GI 3

A client underwent an exploratory laparotomy 2 days ago. The HCP should be called immediately for which physical assessment finding?

A. Abdominal distention and rigidity

Which is a key feature of pancreatic cancer?

A. Anorexia

Which are common manifestations of acute cholecystitis? SATA

A. Anorexia C. Eructation E. Jaundice F. Rebound tenderness

Which tasks can be delegated to the UAP? SATA

A. Assisting Ms. T with perineal care after diarrheal episodes B. Measuring vital signs every 2 hours for Mr. R. C. Transporting Ms. H off the unit for a procedure D. Gently cleansing the nares around MS. D's NG tube F. Helping Mr. K to brush his teeth

Which are the advantages of minimally invasive surgery (MIS) laparoscopic cholecystectomy? SATA

A. Complications are uncommon C. Patients recover more rapidly D. Postoperative pain is less severe E. Bile duct injuries are rare.

For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? SATA

A. Dark urine B. Yellow skin D. Clay-colored stool

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? SATA

A. Ecchymosis B. Yellow sclera E. Pain in the RUQ

Which abnormal laboratory findings are cardinal findings in acute pancreatitis? SATA

A. Elevate serum lipase B. Increase serum amylase D. Elevated serum elastase F. Elevated bilirubin

The nurse is administering ketorolac to a 78-year-old patient for mild to moderate biliary pain management. Which assessment finding indicates the patient is experiencing a side effect of this drug?

A. Gastrointestinal upset

Psychosocial assessment reveals that Mr. A faces several financial and personal problems. Which finding has the most impact on discharge teaching for wound care and other follow-up issues?

A. He is homeless and has no family in the city.

Which factor renders a patient the least likely to benefit from extracorporeal shock wave lithotripsy (ESWL) for the treatment of gallstones?

A. Height 5 feet 10 inches, 325 lbs.

To provide good continuity of care for Mr. A, who is homeless, which members of the interdisiplinary team should routinely have access to Mr. A's medical records? SATA

A. Hospital social worker who is helping Mr. A to locate resources. B. Surgeon who performed Mr. A's appendectomy F. Nurse who works at the shelter where Mr. A frequently stays.

The patient with acute pancreatitis experiences abdominal pain. What is the best intervention to begin managing this pain?

A. IV opioids by means of patient controlled analgesia (PCA)

Which statements are true regarding laparoscopic cholecystectomy? SATA

A. Laparoscopic cholecystectomy is considered the gold standard and is performed far more often than the traditional open approach. C. Removing the gallbladder with the laparoscopic technique reduces the risk of wound complications. D. Patients who have their gallbladders removed by the laparoscopic technique should be taught the importance of early ambulation to promote absorption of carbon dioxide. F. After a laparoscopic cholecystectomy, assess the patient's oxygen saturation level frequently until the effects of the anesthesia have passed.

Which clients would be best to assign to the new RN? SATA

A. Ms. H (acute cholecystitis) B. Ms. D (bowel obstruction) D. Mr. A (appendectomy)

The nurse on a medical-surgical unit is caring for several patients with acute cholecystitis. Which task is best to delegate to the UAP?

A. Obtain the patient's vitals signs.

The RN is observing the nursing student perform an abdominal assessment on Ms. D, who was admitted for bowel obstruction. For which actions will the supervising nurse intervene? SATA

A. Palpating for abdominal distention with the index fingertips B. Auscultating for bowel sounds with the NG tube attached to low wall suction, C. Performing the physical assessment before asking about pain F. Checking for skin turgor over the lower abdominal areas.

The nurse is caring for a patient with pancreatic cancer who had a Whipple procedure. Which interventions and assessments does the nurse implement? SATA

A. Place the patient in semi-fowlers position. B. Place the NG tube on intermittent suction D. Keep the patient on NPO E. Check blood glucose often F. Monitor for signs of hypovolemia to prevent shock.

A patient is admitted with obstructive jaundice. Which sing/symptom does the nurse expect to find upon assessment of the patient?

A. Pruritus

The nurse is collaborating with the dietian to provide diet teaching for a patient with chronic pancreatitis and his family. Which are important teaching points for this teaching plan? SATA

A. The patient will need increased calorie intake (4000-6000) per day to maintain weight. C. Alcohol intake should be avoided D. Provide a bland diet with frequent meals E. Avoid irritating substances such as caffeinated beverages which stimulate the GI system.

Which are potential cardiovascular complications for a patient after surgery for a whipple procedure? SATA

A. Thrombophlebitis C. Myocardial infarction D. Heart failure F. Hemorrhage at anastomosis sites with hypovolemia.

The nurse is reviewing the medication administration record for Ms. T. Which situation needs immediate investigation?

A. Two tablets of senna were given yesterday morning.

Which statements about pancreatic cancer are accurate? SATA

A. Venous thromboembolism (VTE) is a common complication of pancreatic cancer. B. Pancreatic cancer often presents in a slow and vague manner. D. There are no specific blood tests to diagnose pancreatic history. F. Chronic pancreatitis predisposes a patient to pancreatic cancer.

The UAP says, "Why can't Ms. T get out of bed and do things for herself? She's only 29 years old." What is the team leader's best response?

B. "Decreasing activity helps to decrease the diarrhea."

The home health nurse sees that the client is taking cimetidine. What question is the nurse most likely to ask to evaluate the efficacy of the therapy?

B. "Has the medication helped to relieve the acid indigestion?"

The patient is to continue pancreatic enzyme replacement therapy (PERT) after discharge. Which statement indicates that the patient understands the teaching about this therapy?

B. "I will take the enzyme after I take my ranitidine."

The night nurse gives a brief and incomplete report. Which question should the oncoming RN team leader pose to the night shift nurse to help determine the priority actions for MS. H who was admitted for acute cholecystitis?

B. "Is she going to surgery or radiology this morning?"

The nurse is evaluating electrolyte values for a patient with acute pancreatitis and notes that the serum calcium is 6.8 mEq/L. How does the nurse interpret this finding?

B. A result of the body not being able to use bound calcium.

A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? SATA

B. Administer analgesics C. Teach relaxation exercises E. Monitor cardiac rate and rhythm

Which are manifestations of pancreatic cancer? SATA

B. Anorexia C. Splenomegaly D. Ascites E. Leg or calf pain F. Weakness and fatigue

The nurse is teaching a patient and family how to prevent exacerbations of chronic pancreatitis. Which teaching point does the nurse include?

B. Avoidance of alcohol and nicotine.

A nurse is preparing a teaching plan for a client with a history of cholelithasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?

B. Bile flow into the intestine is obstructed.

Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopancreatography (ERCP)?

B. Bilirubin level

A client is returned to the surgical unit after an abdominal cholecystectomy. What is the main reason why the nurse should assess for clinical indicators of respiratory complications?

B. Incision is in close proximity to the client's diaphragm.

Which diagnostic test is the most accurate in verifying a diagnosis of acute pancreatitis?

B. Lipase

Mr. K needs 1200 kcal/day. The enteral feeding formula provides 1 kcal/ml. Yesterdays formula feedings were 100 ml at 7:00 am, 50 ml at 1100, 200 ml at 3:00, and 100 ml at 7:00 pm. What should the nurse do first?

B. Look at the original prescription to determine frequency and amount.

The patient with acute cholecystitis has a pacemaker. Which diagnostic test is contraindicated?

B. Magnetic resonance cholangiopancreatography (MRCP)

The nurse is caring for an older adult patient with acute biliary pain. Which drug order does the nurse question?

B. Meperidine

The patient with acute necrotizing pancreatitis experiences a temperature spike of 104 degrees. What does the nurse suspect?

B. Pancreatic abscess

The nurse detects an epigastric mass while assessing a patient with acute pancreatitis. The patient describes epigastric pain that radiates to his back. What does the nurse suspect?

B. Pancreatic pseudocyst

Before a cholecystectomy, vitamin K is prescribed, which element, should the nurse determine is the purpose of administering this medication?

B. Prothrombin

A patient is scheduled for tests to verify the medical diagnosis of cholecystitis. For which diagnostic test does the nurse provide patient teaching?

B. Ultrasonography of the right upper quadrant.

The RN is teaching the nursing student about enteral feedings for clients such as Mr. K, who has a PEG tube. In the postoperative period, when can enteral feedings be started?

B. When bowel sounds occur, usually within 24 hours.

Mr. A will be discharges with prescriptions for pain medication and an antibiotic. What is the most important point that the nurse will emphasize about the medications?

C. "All of the antibiotics should be taken, even if you feel good."

The daughter of a patient with cholelithiasis has heard that there is a genetic disposition for cholelithiasis. The daughter asks the nurse about the risk factors. How does the nurse respond?

C. "Hormone replacement therapy has been associated with increased risk for cholelithasis."

The nurse has instructed a patient in the recovery phase of acute pancreatitis about diet therapy. Which statement by the patient indicates that teaching has been successful?

C. "I will avoid eating chocolate and drinking coffee?"

The nursing student is caring for a patient with chronic pancreatic enzyme replacement therapy. Which statement by the student indicates the need for further study concerning this therapy?

C. "If the patient has difficulty swallowing the enzyme preparation, I will crush it and mix it with foods."

The new RN asks the team leader if it is okay to give Ms. D a dose of psyllium using the HCP's standing orders. Ms. D says, "She feels constipated and takes pysllium on a regular basis at home." What is the team leader's best response?

C. "Laxatives can cause perforation if there is a bowel obstruction."

While the nurse is teaching Mr. A about dressing changes for his appendectomy wound, he says, "when you live on the street, you can't do everything the way you nurses do in the hospital." What is the most important thing to emphasize in helping him to accomplish self-care?

C. "Wash your hands before a dressing change."

The patient comes to the emergency department with severe abdominal pain in the midepigastric area. The patient states the pain began suddenly, is continuous, radiates to his back. What condition does the nurse suspect?

C. Acute pancreatitis

A patient with acute pancreatitis is at risk for the development of paralytic (adynamic) ileus. Which action provides the nurse with the best indication of bowel function?

C. Asking the patient if he or she has passed flatus or had a stool.

Ms. T is receiving an oral dose of sulfasalazine 500 mg every 6 hours for treatment of ulcerative colitis. Which assessment finding is cause for greatest concern?

C. Decreased urine output

A client with a history of pancreatitis is scheduled for surgery to excise a pseudocysts of the pancreas. The client asks, "What is a pseudocysts?" What information should the nurse include in a response to this question?

C. Dilated space of necrotic tissue and blood

The nurse is caring for a client with a nasogastric tube. Which task can be delegated to experienced UAP?

C. Disconnecting the suction to allow ambulation to the toilet

What is the most common and serious complication after a whipple procedure?

C. Fistula development

What is one of the main advantages of cholecystectomy by the natural orifice transluminal endoscopic surgery (NOTES) procedure?

C. No visible incision lines

The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient is pale, diaphoretic, and describes extreme fatigue. Vital signs are: heart rate of 118/minute, BP 95/70, respirations 32/min, temperature 101 degrees. What is the nurse's priority action at this time?

C. Notify the patients health care provider.

Which patient would the nurse assess as low risk for the development of gallbladder disorders?

C. Patient who is 20 years old and male.

The HCP told Ms. H that she would probably need a laparoscopic cholecystectomy; however, the hepatobiliary iminodiacetic acid (HIDA) scan and laboratory results are still pending. Ms. H asks, "What should I expect?" What is the best intervention at this point?

C. Provide some written material about gallbladder disease and options.

Which reporting tasks are appropriate to delegate to the UAP? SATA

C. Reporting whether Mr. R's blood pressure is below 100/60 mmhg D. Reporting if any of the clients indicate pain E. Reporting if Mr. A is seen leaving the unit to smoke a cigarette. F. Reporting that Mr. K's family has questions

Ms. D reports feeling weak. She seems more confused compared with her baseline. The NG drainage container has a large amount of watery bile-colored fluid. Which laboratory values should be checked first?

C. Sodium level, potassium level, and pH of blood.

The nurse is providing postoperative care for a client who underwent laparoscopic cholecystectomy. What should be reported immediately to the health care provider?

C. The client reports right upper quadrant pain.

A female patient is to have her gallbladder removed by natural orifice transluminal endoscopic surgery. What does the nurse teach about the surgery?

C. The surgeon will use a vaginal approach to remove the gallbladder.

Which condition is most likely to be treated with antibiotics?

D. Acute necrotizing pancreatitis.

The health care provider has assessed a patient's abdomen and found rebound tenderness on deep palpation. What does the nurse recognize?

D. Blimberg's sign

Disseminated Intravascular Coagulation (DIC) is a complication of pancreatitis. What pathophysiology leads to this complication?

D. Consumption of clotting factors and formation of of microthrombi.

All of these clients must receive their routine morning medications. Which client should receive his or her medication last?

D. Mr. K (PEG-tube)

Which type of drug is used to treat acute severe biliary pain?

D. Opioids

After removal of the gallbladder, a patient experiences abdominal pain with vomiting for several weeks. What does the nurse recognize?

D. Postcholecystectomy syndrome

Which statement about the care of patient with a Jackson-Pratt (JP) drain after a traditional cholecystectomy is true?

D. Serosanguineous drainage stained with bile is expected for 24 hours.

Ms. H's HIDA scan shows a decreased bile flow with gallbladder disease and obstruction, the nurse is vigilant for the complication of biliary colic. What are the key signs and symptoms that the nurse with watch for?

D. Severe abdominal pain with tachycardia, pallor, diaphoresis, and prostration

Because of Ms. T's severe diarrhea, the nurse is reviewing the laboratory results. Which laboratory results are cause for greatest concern?

D. The serum sodium and potassium levels are decreased.

The RN is supervising the nursing student in administering Ms. D's (bowel obstruction) medications through the NG tube. When would the nurse intervene?

D. The student crushes tablets and puts all medications in the same cup

Ms. T is discouraged and dispirited about her ulcerative colitis. She is resistant to TPN because "I'm being kept alive with tubes." Which explanation will encourage Ms. T to continue with the TPN therapy?

D. Your bowel can rest, and the diarrhea will decrease.

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding?

D. increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas.

The night shift nurse has just finished giving the RN team leader a report of the six clients. Which client has the highest acuity level and is at greatest risk for shock during the shift?

F. Mr. R (acute pancreatitis)