Chapter 50: Assessment and Management of Patients With Biliary Disorders Prep-u

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? ERCP CT MRI Ultrasound

ERCP Explanation: The ERCP is the most useful study in the diagnosis of chronic pancreatitis. The other answer choices may be used; however, these are not the most useful in the diagnosis of chronic pancreatitis.

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 3 to 5 13 to 18 1 to 2

6 to 12 Explanation: Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time.

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? Increases in the bicarbonate output by the kidneys Increases in the rate of pancreatic secretion Decreases in the physiologic function of major organs Development of local complications

Decreases in the physiologic function of major organs Explanation: Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in physiologic function of major organs with increasing age.

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 Renal failure Inability for the liver to reabsorb serum glucose Ingestion of foods high in sugar

Dysfunction of the pancreatic islet cells Explanation: Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.

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? Muscle twitching and finger numbness Paralytic ileus and abdominal distention Elevated blood glucose concentration Hypotension

Muscle twitching and finger numbness Explanation: Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate. The other data indicate other complications of acute pancreatitis but are not indicators of electrolyte imbalance.

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? Presence of easy bruising and bradycardia Pain with abdominal distention and hypotension Presence of blood in the client's stool and recent hypertension Adventitious breath sounds and hypertension

Pain with abdominal distention and hypotension Explanation: Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with 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? Encourage the client to ambulate frequently. Instruct the client on the proper use of an incentive spirometer. Encourage the client to deep breathe and cough. Place the client in semi-Fowler's position.

Place the client in semi-Fowler's position. Explanation: A client with severe biliary colic is in extreme pain and has a very difficult time taking a deep breath due to severe pain on inspiration. Placing the client in upright or semi-Fowler's position best promotes adequate breathing and best supports the client's function. Ambulation, deep breathing and coughing, and incentive spirometry may be too difficult or impossible for the client with severe biliary colic symptoms.

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

Positioning the client on the side with the knees flexed Explanation: The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

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? Serum amylase Serum calcium Serum potassium Serum bilirubin

Serum amylase Explanation: Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

The nurse is caring for a client with symptoms of gallbladder disease. Which diagnostic test will the nurse anticipate preparing the client for to confirm the diagnosis? Abdominal x-ray Oral cholecystography Cholescintigraphy Ultrasound

Ultrasound Explanation: Ultrasonography is the diagnostic procedure of choice because it is rapid and accurate and can be used for clients with liver dysfunction and jaundice. Ultrasonography can detect calculi in the gallbladder or a dilated common bile duct with 90% accuracy. An abdominal x-ray may be obtained to exclude other causes of symptoms; however, only 10% to 15% of gallstones are calcified sufficiently to be visible on such x-ray studies. Cholescintigraphy is used successfully in the diagnosis of acute cholecystitis or blockage of a bile duct. Cholescintigraphy, however, is more expensive than ultrasonography, takes longer to perform, and exposes the client to radiation. It is often used when ultrasonography is not conclusive, such as in acalculous cholecystitis. Oral cholecystography is used if ultrasound equipment is not available or if the ultrasound results are inconclusive.

The nurse is caring for a client experiencing pain related to chronic pancreatitis. When developing a care plan for alternative strategies to opoid usage, which approaches will the nurse include? Select all that apply. Amitriptyline Vitamin E Ibuprofen Tetracycline Methylprednisolone

Vitamin E Amitriptyline Ibuprofen Explanation: In chronic pancreatitis, management of abdominal pain and discomfort is similar to that of acute pancreatitis; however, the focus is usually on the use of nonopioid methods to manage pain. Adjunct means of pain modulation include the use of antioxidants such as Vitamin E, antidepressants such as amitriptyline, avoiding alcohol, smoking cessation, and the use of nonopioid analgesics like ibuprofen. Tetracycline is an antibiotic and has been implicated as a causative agent of acute pancreatitis. Methylprednisolone is a steroid and may induce acute pancreatitis in some clients.

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? Diarrhea Hypertension Weight loss Fatigue

Weight loss Explanation: Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor 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? lavage decompression instillation gavage

decompression Explanation: Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. "The pancreas decreases bicarbonate secretion with age." "The pancreas develops fatty deposits with age." "The pancreas develops fibrous material with age." "The pancreas enlarges and atrophies with age." "The pancreas decreases secretion of enzymes with age."

"The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas decreases secretion of enzymes with age." "The pancreas decreases bicarbonate secretion with age." Explanation: Age-related changes to the pancreas include: the development of fibrous material and fatty deposits, as well as decreased secretion of both pancreatic enzymes and bicarbonate. The pancreas remains the same size as the client ages and atrophy is not a normal age-related finding.

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 Caffeine consumption and acute pancreatitis Malnutrition and acute pancreatitis Acute hepatitis and alcohol consumption

Alcohol consumption and smoking Explanation: Alcohol consumption in Western societies is a major factor in the development of chronic pancreatitis, as is smoking. Because heavy drinkers usually smoke, it is difficult to separate the effects of the alcohol abuse and smoking. Malnutrition is a major cause of chronic pancreatitis worldwide, but alcohol consumption is more commonly the cause in Western societies. Caffeine consumption is not related to acute pancreatitis. Acute hepatitis does not usually lead to chronic pancreatitis unless complications develop.

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? Carbohydrate digestion Protein digestion Fat digestion Protein synthesis

Carbohydrate digestion Explanation: Amylase is a pancreatic enzyme involved in the breakdown and digestion of carbohydrates. Trypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.

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 may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." "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." "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."

"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." Explanation: If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.

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? 6 to 8 months 3 to 5 months 1 to 2 months 6 to 12 months

6 to 12 months Explanation: Ursodeoxycholic acid (UDCA [Urso, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol (Karch, 2012). Six to 12 months of therapy is required in many patients to dissolve stones, and monitoring of the patient for recurrence of symptoms or the occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time.

A client with acute pancreatitis is prescribed hydromorphone 2 mg intranvenously every 4 hours as needed for severe pain. Which assessment will the nurse prioritize for this client? Heart sounds Development of nausea Bleeding tendency Bowel sounds

Bowel sounds Explanation: Adequate administration of analgesia is essential during the course of acute pancreatitis to provide sufficient pain relief and to minimize restlessness, which may further stimulate pancreatic secretion. Pain relief may require parenteral opioids such as morphine, fentanyl, or hydromorphone. Gastrointestinal paralysis and ileus are common problems in early acute pancreatitis that can be potentiated and aggravated by the use of high-dose opioids. Although opioids can affect heart rate, assessing the effect on heart sounds would not be the priority over assessing for bowel sounds in acute pancreatitis. Bleeding tendency would be a priority if the client is taking nonsteroidal anti-inflammatory drugs. Nausea is not identified as a potential adverse effect when a client with acute pancreatitis receives opioids for pain management.

A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply. Allow the client to have sips of clear liquids. Encourage bed rest to decrease the client's metabolic rate. Withhold oral feedings to limit the release of secretin. Teach the client about the correlation between alcohol intake and pain.

Encourage bed rest to decrease the client's metabolic rate. Teach the client about the correlation between alcohol intake and pain. Withhold oral feedings to limit the release of secretin. Explanation: The acutely ill client is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. The nurse also assesses the home situation and reinforces instructions about fluid and nutrition intake and avoidance of alcohol. Oral feedings are withheld to decrease the secretion of secretin; therefore, having sips of clear liquids is not an appropriate intervention.

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? Increase respiratory effectiveness. Decrease the amount of postoperative analgesia needed. Eliminate the need for nasogastric intubation. Improve nutritional status during recovery.

Increase respiratory effectiveness. Explanation: The nurse must teach the client about using an incentive spirometer to promote lung expansion. The high abdominal incision used in a cholecystectomy interferes with respirations postoperatively, increasing the risk of atelectasis. The client will need to use incentive spirometry to promote lung expansion, increase alveolar inflation, and strengthen respiratory muscles. Most clients don't have a nasogastric tube in place after a cholecystectomy. It isn't appropriate to teach improved nutritional status before surgery. It isn't important for the client to be aware of how to decrease the amount of postoperative analgesia, because this is the responsibility of the health care team.

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? Pancreatitis causes alterations to hemoglobin, impairing oxygenation. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Pancreatitis can atrophy the diaphragm and alter the breathing pattern.

Pancreatitis can elevate the diaphragm and alter the breathing pattern. Explanation: Aggressive pulmonary care is required for clients with acute pancreatitis. Pancreatitis can elevate the diaphragm and alter the breathing pattern of clients. Pancreatitis can cause retention of pulmonary secretions but does not thicken the secretions. Acute pancreatitis does not alter the hemoglobin.

The nurse is assessing a client admitted with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? "How often and how long do you exercise each day? "When was the last time you took acetaminophen?" "How much alcohol do you consume in a day?" "How many meals do you eat every day?"

"How much alcohol do you consume in a day?" Explanation: Chronic pancreatitis is an inflammatory disorder characterized by progressive destruction of the pancreas. Alcohol consumption in Western societies is the major cause of chronic pancreatitis. Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of chronic pancreatitis. The incidence of pancreatitis is 50 times greater in people with alcoholism than in those who do not abuse alcohol. The type of food (like fried or heavily processed foods) rather than the number of meals eaten each day may contribute to pancreatitis and subsequent flare-ups of the condition. The prescibed use of acetaminophen is not a typical risk factor in pancreatitis and is rare with cases of overdose. The amount and/or lack of exercise is not directly linked to pancreatitis. Risk factors do include obesity.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: circumoral pallor. yellow sclerae. light amber urine. black, tarry stools.

yellow sclerae. Explanation: Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

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 shows the sizes of the abdominal organs and detects any masses. It visualizes the gallbladder and bile duct. It visualizes the liver and pancreas. It visualizes the biliary structures and pancreas via endoscopy.

It visualizes the gallbladder and bile duct. Explanation: The cholecystogram is a diagnostic imaging test used to visualize the gallbladder and bile duct. The celiac axis arteriography visualizes the liver and pancreas. Ultrasonography shows the sizes of the abdominal organs and detects any masses. The endoscopic retrograde cholangiopancreatography (ERCP) visualizes the biliary structures and pancreas via endoscopy.

Clinical manifestations of common bile duct obstruction include all of the following except: Clay-colored feces Light-colored urine Pruritus Jaundice

Light-colored urine Explanation: The excretion of the bile pigments by the kidneys gives the urine a very dark color. The feces, no longer colored with bile pigments, are grayish, like putty, or clay-colored. The symptoms may be acute or chronic. Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen, may occur. If it goes untreated jaundice and pruritus can occur.

The nurse knows that the serum amylase concentration returns to normal within which time frame? 12 hours 24 hours 36 hours 48 hours

48 hours Explanation: Serum amylase usually returns to normal within 48 to 72 hours.

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

6 to 12 months Explanation: Six to 12 months of therapy with UDCA is recommended in clients to dissolve the stones.

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? Suction the patient every 4 hours Perform chest physiotherapy Placing the patient in the prone position Frequent changes of positions

Frequent changes of positions Explanation: Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? Ingestion of a low-fat diet History of pancreatitis One-time exposure to petrochemicals Ingestion of caffeinated coffee

History of pancreatitis Explanation: Pancreatitis is associated with the development of pancreatic cancer. Other factors that correlate with pancreatic cancer include diabetes mellitus, a high-fat diet, and chronic exposure to carcinogenic substances (i.e., petrochemicals). Although data are inconclusive, a relationship may exist between cigarette smoking and high coffee consumption (especially decaffeinated coffee) and the development of pancreatic carcinoma.

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

Pancreatic necrosis Explanation: Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Shock and multiple organ failure may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in clients with acute pancreatitis.

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? The patient requires more pain medication. The patient is developing a paralytic ileus. The patient has developed renal failure. The patient has developed peritonitis.

The patient has developed peritonitis. Explanation: Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis (Privette et al., 2011).

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? Instruct the client to cough only when necessary. Use incentive spirometry every hour. Withhold analgesics unless necessary. Monitor pulse oximetry every hour.

Use incentive spirometry every hour. Explanation: The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis.

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms?

"Apply a heating pad to your shoulder for 15 minutes hourly as needed." Explanation: Pain in the right shoulder may occur after laparoscopic cholecystectomy due to migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure. The nurse should instruct the client to apply a heating pad to the shoulder for 15 to 20 minutes every hour as needed for pain relief. The nurse should not instruct the client to take analgesic medication-this is a medical order performed by the health care provider only. This scenario is not life threatening and the client does not need to go to the emergency department. It is also not necessary for the client to place the shoulder in a sling as this is not an injury-related condition.

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? "I can take a shower in a week." "I should wash the site with mild soap and water." "I should remain on bed rest for several days." "I can drive after 2 weeks."

"I should wash the site with mild soap and water." Explanation: After a laparoscopic cholecystectomy, the client should be instructed about pain management, activity and exercise, wound care, nutrition, and follow-up care. The client should be directed to wash the puncture site with mild soap and water when caring for the wound. When resuming activity, the client should be instructed to drive after 3 or 4 days, take a shower or bath after 1 or 2 days, and begin light exercise such as walking immediately.

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 Performing range-of-motion (ROM) leg exercises hourly while the client is awake Teaching the client to choose low-fat foods from the menu Assisting the client to ambulate the evening of the operative day

Assisting the client to turn, cough, and deep breathe every 2 hours Explanation: Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

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? Carbohydrate digestion Fat digestion Protein synthesis Protein digestion

Carbohydrate digestion Explanation: Amylase is a pancreatic enzyme involved in the breakdown and digestion of carbohydrates. Trypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.

Which foods should be avoided following acute gallbladder inflammation? Cheese Coffee Mashed potatoes Cooked fruits

Cheese Explanation: The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

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

Choledocholithotomy Explanation: Choledocholithotomy refers to incision of the common bile duct for the removal of stones. Cholecystostomy refers to opening and draining the gallbladder. Choledochotomy refers to opening into the common duct. Choledochoduodenostomy refers to anastomosis of the common duct to the duodenum.

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

Clay-colored stools Explanation: The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

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

Clay-colored stools Explanation: The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

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? Increased serum calcium levels Elevated urine amylase levels Decreased white blood cell count Decreased liver enzyme levels

Elevated urine amylase levels Explanation: Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

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? Impaired nutrition: less than body requirements Anxiety Nausea Disturbed body image

Impaired nutrition: less than body requirements Explanation: While each diagnosis may be applicable to this client, the priority nursing diagnosis is impaired nutrition: less than body requirements. The physician, nurse, and dietitian emphasize to the client and family the importance of avoiding alcohol and foods that have produced abdominal pain and discomfort in the past. Oral food or fluid intake is not permitted during the acute phase.

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? Administer enteral or parenteral nutrition. Carry out wound care as prescribed. Withhold oral feedings. Maintain the client in a semi-Fowler's position.

Maintain the client in a semi-Fowler's position. Explanation: The nurse maintains the client in the semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. Respiratory distress and hypoxia are common, and the client may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values. The client who has undergone surgery may have multiple drains or an open surgical incision and is at risk for skin breakdown and infection. Oral food or fluid intake is not permitted; therefore, enteral or parenteral feedings may be prescribed.

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

Pancreatitis Explanation: Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. Appendicitis, cholecystitis, and gastric ulcer are less likely to exhibit fluid volume deficit.

A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ? Releases bile in response to cholecystokinin Digests carbohydrates in the jejunum Serves as a storage unit for glucagon Controls the flow of trypsin to digest proteins

Releases bile in response to cholecystokinin Explanation: The gallbladder is a pear-shaped, hollow, saclike organ that lies in a shallow depression on the inferior surface of the liver. When food enters the duodenum, the gallbladder contracts and the sphincter of Oddi relaxes. Relaxation of this sphincter allows the bile to enter the intestine. This response is mediated by secretion of the hormone cholecystokinin (CCK) from the intestinal wall. Gallstones can block the bile duct and digestive juices to the pancreas causing acute pancreatitis. The gallbladder functions as a storage depot for bile. Bile does not digest carbohydrates in the jejunum. The liver controls the flow of trypsin to digest proteins.

Which is the most common report by clients with pancreatitis? Tarry, black stools and dark urine Increased and painful urination Increased appetite and weight gain Severe, radiating abdominal pain

Severe, radiating abdominal pain Explanation: Clients with pancreatitis most commonly report severe mid- to upper-abdominal pain, radiating to both sides and straight to the back. The client may describe the stools as being frothy and foul smelling, not black or tarry. The client's urine may be dark. The client will not experience increased or painful urination, increased appetite, or weight gain.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: can digest high-fat foods. are at risk for gallbladder contraction. are at risk for hepatic encephalopathy. cannot tolerate high-glucose concentration.

cannot tolerate high-glucose concentration. Explanation: Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client? "Inflammation is confined to only the pancreas." "Tissue necrosis occurs within the pancreas." "Inflammation spreads to the surrounding glands." "Normal function returns after about 2 weeks."

"Inflammation is confined to only the pancreas." Explanation: There are two forms of pancreatitis-inflammatory and necrotizing. Interstitial pancreatitis is characterized by diffuse enlargement of the pancreas due to inflammatory edema confined only to the pancreas itself; normal function returns after about 6 months. Necrotizing pancreatitis is life-threatening and tissue necrosis occurs within the pancreas as well as the surrounding glands.

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? "The tube provides relief from nausea and vomiting." "The tube allows toxins to be removed." "The tube helps control fluid and electrolyte imbalance." "The tube allows the gastrointestinal tract to rest."

"The tube allows the gastrointestinal tract to rest." Explanation: Postoperative management of clients who have undergone a pancreatectomy or a pancreaticoduodenectomy is similar to the management of clients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allow the gastrointestinal tract to rest while promoting adequate nutrition.

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

30 mg/dL Explanation: Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulin-like material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function (i.e., lower than 30 mg/dL [1.6 mmol/L]) (Goldman & Schafer, 2012; McPherson & Pincus, 2011).

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? Providing mouth care Administering morphine I.V. as ordered Maintaining nothing-by-mouth (NPO) status Placing the client in a semi-Fowler's position

Administering morphine I.V. as ordered Explanation: The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

A client whose glucose levels were within normal limits is now concerned because their blood glucose levels have been trending from 210 mg/dL to 330 mg/dL since surgery. Which hormone(s) will the nurse explain is causing the increase in blood glucose level? Select all that apply. Epinephrine Insulin Glucagon Adrenocorticosteroids Thyroid hormone

Glucagon Epinephrine Thyroid hormone Adrenocorticosteroids Explanation: The endocrine system controls the level of blood glucose by regulating the rate at which glucose is synthesized, stored, and moved to and from the bloodstream. Through the action of hormones, blood glucose is normally maintained at less than 100 mg/dL. Hormones that raise the blood glucose level include glucagon, epinephrine, thyroid hormone, and adrenocorticosteroids. Insulin is the primary hormone that lowers the blood glucose level.

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

Maintaining normal respiratory function Explanation: Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

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? Instruct the client to avoid coughing. Reposition the client every 2 hours. Monitor pulse oximetry every hour. Withhold oral feedings for the client.

Reposition the client every 2 hours. Explanation: Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

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? To relieve nausea and vomiting To decrease metabolism To reduce gastric and pancreatic secretions To depress the central nervous system and increase the pain threshold

To reduce gastric and pancreatic secretions Explanation: Anticholinergic medications reduce gastric and pancreatic secretion.

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

Withholding all oral intake, as ordered, to decrease pancreatic secretions Explanation: The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Pain relief may require parenteral opioids such as morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). No clinical evidence supports the use of meperidine for pain relief in pancreatitis, and, in fact, accumulation of its metabolites can cause CNS irritability and possibly seizures. Pancreatitis places the client at risk for fluid volume deficit from fluid loss caused by increased capillary permeability. Therefore, this client needs fluid resuscitation, not fluid restriction. A client with pancreatitis is most comfortable lying on the side with knees flexed.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: light amber urine. black, tarry stools. circumoral pallor. yellow sclerae.

yellow sclerae. Explanation: Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? "Maintain a high-fat, high-carbohydrate diet." "Maintain a high-carbohydrate, low-fat diet." "Maintain a high-fat diet and drink at least 3 L of fluid a day." "Maintain a high-sodium, high-calorie diet."

"Maintain a high-carbohydrate, low-fat diet." Explanation: A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan?

Increase respiratory effectiveness. Explanation: The nurse must teach the client about using an incentive spirometer to promote lung expansion. The high abdominal incision used in a cholecystectomy interferes with respirations postoperatively, increasing the risk of atelectasis. The client will need to use incentive spirometry to promote lung expansion, increase alveolar inflation, and strengthen respiratory muscles. Most clients don't have a nasogastric tube in place after a cholecystectomy. It isn't appropriate to teach improved nutritional status before surgery. It isn't important for the client to be aware of how to decrease the amount of postoperative analgesia, because this is the responsibility of the health care team.

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

Maintaining normal respiratory function Explanation: Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

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? Pixelated Pearl Pigment Patterned

Pigment Explanation: There are two major types of gallstones: those composed predominantly of pigment and those composed primarily of cholesterol. Pigment stones probably form when unconjugated pigments in the bile precipitate to form stones; these stones account for 10% to 25% of cases in the United States. There are no gallstones with the names of pearl, patterned, or pixelated.

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? Relieving abdominal pain Maintaining adequate nutritional status Preventing fluid volume overload Teaching about the disease and its treatment

Relieving abdominal pain Explanation: The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

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

Reserving a site for a peripherally inserted central catheter (PICC) Explanation: Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve a site for placement of a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

A nurse cares for a client who is post op cholecystectomy due to the development of cholesterol stones. The client asks the nurse, "Why did I develop these stones?" What is the nurse's best response? "The stones formed from pigments in the bile and are caused by an infection of the biliary tract." "The stones formed from pigments in the bile and are cause by fatty molecules that deposit in the gallbladder." "The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream." "The stones formed from a component in the bile and are caused by excessive fat in the bloodstream."

"The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream." Explanation: There are two types of gallstones-cholesterol and pigment. Cholesterol gallstones are formed from cholesterol (a component in the bile) and are caused by a decrease in bile acid synthesis and increased cholesterol synthesis. Pigment gallstones are formed by unconjugated pigment in the bile.

This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States? 25% 75% 15% 60%

75% Explanation: Cholesterol stones account for approximately 75% of cases of gallbladder disease in the United States.

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Select all that apply. Dark urine Weight gain Jaundice Clay-colored stools Pruritus

Clay-colored stools Dark urine Jaundice Pruritus Explanation: The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected.

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

Coffee Explanation: Post-acute management of the client with acute pancreatitis includes the introduction of solid food. Oral feedings that are low in fat and protein are gradually initiated. Caffeine is eliminated from the diet and therefore coffee, which contains caffeine, should be removed from the client's breakfast tray. Even decaffeinated coffee has a small amount of caffeine but could serve as a compromise for chronic coffee drinkers. The other food items are appropriate for the client.

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

Measure blood glucose concentration every 4 to 6 hours Explanation: Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors the serum glucose concentration every 4 to 6 hours.

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? Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Pancreatitis causes alterations to hemoglobin, impairing oxygenation. Pancreatitis can atrophy the diaphragm and alter the breathing pattern.

Pancreatitis can elevate the diaphragm and alter the breathing pattern. Explanation: Aggressive pulmonary care is required for clients with acute pancreatitis. Pancreatitis can elevate the diaphragm and alter the breathing pattern of clients. Pancreatitis can cause retention of pulmonary secretions but does not thicken the secretions. Acute pancreatitis does not alter the hemoglobin.

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? Oral bile acids Potassium Vitamin B Vitamin K

Vitamin K Explanation: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

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? Bile-stained vomiting Hypertension Weight loss Warm, dry skin

Bile-stained vomiting Explanation: Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.

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? Warm, dry skin Hypertension Weight loss Bile-stained vomiting

Bile-stained vomiting Explanation: Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.