Chapter 44: Assessment and Management of Patients with Biliary Disorders

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective?

"I should wash the site with mild soap and water."

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?

"Maintain a high-carbohydrate, low-fat diet."

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?

"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."

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas? Select all that apply.

- "Internal secretion of hormones is the function of the endocrine pancreas." - "The endocrine pancreas secretes hormones through a ductless gland." - "The exocrine pancreas secretes hormones from excretory ducts." - "The exocrine pancreas secretes pancreatic enzymes into the GI tract."

A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply.

- administer pain-relieving medication - administer electrolytes - administer plasma - assist the client to a sem-Fowler position

The nurse reviews data collected during a health history with a client. Which finding(s) does the nurse identify that increases the client's risk of developing cholesterol gallbladder stones? Select all that apply.

- age 45 - female

A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply.

- changes in weight - cystic fibrosis - diabetes - obesity

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?

6 to 12

A client with a history of alcohol use disorder comes to the emergency department and reports 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 their back. Which intervention takes priority for this client?

Administering pain medication as ordered

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis?

Alcohol consumption and smoking

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client?

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

Which term most precisely refers to the incision of the common bile duct for removal of stones?

Choledocholithotomy

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?

Dysfunction of the pancreatic islet cells

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?

Hot roast beef sandwich with gravy

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam?

It visualizes the gallbladder and bile duct

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system?

Maintain the client in a semi-Fowler's position

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?

Measure blood glucose concentration every 4 to 6 hours

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?

Pain with abdominal distention and hypotension

When caring for a client with acute pancreatitis, the nurse should use which comfort measure?

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 health care provider diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?

Relieving abdominal pain

A client with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the client guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this client?

The client has developed peritonitis

The nurse is caring for a client with acute pancreatitis. The client has an order for an anticholinergic medication. The nurse explains that the client will be receiving that medication for what reason?

To reduce gastric and pancreatic secretions

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?

Use incentive spirometry every hour

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The health care provider diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

acute pain related to biliary spasms

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:

cannot tolerate high-glucose concentration

A client with calculi in the gallbladder is said to have

cholelithiasis

Which is a clinical manifestation of cholelithiasis?

clay-colored stools

The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray?

coffee

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The health care provider said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?

decompression

When the nurse is caring for a client with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions?

frequent changes in position

A client with suspected biliary obstruction due to gallstones reports changes to the color of their stools. Which stool color does the nurse recognize as common to biliary obstruction?

gray

A nurse is caring for a client who was admitted with pain, tenderness, and rigidity of the upper right abdomen, suggesting a gall bladder issue. The client has also been experiencing nausea and vomiting for the past 3 days. The admitting service is planning for tests to be conducted in the morning.

lab: cholesterol is elevated in biliary obstruction ultrasonography: It is used to visualize calculi in the gallbladder cholescintigraphy: the radioactive dye allows for visualization of the biliary tract

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?

pancreatitis

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right?

pigment

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?

weight loss

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

yellow sclerae