Quiz 4 Biliary and Pancreas

The patient is to continue pancreatic enzyme replacement therapy (PERT) after discharge. Which statement indicates that the patient understands teaching about this therapy? A. "I will take the enzymes before meals with a full glass of water" B. "I will take the enzymes after I take my ranitidine" C. "I will mix the enzymes with chopped meat" D. "I will chew the capsules before swallowing the enzymes"

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

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? A. Within normal limits is considering the diagnosis of acute pancreatitis B. A result of the body not being able to use bound calcium C. A protective measure that will reduce the risk of complications D. Full compensation of the parathyroid gland

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 A. Provide a low-fat diet B. Administer analgesics C. Teach relaxation exercises D. Encourage walking in the hall E. Monitor cardiac rate and rhythm F. Observe for signs of hypercalcemia

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

The nurse is teaching a patient and family how to prevent exacerbations of chronic pancreatitis. Which teaching point does the nurse include? A. Moderation in the use of caffeinated beverages B. Avoidance of alcohol and nicotine C. Consume a bland, high-fat, low-protein diet D. Regular exercise, emphasizing aerobic activities

B. Avoidance of alcohol and nicotine

A nurse is preparing a teaching plan for a client with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in this teaching plan? A. Fatty foods are hard to digest B. Bile flow into the intestine is obstructed C. The liver is manufacturing inadequate bile D. There is inadequate closure of the ampulla of Vater

B. Bile flow into the intestine is obstructed

Which diagnostic test is the most accurate in verifying a diagnosis of acute pancreatitis? A. Trypsin B. Lipase C. Alkaline phosphatase D. Alanine aminotransferase

B. Lipase

The patient with acute cholecystitis has a pacemaker. Which diagnostic test is contraindicated? A. Extracorporeal shock wave lithotripsy B. Magnetic resonance cholangiopancreatography (MRCP) C. Ultrasonography of the right upper quadrant D. Hepatobiliary (HIDA) scan

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? A. Ketorolac B. Meperidine C. Morphine D. Hydromorphone

B. Meperidine

The patient with acute necrotizing pancreatitis experiences a temperature spike of 104F. What does the nurse suspect? A. Pancreatic pseudocyst B. Pancreatic abscess C. Chronic pancreatitis D. Pancreatic cancer

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? A. Liver cirrhosis B. Pancreatic pseudocyst C. Gallstones D. Chronic pancreatitis

B. Pancreatic pseudocyst

A patient is scheduled for tests to verify the medical diagnosis of cholecystitis. For which diagnostic test does the nurse provide patient teaching? A. Extracorporeal shock wave lithotripsy (ESWL) B. Ultrasonography of the right upper quadrant C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Serum level of aspartate aminotransferase (AST)

B. Ultrasonography of the right upper quadrant

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? A. "There is no evidence that first degree relatives have an increased risk for this disease" B. "Choletlithiasis is seen more frequently in patients who are underweight" C. "Hormone replacement therapy has been associated with an increased risk for cholelithiasis" D. "Patients with diabetes mellitus are at increased risk for cholelithiasis"

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

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? A. "I will eat the usual three meals a day that I am used to" B. "I am eating tacos for my first meal back home" C. "I will avoid eating chocolate and drinking coffee" D. "I will limit the amount of protein in my diet"

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

The nursing student is caring for a patient with chronic pancreatitis who is receiving pancreatic enzyme replacement therapy. Which statement by the student indicates the need for further study concerning this therapy? A. "The enzymes will be administered with meals" B. "The patient will take the drugs with a glass of water" C. "If the patient has difficulty swallowing the enzyme preparation, I will crush it and mix it with foods" D. "The effectiveness of pancreatic enzyme treatment is monitored by the frequency and fat content of stools"

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

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? A. Observing contents of the nasogastric drainage B. Weighing the patient every day at the same time C. Asking the patient if he or she has passed flatus or had a stool D. Obtaining a computed tomography (CT) scan of the abdomen with contrast medium

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

What is the most common and serious complication after a Whipple procedure? A. Diabetes mellitus B. Wound infection C. Fistula development D. Bowel obstruction

C. Fistula development

What is one of the main advantages of cholecystectomy by the natural orifice transluminal endoscopic surgery (NOTES) procedure? A. Very small visible incisions B. Jackson-Pratt drain removes excess fluid C. No visible incision lines D. resumption of normal activities the day of surgery

C. No visible incision lines

The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient is pale, is diaphoretic, and describes extreme fatigue. Vital signs are: heart rate of 118/minute, BP 95/70, respirations 32/min, temperature 101F. What is the nurse's priority action at this time? A. Instruct the unlicensed assistive personnel (UAP) to reposition the patient for comfort B. Auscultate the patient's abdomen in all four quadrants C. Notify the healthcare provider D. Administer the ordered opioid analgesics

C. Notify the healthcare provider

Which patient would the nurse assess as low risk for the development of gallbladder disorders? A. Patient with sickle cell anemia B. Patient who is Mexican American C. Patient who is 20 years old and male D. Patient with a history of prolonged parenteral nutrition

C. Patient who is 20 years old and male

A female patient is to have her gallbladder removed by natural orifice transluminal endoscopic surgery. What does the nurse teach about this surgery? A. The surgeon will use powerful shock waves to break up the gallstones B. The surgeon will insert a transpheatic biliary catheter to open blocked bile ducts C. The surgeon will use a vaginal approach to remove the gallbladder D. The surgeon will inject ursodeoxycholic acid to dissolve any remaining gallstone fragments

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

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? A. Promotes the formation of calculi in the cystic duct B. Stimulates the pancreas to secrete more insulin that it can immediately produce C. Alters the composition of enzymes so they are capable of damaging the pancreas D. Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

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

After removal of the gallbladder, a patient experiences abdominal pain with vomiting for several weeks. What does the nurse recognize? A. Chronic cholecystitis B. Recurrence of acute cholecystitis C. Unremoved gallstones D. Postcholecystectomy syndrome

D. Postcholecystectomy syndrome

Which statement about the care of a patient with a Jackson-Pratt (JP) drain after a traditional cholecystectomy is true? A. The patient is maintained in the prone position B. When the patient is allowed to eat, the JP drain is clamped continuously C. The JP drain is irrigated every hour for the first 24 hours D. Serosanguineous drainage stained with bile is expected for 24 hours

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

Which is a key feature of pancreatic cancer? A. Anorexia B. Weight gain C. Pale urine D. Dark-colored stools

A. Anorexia

Which are common manifestations of acute cholecystitis? SATA A. Anorexia B. Ascites C. Eructation D. Steatorrhea E. Jaundice F. Rebound tenderness

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

Which are advantages of minimally invasive surgery (MIS) laparoscopic cholecystectomy? SATA A. Complications are uncommon B. The mortality is similar to traditional cholecystectomy C. Patients recovery more rapidly D. Postoperative pain is less severe E. Bile duct injuries are rare F. IV antibiotics are never needed because of decreased infection rates

A. Complications are uncommon C. Patients recovery 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 C. Pain on urination D. Clay-colored stool E. Coffee ground vomitus

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 C. Dark brown stool D. Straw-colored urine E. Pain in right upper quadrant

A. Ecchymosis B. Yellow sclera E. Pain in right upper quadrant

Which abnormal laboratory findings are cardinal findings in acute pancreatitis? SATA A. Elevated serum lipase B. Increased serum amylase C. Decreased serum trypsin D. Elevated serum elastase E. Decreased serum glucose F. Elevated bilirubin

A. Elevated serum lipase B. Increased serum amylase D. Elevated serum elastase F. Elevated bilirubin

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care? A. Encouraging expression of concerns B. Administering antibiotics as prescribed C. Teaching the importance of getting rest D. Explaining that everything will be all right

A. Encouraging expression of concerns

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 B. Ventricular cardiac dysrhythmias C. Decreased urinary output D. Jaundice

A. Gastrointestinal upset

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 lb B. Cholesterol-based stones C. Height 5 feet 7 inches, 138 lbs D. Small gallstones

A. Height 5 feet 10 inches, 325 lb

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) B. Oral opioids such as morphine sulfate given as needed C. Intramuscular opioids given every 6 hours D. Oral hydromorphone (Dilaudid) given twice a day

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 B. Patients with chronic lung disease or heart failure who are unable to tolerate the oxygen used in the laparoscopic procedure are examples of patients who have the open surgical approach (abdominal laparotomy) 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 E. Use of laparoscopic cholecystectomy puts the patient at increased risk for bile duct injuries F. After a laparoscopic cholecystectomy, assess the patient's oxygen saturation level frequently until the effects of anesthesia have passed

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 anesthesia have passed

The nurse on a medical-surgical unit is caring for several patients with acute cholecystitis. Which task is best to delegate to the unlicensed assistive personnel (UAP)? A. Obtain the patient's vital signs B. Determine if any foods are not tolerated C. Assess what measures relieve the abdominal pain D. Ask the patients to describe their daily activity or exercise routines

A. Obtain the patient's vital signs

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-Fowler's position B. Place the NG tube on intermittent suction C. Monitor NG drainage, which should be bile-tinged and contain blood D. Keep the patient NPO E. Check blood glucose often F. Monitor for signs of hypovolemia to prevent shock

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

A patient is admitted with obstructive jaundice. Which sign/symptom does the nurse expect to find upon assessment of the patient? A. Pruritus B. Pale urine in increased amounts C. Pink discoloration of sclera D. Dark, tarry stools

A. Pruritus

The nurse is collaborating with the dietitian 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 to increase calorie intake (4000-6000) per day to maintain weight B. Be sure to include foods that are high in fat because they are essential for healing 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 F. Add rich foods to the diet to help meet the caloric requirements

A. The patient will need to increase 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 B. Pulmonary embolism C. Myocardial infarction D. Heart failure E. Renal failure F. Hemorrhage at anastomosis sites with hypovolemia

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

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 C. Severe pain is an early feature of this disease D. There are no specific blood tests to diagnose pancreatic cancer E. Chemotherapy is the treatment of choice for pancreatic cancer F. Chronic pancreatitis predisposes a patient to pancreatic cancer

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 cancer F. Chronic pancreatitis predisposes a patient to pancreatic cancer

Which are manifestations of pancreatic cancer? SATA 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

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

The patient comes to the emergency department (ED) with severe abdominal pain in the midepigastric area. The patient states that the pain began suddenly, is continuous, radiates to his back, and is worse when he lies flat on his back. What condition does the nurse suspect? A. Acute cholecystitis B. Pancreatic cancer C. Acute pancreatitis D. Pancreatic pseudocyst

C. Acute pancreatitis

Which condition is most likely to be treated with antibiotics? A. Cancer of the gallbladder B. Acute cholelithiasis C. Chronic pancreatitis D. Acute necrotizing pancreatitis

D. Acute necrotizing pancreatitis

The healthcare provider has assessed a patient's abdomen and found rebound tenderness on deep palpation. What does the nurse recognize? A. Steatorrhea B. Eructation C. Biliary colic D. Blumberg's sign

D. Blumberg's sign

Disseminated intravascular coagulation (DIC) is a complication of pancreatitis. What pathophysiology leads to this complication? A. Hypovolemia B. Peritoneal irritation and seepage of pancreatic enzymes C. Disruption of alveolar-capillary membrane D. Consumption of clotting factors and formation of microthrombi

D. Consumption of clotting factors and formation of microthrombi

Which type of drug is used to treat acute severe biliary pain? A. Acetaminophen B. Nonsteroidal antiinflammatory drugs (NSAIDs) C. Antiemetics D. Opioids

D. Opioids