Chapter 59 EAQ

What patient has the highest risk for development of cholecystitis? 28-year-old Caucasian male who just had gastric bypass 55-year-old American Indian female with Crohn's disease 38-year-old African American male patient with elevated cholesterol 32-year-old African American female oncology patient receiving total parenteral nutrition (TPN)

55-year-old American Indian female with Crohn's disease

A patient who has undergone an open cholecystectomy reports mild to moderate nausea. Which nursing action is correct? Administer an antiemetic as prescribed as soon as possible. Give the patient clear liquids and monitor the patient's response. Notify the provider that the patient may have an abdominal obstruction. Withhold antiemetic medications until the patient has increased nausea.

Administer an antiemetic as prescribed as soon as possible.

What interventions are necessary in a patient with acute pancreatitis who is at risk for paralytic ileus? Select all that apply. Some correct answers were not selected Provide enteral feedings Decrease pain medication Administer a saline enema Ask if patient has passed flatus Maintain a patent nasogastric (NG) tube

Ask if patient has passed flatus Maintain a patent nasogastric (NG) tube

A patient who has just undergone a laparoscopic cholecystectomy is complaining of shoulder pain. What is most likely the cause of this pain? Lack of mobility Carbon dioxide gas Positioning during surgery Pain from remaining from gallstones

Carbon dioxide gas

A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis? Acute Chronic Calculous Acalculous

Chronic

A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition? Peritonitis Malnutrition Vitamin deficiency Chronic cholecystitis

Chronic cholecystitis

When performing an abdominal assessment on a patient diagnosed with pancreatitis, the nurse notes gray-blue discoloration around the periumbilical area, a dull sound on percussion, and normal bowel sounds. What action by the nurse is priority? Document the findings Prepare the patient for the operating room Contact the health care provider immediately Obtain a stat hemoglobin and hematocrit level

Document the findings

The nurse suspects that a patient may have acute pancreatitis as evidenced by which group of laboratory results? Elevated bilirubin, elevated alkaline phosphatase Deceased calcium, elevated amylase, decreased magnesium Elevated lipase, elevated white blood cell count, elevated glucose Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

Elevated lipase, elevated white blood cell count, elevated glucose

A patient is admitted to the hospital for treatment for acute pancreatitis. The patient's spouse asks the nurse when the patient will be allowed to eat. The nurse bases her response upon which understanding of care of a patient with acute pancreatitis? The patient will be NPO until all symptoms have resolved. The patient will require long-term total parenteral nutrition (TPN). Food is withheld during the acute phase to reduce enzyme secretion. Food is allowed when the patient is hungry and the appetite returns to normal.

Food is withheld during the acute phase to reduce enzyme secretion.

What diet does the health care provider prescribe for a patient during the healing phase of acute pancreatitis? Select all that apply. Some correct answers were not selected Alcohol High protein Low fat meal Coffee and tea High carbohydrates

High protein Low fat meal High carbohydrates

A patient diagnosed with cholelithiasis has a gallstone lodged in the common bile duct. What assessment findings are consistent with this diagnosis? Select all that apply. Some correct answers were not selected Icterus Ascites Jaundice Hematochezia Light amber urine

Icterus Jaundice

The nurse in the emergency department is assessing a patient. Which assessment findings, if present in the patient, would prompt the nurse to suspect chronic cholecystitis? Select all that apply. Some correct answers were not selected Icterus Jaundice Halitosis Cholangitis Odynophagia

Icterus Jaundice Cholangitis

The nurse is reviewing the lab results of a patient diagnosed with cholecystitis. Elevations in which results would prompt the nurse to suspect abnormal liver function in this patient. Select all that apply. Some correct answers were not selected Serum amylase White blood cell count Lactate dehydrogenase Serum alkaline phosphate Aspartate aminotransferase

Lactate dehydrogenase Serum alkaline phosphate Aspartate aminotransferase

A patient is undergoing extracorporeal shockwave lithotripsy. The patient complains of pain in the abdomen. What action by the nurse is appropriate? Reposition the patient. Prepare for conscious sedation. Ask the interventionist to stop the procedure. Let the patient know this is normal when the stones are breaking up and moving.

Let the patient know this is normal when the stones are breaking up and moving.

Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas? Lipase Trypsin Elastase Kallikrein

Lipase

The nurse expects which patient will be discharged to the home environment first? Older obese adult who has had a laparoscopic cholecystectomy Middle-aged thin adult who has had a laparoscopic cholecystectomy Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

Middle-aged thin adult who has had a laparoscopic cholecystectomy

A patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach? Normal weight Absence of infection Low serum cholesterol Ability to tolerate iodine

Normal weight

A patient has an external drain attached to a percutaneous transhepatic biliary catheter that is to be drained and measured every 4 hours. At 1600, the nurse notes a reduction in bile drainage from when she emptied the drain at 0800 and 1200. Which nursing action is correct? Place the patient in the Trendelenburg position. Cap the drain to determine if it may be discontinued. Irrigate the transhepatic biliary catheter with normal saline. Notify the provider that the drain is not functioning correctly.

Notify the provider that the drain is not functioning correctly.

Which of the following factors may be associated with the development of cholelithiasis? Select all that apply. Some correct answers were not selected Smoking Weight loss Nutrition habits Sedentary lifestyle Mexican-American populations

Nutrition habits Sedentary lifestyle Mexican-American populations

Which patients are suitable candidates for extracorporeal shock wave lithotripsy (ESWL) to treat gallstones? Select all that apply. Some correct answers were not selected Patient with normal body weight Patient with cancer of the gallbladder Patient with cholesterol-based stones Patient with good gallbladder function Patient with severe biliary obstruction

Patient with normal body weight Patient with cholesterol-based stones Patient with good gallbladder function

The nurse is caring for a patient who underwent an open cholecystectomy 2 hours ago. What finding would require immediate intervention? Pain level of 6/10 Absent bowel sounds Refusal to cough and deep breathe 40 mL of green drainage from the Jackson-Pratt drain

Refusal to cough and deep breathe

What finding is most concerning for a patient who has just undergone an open cholecystectomy? Output of 25 mL/hr Reddened incision site Pain of 7/10 at the incision site Respiratory rate of 8 breaths/minute

Respiratory rate of 8 breaths/minute

A patient is diagnosed with acute pancreatitis. Which test is a sensitive indicator of biliary obstruction in this disorder? Serum amylase Serum bilirubin Alkaline phosphatase Serum alanine aminotransferase

Serum alanine aminotransferase

The nurse is reviewing lab values of a patient diagnosed with cholecystitis. Elevations in which additional labs would prompt the nurse to suspect pancreatic involvement? Select all that apply. Some correct answers were not selected Serum lipase Serum amylase Alkaline phosphate White blood cell count Lactate dehydrogenase

Serum lipase Serum amylase

A patient who has acute pancreatitis is ordered to receive ranitidine. The nurse explains that this drug is given for which purpose? To alleviate pain caused by the release of pancreatic enzymes To decrease gastric acid secretion that often occurs with pancreatitis To improve the patient's ability to absorb food as the disease is resolving To minimize the side effects of other medications used to treat pancreatitis

To decrease gastric acid secretion that often occurs with pancreatitis

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

Turkey sandwich on wheat bread

Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis, in order to dissolve remaining stone fragments? Ketorolac Morphine sulfate Bethanechol Ursodeoxycholic acid

Ursodeoxycholic acid

A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this procedure? Mouth Vagina Rectum Umbilicus

Vagina

A patient is diagnosed with pancreatic cancer. Which is a common complication that the patient can develop? Infection Dyspepsia Eructation Venous emboli

Venous emboli

The nurse is preparing to instruct a patient with chronic pancreatitis who is to begin taking pancrelipase. Which instruction does the nurse include when teaching the patient about this medication? 'Chew tablets before swallowing.' 'Wipe your lips after taking pancrelipase.' 'Take pancrelipase 45 minutes before meals.' 'Administer pancrelipase before taking an antacid.'

Wipe your lips after taking pancrelipase.'

The nurse is providing dietary education to a patient diagnosed with cholecystitis. What foods chosen by the patient indicate that the teaching has been effective? Select all that apply. Some correct answers were not selected Low-fat foods High-fiber foods High-calorie foods Low-protein foods Low-carbohydrate foods

Low-fat foods High-fiber foods Low-carbohydrate foods

A patient with acute cholecystitis is admitted to the medical-surgical unit. Which nursing intervention is most appropriately delegated to the unlicensed assistive personnel (UAP)? Checking for bowel sounds and distention Assessing dietary risk factors for cholecystitis Determining precipitating factors for abdominal pain Obtaining the admission weight, height, and vital signs

Obtaining the admission weight, height, and vital signs

A patient receiving chenodiol acid for cholelithiasis has just received teaching about the medication. What statement by the patient indicates that the teaching was effective? 'If I have diarrhea, I will call my doctor.' 'I can take this medication for up to 5 years.' 'I should take the medication on an empty stomach.' 'I will need to have gallbladder ultrasound every 2 months for a year.'

'If I have diarrhea, I will call my doctor.'

What findings should be reported to the health care provider prior to a patient having magnetic resonance cholangiopancreatography? Select all that apply. Some correct answers were not selected Pacemaker Iodine allergy Presence of jaundice Elevated lactate dehydrogenase Implantable cardioverter-defibrillator

Pacemaker Implantable cardioverter-defibrillator

In acute pancreatitis, what does elevated serum lipase indicate? Inflammation Pancreatic cell injury Hepatobiliary obstruction Hepatobiliary involvement

Pancreatic cell injury

Which is a priority nursing assessment for the patient with severe acute pancreatitis? Fever and other signs of infection Perfusion and other signs of shock Pain level and other signs of discomfort Breath sounds and other signs of pneumonia

Perfusion and other signs of shock

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

Young adult patient with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min

Which patient characteristics are risk factors for cholelithiasis? Select all that apply. Some correct answers were not selected Aging Obesity Depression Diabetes mellitus Vitamin deficiency

Aging Obesity Diabetes mellitus

The nurse is providing teaching about pancreatic enzyme replacement to a patient diagnosed with chronic pancreatitis. What statement by the patient indicates need for further teaching? 'I will swallow the tablet without chewing.' 'I won't mix the enzyme with protein foods.' 'I will take my pancreatic enzymes after my antacid.' 'I will take the pancreatic enzyme half an hour before meals.'

'I will take the pancreatic enzyme half an hour before meals.'

The nurse is caring for a patient recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The patient asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? 'The diabetes could be related to your obesity.' 'Do you consume alcohol on a frequent basis?' 'What has your doctor told you about your disease?' 'Type 1 diabetes can occur when the pancreas is destroyed by disease.'

'Type 1 diabetes can occur when the pancreas is destroyed by disease.'

A patient is in the healing stage of pancreatitis. The patient asks the nurse how to go about planning daily menus based around some favorite foods. Which meal is most appropriate for this patient? A scoop of mildly seasoned chicken salad served with crackers Two slices of ham on a piece of wheat toast served with iced black tea A small unseasoned portion of fish with a side of macaroni and cheese A skinless breast of poached chicken seasoned with pepper with a side of rice

A scoop of mildly seasoned chicken salad served with crackers

Which is the primary risk factor for chronic calcifying pancreatitis? Alcoholism Cholecystitis Viral infection Metabolic disturbances

Alcoholism

Which symptom of chronic pancreatitis also occurs with acute pancreatitis? Ascites Abdominal pain Protein malabsorption Loss of exocrine function

Abdominal pain

Which possible complication of chronic pancreatitis presents as a painful, palpable mass in the left upper quadrant? Ascites Steatorrhea Cholecystitis Abscess or pseudocyst

Abscess or pseudocystAbscess or pseudocyst

A patient with chronic pancreatitis has edema of the feet, legs, and hands. This is a sign of which problem associated with chronic pancreatitis? Hypovolemia Hypocalcemia Fat malabsorption Protein malabsorption

Protein malabsorption

Which factors increase the risk of developing pancreatic cancer? Select all that apply. Some correct answers were not selected Aging Cirrhosis Smoking Vitamin deficiency Chronic pancreatitis

Cirrhosis Smoking Chronic pancreatitis

To monitor the effectiveness of pancreatic enzyme therapy, what does the nurse assess? Weight Urine output Blood glucose Consistency and number of stools

Consistency and number of stools

A patient who has just undergone a Whipple procedure for pancreatic cancer has frank blood and an increased output from the biliary drainage tubes. What action by the nurse is priority? Contact the surgeon Document the output Assess the patient's vital signs Clamp the nasogastric (NG) tube

Contact the surgeon

What imaging will provide the most reliable diagnosis of acute pancreatitis? Chest x-ray Abdominal ultrasound Contrast-enhanced computed tomography Endoscopic retrograde cholangiopancreatography (ERCP)

Contrast-enhanced computed tomography

The nurse is preparing a patient for a magnetic resonance cholangiopancreatography (MRCP) scan. Which contrast medium does the nurse tell the patient will be administered prior to the procedure? Ketorolac Morphine Meperidine Gadolinium

Gadolinium

A patient diagnosed with chronic cholecystitis developed jaundice and clay-colored stools. For which other signs and/or symptoms should the patient be assessed? Select all that apply. Some correct answers were not selected Icterus Ascites Asterixis Steatorrhea Peripheral edema

Icterus Steatorrhea

The patient presents to the emergency department with recurrent right upper quadrant abdominal pain following meals. Additional symptoms include belching and indigestion. Cholecystitis is diagnosed. Which comorbidities prompt the nurse to suspect the patient is suffering from calculous cholecystitis? Select all that apply. Some correct answers were not selected Sepsis Hypovolemia Multisystem organ failure Impaired gallbladder motility Abnormal metabolism of cholesterol

Impaired gallbladder motility Abnormal metabolism of cholesterol

Which diagnostic results lead the nurse to suspect that a patient may have gallbladder disease? Increased WBC count, visualization of calcified gallstones, edema of the gallbladder wall Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

Increased WBC count, visualization of calcified gallstones, edema of the gallbladder wall

The patient presents to the emergency department with severe abdominal pain. The nurse is reviewing the patient's lab results. What laboratory findings would prompt the nurse to suspect a diagnosis of acute pancreatitis? Select all that apply. Some correct answers were not selected Decreased bilirubin Increased serum amylase Decreased serum glucose Decreased serum calcium Increased alanine aminotransferase

Increased serum amylase Decreased serum calcium Increased alanine aminotransferase

The nurse is assessing a patient in the emergency department. Which assessment findings, if present in the patient, would prompt the nurse to suspect a pancreatic pseudocyst? Select all that apply. Some correct answers were not selected Jaundice Steatorrhea Odynophagia Palpable epigastric mass Epigastric pain radiating to the back

Jaundice Palpable epigastric mass Epigastric pain radiating to the back

A patient with acute pancreatitis continues to be unable to eat 48 hours after onset of the illness. The nurse notifies the provider to discuss which intervention to provide nutrition for this patient? Gastric tube feedings Jejunal tube feedings A clear, fortified liquid diet Total parenteral nutrition (TPN)

Jejunal tube feedings

Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin? Lipase Trypsin Elastase Kallikrein

Kallikrein

A patient scheduled for a cholecystectomy because of gallstones causing cholecystitis reports a pain level of 4 on a 0-to-10 pain scale. Which analgesic medication does the nurse anticipate will be prescribed for the patient? Ketorolac Morphine Meperidine Hydromorphone

Ketorolac

A patient has undergone a Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which interventions does the nurse implement to prevent complications? Select all that apply. Some correct answers were not selected Monitor mental status. Measure blood glucose levels. Assess bowel sounds and stools. Ensure that biliary drainage is colorless and clear. Place the patient in the supine position.

Monitor mental status. Measure blood glucose levels. Assess bowel sounds and stools.

The nurse understands that which patient is at highest risk for developing gallstones? Thin female who has recently given birth Obese female on hormone replacement therapy Thin male with a history of coronary artery bypass grafting Obese male with a history of chronic obstructive pulmonary disease

Obese female on hormone replacement therapy

A patient has been diagnosed with Stage 4 metastatic pancreatic cancer. Which management strategy is typical for this type of cancer? Curative Palliative Preventive No treatment

Palliative

The nurse is caring for a patient diagnosed with acute pancreatitis who has had increased pain and guarding along with the following vital signs: blood pressure 108/60, pulse 125, temperature of 103.8°F, and an O 2 saturation of 95% on 2 L via nasal cannula. The nurse suspects the patient has a pancreatic abscess. After contacting the health care provider, what should the nurse do first? Reassess the vital signs Place the patient supine Administer rectal acetaminophen Prepare the patient for pancreatic drainage

Prepare the patient for pancreatic drainage

What medications are administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply. Some correct answers were not selected Imipenem Ranitidine Meperidine Omeprazole Ciprofloxacin

Ranitidine Omeprazole

A patient with chronic pancreatitis linked to alcoholism tells the nurse that absolute abstention from alcohol is impossible, but states an intention to consume only one alcoholic beverage a day. Which response by the nurse is correct? Ask the patient's family to remove all alcohol from the home Suggest that the patient wean from daily alcohol use gradually Recommend that the patient contact an alcoholic support group Tell the patient that continued use of alcohol will likely be fatal

Recommend that the patient contact an alcoholic support group

A patient who has undergone an open cholecystectomy 12 hours prior has a Jackson-Pratt (JP) drain. The nurse empties the drainage and notes bile-stained serosanguineous fluid. Which nursing action is correct? Contact the provider to report a possible surgical infection. Notify the provider that the patient may have a perforation of the bile duct. Raise the drainage system above the site of insertion to minimize blood loss. Record the amount and color of the fluid and continue to monitor the patient.

Record the amount and color of the fluid and continue to monitor the patient.

A patient who has undergone an open Whipple procedure for pancreatic cancer has a heart rate of 110 beats/min, blood pressure of 90/62 mm Hg, and urine output less than 1 ml/kg/hr. The nurse notifies the surgeon to report which postoperative complication? Shock Fistula Heart failure Renal failure

Shock

The nurse is attempting to position a patient having an acute attack of pancreatitis in the most comfortable position possible. Which position is appropriate for this patient? Supine, with a pillow supporting the abdomen High Fowler's position, with pillows used as needed Side-lying position, with knees drawn up to the chest Up in a chair between frequent periods of ambulation

Side-lying position, with knees drawn up to the chest

A nurse is assessing a patient who presents with severe abdominal pain radiating at times to the shoulder. The nurse notes the patient's skin and sclera are yellow in appearance. The patient reports a sedentary lifestyle and experiences rebound tenderness when tested for Blumberg sign. What does the nurse suspect? The patient has chronic cholecystitis because Blumberg sign is present in this form of the disease. The patient has acute cholecystitis because Blumberg sign is present in this form of the disease. The patient has acute cholecystitis because jaundice and icterus are common in this form of the disease. The patient has chronic cholecystitis because jaundice and icterus are common in this form of the disease.

The patient has chronic cholecystitis because jaundice and icterus are common in this form of the disease.

As part of the pathophysiologic process during acute pancreatitis, proteolysis results in which effect? Lipolysis of calcium and hypocalcemia Thrombosis and gangrene of the pancreas Necrosis of blood vessels and hemorrhage Fat necrosis and cell membrane disruption

Thrombosis and gangrene of the pancreas

A patient admitted for cholecystitis who is scheduled for a cholecystectomy in 6 hours reports pain of 3/10 and requests pain medication. Vital signs are blood pressure 120/68, pulse 86, and temperature of 98.9° F. What medication does the nurse anticipate administering? Ketorolac IV Morphine IV Ibuprofen PO Acetaminophen PO

Ketorolac IV

When caring for a patient with pancreatic cancer who is having severe pain, which intervention is the priority? Supplementation with nonnarcotic medications to minimize opioid use Reassurance that pain medication doses will be increased when needed Use of adjunctive pain management strategies to prevent drug dependency Administration of high-dose opioid analgesics when the patient reports pain

Administration of high-dose opioid analgesics when the patient reports pain

A patient admitted for cholecystitis presents with the following vital signs: blood pressure 145/92, pulse 108, and temperature of 101.8°F. What action by the nurse is priority? Request a STAT ultrasound Administer PRN ketorolac (IV) Request an order to increase the IV fluids Place the patient supine with the head of bed flat

Administer PRN ketorolac (IV)

A patient with cholecystitis reports pain in the right upper abdominal quadrant after a meal. The nurse assesses the patient and notes a heart rate of 115 beats/min, pallor, and diaphoresis. Which nursing action is correct? Elevate the head of the bed. Notify the health care provider. Administer an analgesic medication. Palpate to assess for rebound tenderness.

Administer an analgesic medication.

A patient who has undergone a laparoscopic cholecystectomy is complaining of upper chest and shoulder pain. What action by the nurse is most appropriate? Administer heat Place arm in a sling Tell the patient to rest the arm Encourage range-of-motion exercises

Administer heat

A patient is experiencing an attack of acute pancreatitis. Which nursing intervention is the highestpriority for this patient? Administer opioid analgesic medication. Do not administer food or fluids by mouth (NPO). Measure intake and output every shift. Assist the patient to assume a position of comfort.

Administer opioid analgesic medication.

The nurse is caring for a patient who has been admitted multiple times for pancreatitis. The patient has inflammation and fibrosis of the tissue and diminished pancreatic function. What assessment is priority for this patient? Nicotine use Family support Alcohol consumption Adherence to prescribed medication regimen

Alcohol consumption

The patient diagnosed with acute pancreatitis has a positive Chvostek's sign. What action by the nurse is priority? Assess the serum calcium level Evaluate the sclera for jaundice Contact the health care provider Administer PRN pain medication

Assess the serum calcium level

A patient suspected of having cholecystitis presents with severe upper epigastric pain radiating to the right shoulder. The patient is vomiting and has abdominal distention. What findings do these symptoms indicate? Biliary colic Liver involvement Chronic cholecystitis Positive Blumberg's sign

Biliary colic

What dietary suggestions are indicated for a patient who is in the healing phase after acute pancreatitis? Select all that apply. Some correct answers were not selected Bland foods Low-fat foods Low-protein foods Small, frequent meals Low-carbohydrate foods

Bland foods Low-fat foods Small, frequent meals

A patient who has undergone a laparoscopic cholecystectomy reports mild postoperative abdominal bloating and discomfort. Which nursing action is correct? Notify the provider of possible peritonitis Administer an opioid analgesic medication Encourage the patient to ambulate in the hall Withhold oral fluids until these symptoms have passed

Encourage the patient to ambulate in the hall

The nurse is reviewing the laboratory results for a patient with acute pancreatitis. Which findings does the nurse expect to find in the report? Select all that apply. Some correct answers were not selected Increase in platelet count Decrease in albumin level Decrease in triglyceride level Increase in serum glucose level Increase in blood urea nitrogen (BUN)

Decrease in albumin level Increase in serum glucose level Increase in blood urea nitrogen (BUN)

The nurse is planning discharge teaching for a patient following a cholecystectomy. Which symptoms of post-cholecystectomy syndrome should the patient be taught to report? Select all that apply. Some correct answers were not selected Diarrhea Vomiting Dyspepsia Eructation Epigastric pain

Diarrhea Vomiting Epigastric pain

The nurse is preparing a patient for a laparoscopic cholecystectomy. After reinforcing the surgeon's preoperative teaching, what other information should the nurse include in teaching? Discuss postoperative pain medications, deep-breathing, and leg exercises. Show the patient the T-tube drain and give instructions about how to care for it. Teach the patient and family about the need to maintain a no-fat diet after surgery. Give information about home health agencies to provide postoperative nursing care.

Discuss postoperative pain medications, deep-breathing, and leg exercises.

A patient with chronic pancreatitis has developed a pseudocyst that has not resolved after 8 weeks, and the provider plans a percutaneous drainage procedure. The patient asks the nurse why this is necessary since it does not seem to be causing problems. Which complication does the nurse explain the procedure will prevent? Abscess Infection Steatorrhea Hemorrhage

Hemorrhage

Which finding is expected in a patient who has a liver function abnormality? Increased white blood cell (WBC) count Decreased level of lactate dehydrogenase Decreased level of aspartate aminotransferase Increase in serum levels of alkaline phosphatase

Increase in serum levels of alkaline phosphatase

A patient who has had acute mid-epigastric pain for 3 days has elevated glucose, bilirubin, serum lipase, and a threefold increase in alanine aminotransferase. The serum amylase is normal. What does the nurse suspect about the possible cause of this patient's pain? It is not caused by pancreatitis. It may be caused by pancreatitis. It is caused by acute biliary pancreatitis. It is caused by hepatobiliary inflammation only.

It is caused by acute biliary pancreatitis.

Which symptoms present in a patient with acute pancreatitis indicate complications? Select all that apply. Some correct answers were not selected Vertigo Jaundice Depression Darkened urine Clay-colored stools

Jaundice Darkened urine Clay-colored stools

The nurse is caring for a patient with chronic pancreatitis. What assessment findings are related to this disease process? Select all that apply. Some correct answers were not selected Diarrhea Jaundice Polydipsia Polyphagia Weight gain

Jaundice Polydipsia Polyphagia

A patient hospitalized with pancreatitis is being discharged with home health services. The patient is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the patient's strength? Limiting the patient's activities to one floor of the home Asking the health care provider for a request for PRN nasal oxygen Instructing the patient to take an as-needed (PRN) sleeping medication at night Arranging for the patient to have a nutritional consult to assess the patient's diet

Limiting the patient's activities to one floor of the home

The nurse is preparing to administer the prescribed dose of pancrelipase to a patient with chronic pancreatitis. What pancreatic enzymes make up this medication? Select all that apply. Some correct answers were not selected Lipase Trypsin Elastase Amylase Protease

Lipase Amylase Protease

What labs should the nurse review for a patient suspected of having cholecystitis? Select all that apply. Some correct answers were not selected Platelets Hematocrit Liver function White blood cells Alkaline phosphate

Liver function White blood cells Alkaline phosphate

A patient with a history of chronic pancreatitis presents with left upper quadrant pain, fever, and a palpable mass. A diagnosis of pancreatic abscess is made. Which intervention is most likely to promote a positive patient outcome? Performance of an abdominal ultrasound Administration of broad-spectrum intravenous (IV) antibiotics Placement of a percutaneous drain in the pancreatic abscess Measurement of serum electrolytes and a complete blood count

Placement of a percutaneous drain in the pancreatic abscess

The nurse is caring for a patient with acute pancreatitis. The patient is complaining of shortness of breath and orthopnea. The patient's vital signs are: blood pressure 140/80, pulse 110, oxygen saturation 90% on room air, and temperature 99.8° F. What complication does the nurse suspect? Hemorrhage Paralytic ileus Pleural effusion Pancreatic infection

Pleural effusion

The patient is evaluated for use of extracorporeal shockwave lithotripsy for treatment of cholelithiasis. What findings should the nurse notify the health care provider about? Body mass index (BMI) of 27 Upper abdominal pain Cholesterol-based stones Poor gallbladder function

Poor gallbladder function

Which factor is considered a risk factor in the development of cholelithiasis? Anemia Pregnancy Less than age 40 years Low body mass index (BMI)

Pregnancy

A patient with an external transhepatic biliary catheter has had a reduction in drainage. What does this finding indicate? The catheter is not working. The patient needs to change positions. There is a decrease in biliary secretions. The patient will need to increase the medication.

The catheter is not working.

A patient diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? 'This may be an indication of pancreatic disease.' 'This may be an indication that you are developing sepsis.' 'The gallstones are present, but have become fibrotic and contracted.' 'This type of gallbladder inflammation is associated with severe dehydration.'

This type of gallbladder inflammation is associated with severe dehydration.'

The nurse is teaching a female patient about cholecystectomy via a natural orifice transluminal endoscopic surgery. What statement by the patient indicates that the teaching has been effective? 'I will only have two small scars.' 'I can still have gallstones after this procedure.' 'This procedure will repair, not remove, my gallbladder.' 'A small incision will be made in my vagina to access my gallbladder.'

'A small incision will be made in my vagina to access my gallbladder.'

The nurse is providing discharge teaching to a patient who is being discharged home after hospitalization for acute pancreatitis. Which statement by the patient indicates a need for further teaching? 'I may have caffeine and chocolate in moderation.' 'I should avoid alcohol even after symptoms resolve.' 'I may need to take fat-soluble vitamins and other supplements.' 'I will consume a diet high in carbohydrates and protein and low in fats.'

'I may have caffeine and chocolate in moderation.'

The nurse is teaching a patient with chronic pancreatitis about pancreatic-enzyme replacement therapy. Which statement by the patient indicates a correct understanding of the teaching? 'I should mix the capsule contents with high-protein foods.' 'I should drink a minimum amount of water after taking the medication.' 'If I can't swallow the capsule, I may break it open and chew the contents.' 'I may spread the capsule contents over applesauce, mashed fruit, or rice cereal.'

'I may spread the capsule contents over applesauce, mashed fruit, or rice cereal.'

A patient receiving chenodiol for cholelithiasis has just received teaching about the medication. What statement by the patient indicates the teaching was effective? 'Diarrhea is a normal side effect of this medication.' 'I should take the medication on an empty stomach.' 'I will need to have gallbladder ultrasound every 6 months for a year.' 'I will need to take this medication for the rest of my life, or until I have my gallbladder removed.'

'I will need to have gallbladder ultrasound every 6 months for a year.'

The nurse is teaching a patient about extracorporeal shockwave lithotripsy. What statement by the patient indicates a need for further teaching? 'I will sit in 12 inches of water.' 'The stones will pass through my digestive system.' 'The shockwaves will turn the big stones into small stones.' 'I may need to take ursodeoxycholic acid after this procedure.'

'I will sit in 12 inches of water.'

A patient has been discharged to home after being hospitalized with an acute episode of pancreatitis. The patient, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the patient's spouse expresses frustration to the home health nurse regarding the patient's refusal. What is the nurse's best response? 'I'll get you some information on the support group Al-Anon.' 'Keep mentioning the AA meetings to your spouse on a regular basis.' 'Tell me more about your frustration with your spouse's refusal to participate in AA.' 'Your spouse will sign up for the meetings only when he is ready to deal with his problem.'

'I'll get you some information on the support group Al-Anon.'

The nurse is providing postoperative teaching to a patient scheduled for a laparoscopic cholecystectomy. What instructions should be included? 'Introduce high-fat foods one at a time.' 'The sutures will be removed in 14 days.' 'You will be back to normal activities within 4 weeks.' 'You will not be able to eat regular food for 24 to 48 hours.'

'Introduce high-fat foods one at a time.'

A patient who underwent a traditional cholecystectomy is concerned that the drainage in the Jackson-Pratt drain is now green. What statement by the nurse is most appropriate? 'It is normal for the first 24 hours.' 'The drain may need to be repositioned.' 'Why don't we have you roll on your other side?' 'I'm going to take a small sample and send it to the lab.'

'It is normal for the first 24 hours.'

An older patient diagnosed with cholecystitis presents with acute confusion and minimal pain. The family is concerned that the patient is confused and wants to know why the patient did not have other symptoms associated with cholecystitis. What statement by the nurse is most appropriate? 'I'll have the health care provider come and talk to you.' 'Older patients often don't have expected symptoms of cholecystitis.' 'The patient probably wasn't able to tell you because of the confusion.' 'Most of the time, confusion is the only thing the patients present with.'

'Older patients often don't have expected symptoms of cholecystitis.'

A patient with an internal/external biliary drainage tube contacts the health care provider's office to report jaundice and leakage around the catheter site. What instructions should the nurse provide? 'Reconnect the drainage bag.' 'Take your ursodeoxycholic acid.' 'Go to the emergency department.' 'Go to the lab to have your bilirubin level checked.'

'Reconnect the drainage bag.'

A patient has developed acute pancreatitis caused by gallstones in the biliary system. Which is the highest priority instruction for this patient to avoid further attacks of pancreatitis? 'You'll need to drastically modify your alcohol intake.' 'You may need a surgical consult for removal of your gallbladder.' 'See your health care provider immediately when experiencing symptoms of a gallbladder attack.' 'If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider.'

'See your health care provider immediately when experiencing symptoms of a gallbladder attack.'

The nurse is assessing a patient's alcohol intake to determine whether it is the underlying cause of the patient's attacks of pancreatitis. Which question does the nurse ask to elicit this information? 'Do you usually binge drink?' 'Tell me more about your alcohol intake.' 'Do you tend to drink more on holidays or weekends?' 'Estimate how many episodes of binge drinking you do in a week.'

'Tell me more about your alcohol intake.'

A patient admitted with a diagnosis of pancreatitis is questioning the NPO order. What statement by the nurse is most appropriate? 'This alleviates the pain.' 'This reduces pancreatic enzyme secretion.' 'This rests your stomach and decreases vomiting.' 'We will provide IV fluid replacement with calcium.'

'This reduces pancreatic enzyme secretion.'

A patient has just been diagnosed with pancreatic cancer. The patient's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? 'Maybe you should find a support group to join.' 'Do you want me to try to find a therapist for you?' 'Do you have any friends whom you want me to call?' 'Would you like me to contact the hospital chaplain for you?'

'Would you like me to contact the hospital chaplain for you?'

What are risk factors for cholecystitis? Select all that apply. Some correct answers were not selected Pregnancy Male gender Prolonged fasting African American ethnicity Family history of gallstones

Pregnancy Prolonged fasting Family history of gallstones

A patient reports severe mid-epigastric pain radiating to the left flank and back. The nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen and periumbilical area. The nurse suspects which cause of acute pain in this patient? Pancreatitis Biliary colic Cholecystitis Gastroenteritis

Pancreatitis

Which set of assessment findings indicates to the nurse that a patient may have acute pancreatitis? Absence of jaundice, pain of gradual onset Presence of jaundice, pain worsening when sitting up Absence of jaundice, pain in right abdominal quadrant Presence of jaundice, pain worsening when lying supine

Presence of jaundice, pain worsening when lying supine

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

Protein