Complex Ch 50: Metabolic
Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a) Hot roast beef sandwich with gravy b) Vanilla pudding c) White rice d) Mashed potatoes
Answer: A The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as fried chicken, because fatty foods may bring on an episode of cholecystitis. (page 1395)
A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: a) Edema and inflammation b) Disseminated intravascular coagulopathy c) Pleural effusion d) Sepsis
Answer: A Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas (page 1182)
Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels? a) Dry mouth, which makes the patient thirsty b) Frequent vomiting leading to loss of fluid volume c) Acetone in the urine d) High glucose levels in the blood
Answer: B Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the patient's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the patient daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea. (page 1404)
A patient discharged following a laparoscopic cholecystectomy calls the surgeon's office complaining of severe right shoulder pain 24 hours after surgery. Which of the following statements is the correct information for the nurse to provide to this patient? a) This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated. b) 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. c) This pain is caused from your incision. Take analgesics as needed and as prescribed and report to surgeon if pain is unrelieved even with analgesic use. d) This may be the beginning symptoms of an infection. You need to come to see the surgeon today for an evaluation.
Answer: B 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 (page 1400)
When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? a) One-time exposure to petrochemicals b) History of pancreatitis c) Ingestion of a low-fat diet d) Ingestion of caffeinated coffee
Answer: B 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. (page 1410)
The nurse is planning care for a patient following an incisional cholecystectomy for cholelithiasis. Which of the following interventions is the highest nursing priority for this patient? a) Performing range-of-motion (ROM) leg exercises hourly while the patient is awake b) Assisting the patient to ambulate the evening of the operative day c) Assisting the patient to turn, cough, and deep breathe every 2 hours d) Teaching the patient to choose low-fat foods from the menu
Answer: C Assessment should focus on the patient'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. (page 1399)
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? a) Providing mouth care b) Maintaining nothing-by-mouth (NPO) status c) Administering morphine I.V. as ordered d) Placing the client in a semi-Fowler's position
Answer: C 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. (page 1403)
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? a) Maintaining adequate nutritional status b) Preventing fluid volume overload c) Relieving abdominal pain d) Teaching about the disease and its treatment
Answer: C 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. (page 1402)
A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? a) Serum bilirubin level greater than 1.0 mg/dL b) Serum albumin concentration of 4.0 g/dL c) Serum ammonia concentration of 90 mg/dL d) Serum globulin concentration of 2.0 g/dL
Answer: A If the flow of bile is impeded (e.g., by gallstones in the bile ducts), bilirubin does not enter the intestine. As a result, blood levels of bilirubin increase. (page 1390)
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? a) Decreased white blood cell count b) Elevated urine amylase levels c) Decreased liver enzyme levels d) Increased serum calcium levels
Answer: B 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 (page 1402)
Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis? a) Shock b) Tetany c) Pancreatic necrosis d) Multiple organ dysfunction syndrome (MODS)
Answer: C Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Shock and MODS may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in patients with acute pancreatitis (page 1404)
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a) Over 1 year b) 1 to 4 months c) 4 to 6 months d) 6 to 12 months
Answer: D Six to 12 months of therapy with UDCA is recommended in patients to dissolve the stones. (page 1395)
Which of the following is clinical manifestation of cholelithiasis? a) Epigastric distress prior to a meal b) Nonpalpable abdominal mass c) Upper left quadrant abdominal pain d) Clay-colored stools
Answer: D The patient 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 patient develops a fever and may have a palpable abdominal mass (page 1393)
The physician has written the following orders: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) for a new patient admitted with pancreatitis. The nurse attributes which of the following as the cause for NPO status? a) To avoid inflammation of the pancreas b) To aid opening up of pancreatic duct c) To drain the pancreatic bed d) To prevent the occurrence of fibrosis
Answer: A Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas. (page 1406)
The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? a) Low-sodium, high-potassium, low-fat diet b) Low-carbohydrate, high-potassium diet c) High-carbohydrate, high-protein, low-fat diet d) High-carbohydrate, low-protein, low-fat diet
Answer: D The nurse should provide a high-carbohydrate, low-protein, low-fat diet when tolerated. These foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond. (page 1407)
A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply.) a) Hyperglycemia b) An abnormal glucose tolerance c) Hypoglycemia d) Glucosuria e) Elevated lipase level
Answer: A, B, D An important sign, if present, is the onset of symptoms of insulin deficiency: glucosuria, hyperglycemia, and abnormal glucose tolerance. Therefore, diabetes may be an early sign of carcinoma of the pancreas. (page 1410)
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a) 4 months b) Over 1 year c) 7 months d) 1 month
Answer: C Six to 12 months of therapy with UDCA is recommended in patients to dissolve the stones. (page 1395)
A nurse is caring for a client in the emergency department who is complaining of severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value requires immediate intervention? a) Calcium level of 7.8 mg/dl b) Serum glucose level of 240 mg/dl c) White blood cell (WBC) count of 18,000 mm3 d) Troponin of 2.3 mcg/L
Answer: D An elevated troponin level indicates myocardial damage and needs immediate further investigation. Hyperglycemia (evidenced by a serum glucose of 240 mg/dl), an elevated WBC count, and hypocalcemia (evidenced by a calcium level of 7.8 mg/dl), although commonly seen in pancreatitis, don't require immediate action. (page 1182)
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? a) Maintaining nothing-by-mouth (NPO) status b) Placing the client in a semi-Fowler's position c) Providing mouth care d) Administering morphine I.V. as ordered
Answer: D 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 (page 1403)
The nurse identifies a potential collaborative problem of electrolyte imbalance for a patient with severe acute pancreatitis. Which of the following assessment findings would alert the nurse to an electrolyte imbalance associated with acute pancreatitis? a) Paralytic ileus and abdominal distention b) Muscle twitching and finger numbness c) Elevated blood glucose levels d) Hypotension
Answer: B 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. (page 1406)
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a) Encouraging frequent visits from family and friends b) Administering frequent oral feedings c) Positioning the client on the side with the knees flexed d) Administering an analgesic once per shift, as ordered, to prevent drug addiction
Answer: C 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 (page 1404)
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 boardlike and no bowel sounds are detected. What is the major concern for this patient? a) The patient has developed renal failure. b) The patient requires more pain medication. c) The patient is developing a paralytic ileus. d) The patient has developed peritonitis.
Answer: D Abdominal guarding is present. A rigid or boardlike abdomen may develop and is generally an ominous sign, usually indicating peritonitis. (page 1402)
The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? a) Jaundice b) Fever c) Mental agitation d) Severe abdominal pain
Answer: D Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas. (page 1402)
Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy? a) Semi-Fowler's position b) Low-carbohydrate, low-protein diet immediately after surgery c) Observe color of sclera d) NPO status postop for 2 days
Answer: C The nurse should be particularly observant of the color of the sclera. After recovery from anesthesia, the patient is placed in the low Fowler's position. Water and other fluids may be administered within hours after laparoscopic procedures. A soft diet is started after bowel sounds return. (page 1399)
Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? a) Pancreatitis b) Peptic ulcer c) Appendicitis d) Cholecystitis
Answer: A Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit. (page 1402)
A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Acute pain related to biliary spasms c) Deficient knowledge related to prevention of disease recurrence d) Anxiety related to unknown outcome of hospitalization
Answer: B The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.
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? a) Monitor pulse oximetry every hour. b) Withhold analgesics unless necessary. c) Instruct the client to cough only when necessary. d) Use incentive spirometry every hour.
Answer: D 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. (page 1403)
What is a major concern for the nurse when caring for a patient with chronic pancreatitis? a) Mental status changes b) Weight loss c) Nausea d) Pain
Answer: B Weight loss is a major problem in chronic pancreatitis. More than 80% of patients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. (page 1408)
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? a) To depress the central nervous system and increase the pain threshold b) To decrease metabolism c) To reduce gastric and pancreatic secretions d) To relieve nausea and vomiting
Answer: C Anticholinergic medications reduce gastric and pancreatic secretion. (page 1406)
A 70-year-old patient 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 of the following gerontologic considerations associated with the pancreas? a) Increases in the bicarbonate output by the kidneys b) Decreases in the physiologic function of major organs c) Development of local complications d) Increases in the rate of pancreatic secretion
Answer: B 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 patients 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. (page 1401)
A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.) a) Amber-colored urine b) Clay-colored feces c) Jaundice d) Pain in the left upper abdominal quadrant e) Pruritus
Answer: B, C, E Jaundice occurs in a few patients with gallbladder disease, usually with obstruction of the common bile duct. The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin and mucous membranes a yellow color. This is frequently accompanied by marked pruritus (itching) of the skin. 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 (page 1393)
Several clinical manifestations are associated with a tumor of the head of the pancreas. Choose all that apply. a) Amber-colored urine b) Dark urine c) Dark-colored stools d) Clay-colored stools e) Jaundice
Answer: B, D, E Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. 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. (page 1411)
A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to a) Presence of diabetes mellitus b) Cigarette smoking c) Age d) Dietary intake of fat
Answer: C Incidence of pancreatic cancer increases with age, peaking in the seventh and eighth decades for both men and women. It is very rare before 45 years, and most patients present in or beyond the sixth decade of life. Cigarette smoking, exposure to industrial chemicals or toxins in the environment, and a diet high in fat, meat, or both are associated with pancreatic cancer, although their roles are not completely clear. Diabetes mellitus, chronic pancreatitis, and hereditary pancreatitis are also associated with pancreatic cancer. (page 1410)
Total parental nutrition (TPN) should be used cautiously in patients with pancreatitis due to which of the following? a) They can digest high-fat foods. b) They are at risk for hepatic encephalopathy. c) They are at risk for gallbladder contraction. d) They cannot tolerate high-glucose concentration.
Answer: D Total parental nutrition (TPN) is used carefully in patients with pancreatitis because some patients cannot tolerate a high-glucose concentration, even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, while intake of high protein increases risk for hepatic encephalopathy in patients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest. (page 1404)
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: a) Serum bilirubin b) Serum calcium c) Serum lipase d) Serum amylase
Answer: C In most cases, serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days longer than amylase. (page 1402)
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? a) Decreased liver enzyme levels b) Increased serum calcium levels c) Elevated urine amylase levels d) Decreased white blood cell count
Answer: C 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. (page 1402)
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a) Dysfunction of the pancreatic islet cells b) Inability for the liver to reabsorb serum glucose c) Ingestion of foods high in sugar d) Renal failure
Answer: A 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. (page 1409)
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? a) Disturbed body image b) Anxiety c) Nausea d) Impaired nutrition: less than body requirements
Answer: D 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. (page 1409)
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? a) Elevated urine amylase levels b) Increased serum calcium levels c) Decreased white blood cell count d) Decreased liver enzyme levels
Answer: A 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. (page 1402)
A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a) Reserving an antecubital site for a peripherally inserted central catheter (PICC) b) Providing generous servings at mealtime c) Providing the client with plenty of P.O. fluids d) Limiting I.V. fluid intake according to the physician's order
Answer: A Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for 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. (page 1404)
Which dietary modification is utilized for a patient diagnosed with acute pancreatitis? a) High-protein diet b) Elimination of coffee c) High-fat diet d) Low-carbohydrate diet
Answer: B A high-carbohydrate, low-fat, and low-protein diet should be implemented. Alcohol, caffeine, and spicy foods should be avoided. (page 1407)
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a) Sepsis b) Edema and inflammation c) Disseminated intravascular coagulopathy d) Pleural effusion
Answer: B Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months. (page 1401)
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) a) Assisting the patient into the prone position b) Encouraging bed rest to decrease the metabolic rate c) Administering parenteral opioid analgesics as ordered d) Administering prophylactic antibiotics e) Withholding oral feedings to limit the release of secretin
Answer: B, C, E The current recommendation for pain management is the use of opioids, with assessment for their effectiveness and altering therapy if pain is not controlled or increased (Marx, 2009). Nonpharmacologic interventions such as proper positioning (not prone), music, distraction, and imagery may be effective in reducing pain when used along with medications. In addition, oral feedings are withheld to decrease the secretion of secretin (page 1404)
The digestion of carbohydrates is aided by a) secretin. b) lipase. c) amylase. d) trypsin.
Answer: C Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas. (page 1390)
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? a) Maintaining nothing-by-mouth (NPO) status b) Providing mouth care c) Administering morphine I.V. as ordered d) Placing the client in a semi-Fowler's position
Answer: C 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. (page 1403)
Which of the following terms most precisely refers to the incision of the common bile duct for removal of stones? a) Choledochotomy b) Choledochoduodenostomy c) Cholecystostomy d) Choledocholithotomy
Answer: D Choledocholithotomy refers to incision of the common bile duct for the removal of stones (liths). Cholecystostomy refers to opening and drainage of the gallbladder. Choledochotomy refers to opening into the common duct. Choledochoduodenostomy refers to anastomosis of the common duct to the duodenum. (page 1398)
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? a) 15% b) 60% c) 25% d) 75%
Answer: D Cholesterol stones account for approximately 75% of cases of gallbladder disease in the United States.
A patient is admitted to the health care center with severe abdominal pain rated at 10 on a 1-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP) as ordered. The nurse plans for which of the following goals following the administration of this mediation? a) To control BP b) To diagnose the cause of abdominal pain c) To control muscle spasms d) To increase the patient's pain threshold
Answer: D Morphine, fentanyl, and hydromorphone act by depressing the central nervous system and thereby increasing the patient's pain threshold. (page 1406)
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? a) Teaching about the disease and its treatment b) Maintaining adequate nutritional status c) Preventing fluid volume overload d) Relieving abdominal pain
Answer: D 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. (page 1402)
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? a) 30 mg/dL b) 50 mg/dL c) 70 mg/dL d) 90 mg/dL
Answer: A Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulinlike 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]). (page 1413)
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? a) Potassium b) Vitamin K c) Vitamin B d) Oral bile acids
Answer: D (page
A patient with acute pancreatitis has been started on total parenteral nutrition (TPN). Following the administration of the TPN, which of the following should the nurse plan to monitor? a) Blood glucose levels every 4 to 6 hours b) Auscultate the abdomen for bowel sounds every 4 hours c) Complaints of nausea and vomiting d) Measure the abdominal girth every shift
Answer: A Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels every 4 to 6 hours. (page 1404)
A patient has a nasogastric (NG) tube for suction and is NPO following a pancreaticoduodenectomy. Which of the following explanations made by the nurse is the major purpose of this treatment? a) The tube will allow the gastrointestinal (GI) tract to rest. b) The tube will allow the removal of toxins. c) The tube will provide relief from nausea and vomiting. d) The tube will help control fluid and electrolyte imbalance.
Answer: A Postoperative management of patients who have undergone a pancreatectomy or a pancreaticoduodenectomy is similar to the management of patients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allows the GI tract to rest while promoting adequate nutrition. (page 1412)
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? a) To decrease metabolism b) To reduce gastric and pancreatic secretions c) To depress the central nervous system and increase the pain threshold d) To relieve nausea and vomiting
Answer: B Anticholinergic medications reduce gastric and pancreatic secretion. (page 1406)
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) light amber urine. b) circumoral pallor. c) black, tarry stools. d) yellow sclerae.
Answer: D 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. (page 1393)
