fat diet has changed the consistency of your stool." D. "The gallstones are blocking digestive fluids that add the color to your bowel movement"

D

What instruction will the nurse provide to a client to prepare him or her to undergo ultrasonography of the right upper abdominal quadrant to diagnose gallstones? A. Do not eat or drink for at least 6 hours before the test. B. Shower with an antibacterial soap the morning before the test. C. Be sure to have someone come with you who can drive you home. D. A small instrument will be rolled over your upper abdomen and there will be no pain.

D

Which statement by the client who is prescribed to take pancreatic enzyme replacements indicates a need for further teaching by the nurse? A. "I need to take the enzymes at every meal and with snacks." B. "After taking the enzymes, I should drink a glass of water." C. "I should wipe my mouth in case any of the enzyme got on my lips." D. "I should chew each capsule carefully so that it works in my stomach."

D

After completing a patient assessment, nurse is highly suspicious of acute cholecystitis. Which of the following would be most helpful to include in the recommendation portion of an SBAR to the provider? A. A complete set of vital signs B. Trending of previous lab results C. A contrast enhanced CT scan D. An abdominal ultrasound

D

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection indicates that the client understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

D

When caring for a client whose condition is too unstable to undergo sedation for ERCP, which radiologic study does the nurse anticipate as a diagnostic equivalent alternative? A. HIDA scan B. Abdominal ultrasound C. CT without contrast D. MRCP

D

Which client will the nurse recognize as having the highest risk for pancreatic cancer? A. 27-year-old man who is underweight and has opioid use disorder B. 35-year-old woman who is overweight and uses oral contraceptives C. 50-year-old woman who has ductal breast cancer and receiving radiotherapy D. 60-year old man who smokes two packs of cigarettes daily and has liver cirrhosis

D

Which statement indicates to the nurse that a client who is experiencing frequent episodes of "indigestion" and flatulence may have cholecystitis? A. "My stools are sometimes very dark and tarry looking." B. "Sometimes at night I have bad-tasting fluid in my mouth." C. "Usually about a half hour after I eat, I become sweaty and nauseated." D. "My right arm and shoulder always seem to hurt after I eat fried foods."

D

Which teaching will the nurse provide when discharging a client with chronic pancreatitis? A. Weight reduction and daily exercise regimen B. Relaxation techniques and stress management C. Constipation precautions including daily laxative use D. Dietary adjustments to avoid high-fat foods, caffeine, and alcohol

D

A client is admitted to the emergency department with possible acute pancreatitis. What is the nurse's priority assessment at this time? A. Respiratory assessment B. Cardiovascular assessment C. Abdominal assessment D. Pain intensity assessment

A

A nurse cares for a client with end-stage pancreatic cancer. The client asks, "Why is this happening to me?" How would the nurse respond? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's important to keep a positive attitude for your family right now." c. "Scientists have not determined why cancer develops in certain people." d. "I think that this is a trial so you can become a better person because of it."

A

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min. B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain. C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography. D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL (13.1 mmol/L).

A

For which client will the nurse expect extracorporeal shock wave lithotripsy (ESWL) as treatment for gallstones to be contraindicated? A. 30-year-old who is 70 inches (1.75 m) tall and weighs 325 lb (147.2 kg) B. 35-year-old who has cholesterol-based stones C. 45-year-old who has a shellfish allergy and uses hormone replacement therapy D. 55-year-old who has bilateral total knee replacements

A

The nurse is caring for a client who has possible acute pancreatitis. What serum laboratory findings would the nurse expect for this client? (Select all that apply.) a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte coun

ABCDEF

Which signs and symptoms will the nurse expect to see in a client who is diagnosed with advanced pancreatic cancer? Select all that apply. A. Light-colored urine and dark-colored stools B. Anorexia and weight loss C. Splenomegaly D. Ascites E. Leg or calf pain F. Weakness and fatigue

ABCDEF

The nurse is preparing a client who has chronic pancreatitis about how to prevent exacerbations of the disease. Which health teaching will the nurse include? (Select all that apply.) a. "Avoid alcohol ingestion." b. "Be sure and balance rest with activity." c. "Avoid caffeinated beverages." d. "Avoid green, leafy vegetables." e. "Eat small meals and high-calorie snacks."

ABCE

Which signs or symptoms will the nurse assess for in a client who is suspected of having cholecystitis? Select all that apply. A. Anorexia B. Jaundice C. Ascites D. Steatorrhea E. Eructation F. Rebound tenderness

ABDEF

A client has postcholecystectomy syndrome (PCS) with persistent abdominal pain accompanied by vomiting for several weeks after removal of the gallbladder. Which possible causes or complications will the nurse remain alert for in this client? Select all that apply. A. Pseudocyst B. Common bile duct leak C. Dumping syndrome D. Diverticular compression E. Ductal stricture or obstruction F. Sphincter of Oddi dysfunction G. Primary sclerosis cholangitis H. Retained or new gallstones

ABDEFGH

Which serum laboratory values will the nurse expect to be elevated in a client who has acute pancreatitis? Select all that apply. A. Amylase B. Bilirubin C. Calcium D. Lipase E. Magnesium F. Glucose

ABDF

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element?A. High fatB. High fiberC. CarbohydratesD. Protein

ACD

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? (Select all that apply.) a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein foods."

AE

A client is scheduled for a hepatobiliary iminodiacetic acid (HIDA) scan. What would the nurse include in client teaching about this diagnostic test? a. "You'll have to drink a contrast medium right before the test." b. "You'll need to do a bowel prep the nursing before the test." c. "You'll be able to drink liquids up until the test begins." d. "You'll have a large camera close to you during the test."

D

A client with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which priority laboratory finding will the nurse assess? A. Lipase level B. Total bilirubin C. Liver function tests D. White blood cell count

B

After evaluating vital signs reported by the CNA, which patient would the nurse see first? A. A 57 year old with chronic pancreatitis and abdominal pain at 6/10 B. A 23 yo with acute pancreatitis and an oral temp of 103.4F C. A 34 year old with acute pancreatitis with a BP of 106/ 74 D. A 42 year old with a respiratory rate of 26 after showering

B

The nurse is caring for a client who is recovering from an open traditional Whipple surgical procedure. What action would the nurse take? a. Clamp the nasogastric tube. b. Place the patient in semi-Fowler position. c. Assess vital signs once every shift. d. Provide oral rehydration.

B

A young adult client admitted with a diagnosis of cholecystitis from cholelithiasis has severe abdominal pain, nausea, and vomiting. Based on these assessment findings, which client problem is the highest priority for nursing intervention at this time? A. Anxiety B. Risk for dehydration C. Acute pain D. Malnutrition

C

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

C

Which is the most effective action for the nurse to take to assess adequate bowel function in a client with acute pancreatitis who is at risk for the development of paralytic (adynamic) ileus? A. Observing contents of the nasogastric drainage B. Listening for bowel sounds in all four abdominal quadrants C. Asking the client if he or she has passed flatus or had a stool D. Interpreting the report of a CT scan of the abdomen with contrast medium

C

While assessing a patient who presented with severe boring abdominal pain, the nursed notes bruising around the umbilicus. Which term correctly identifies this finding. A. Grey-Turner's sign B. Blumberg's sign C. Cullen's sign D. Kehr's sign

C