Gallbladder/Biliary

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

A) yellow sclera Yellow sclerae may be the first sign of jaundice, which occurs when the common bile duct is obstructed.

Which of the following tests is most commonly used to diagnose cholecystitis? A) Abdominal CT scan B) Abdominal ultrasound C) Barium swallow D) Endoscopy

B) Abdominal ultrasound An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present.

When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important? A) Eat a low-protein diet B) Eat a low-fat, low-cholesterol diet C) Limit exercise to 10 minutes/day D) Keep weight proportionate to height

D) Keep weight proportionate to height Obesity is a known cause of gallstones, and maintaining a recommended weight will help protect against gallstones.

The hospital administrator had undergone percutaneous transhepatic cholangiography. which assessment finding indicates complication after the operation? A) Fever and chills B) Hypertension C) Bradycardia D) Nausea and diarrhea

A) Fever and chills Septicemia is a common complication after a percutaneous transhepatic cholangiography. Evidence of fever and chills, possibly indicative of septicemia, is important.

Glenda has cholelithiasis (gallstones). You expect her to complain of: A) Pain in the right upper quadrant, radiating to the shoulder B) Pain in the right lower quadrant, with rebound tenderness C) Pain in the left upper quadrant, with shortness of breath D) Pain in the left lower quadrant, with mild cramping

A) Pain in the right upper quadrant, radiating to the shoulder The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the shoulder.

Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy? A) Passage of two or three soft stools daily B) Evidence of watery diarrhea C) Daily deterioration in the client's handwriting D) Appearance of frothy, foul-smelling stools

A) Passage of two or three soft stools daily

For Jayvin who is taking antacids, which instruction would be included in the teaching plan? A) "Take the antacids with 8 oz of water." B) "Avoid taking other medications within 2 hours of this one." C) "Continue taking antacids even when pain subsides." D) "Weigh yourself daily when taking this medication."

B) "Avoid taking other medications within 2 hours of this one." Antacids neutralize gastric acid and decrease the absorption of other medications. The client should be instructed to avoid taking other medications within 2 hours of the antacid.

George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage? A) "If there is any drainage, notify the surgeon immediately." B) "The drainage will decrease daily until the bile duct heals." C) "First, the drainage is dark green; then it becomes dark yellow." D) "If the drainage stops, milk the tube toward the puncture wound."

B) "The drainage will decrease daily until the bile duct heals." As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.

Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis? A) Administration of antibiotics B) Assessment for complications C) Preparation for lithotripsy D) Preparation for surgery

B) Assessment for complications The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis.

The nurse would assess the client experiencing an acute episode of cholecysitis for pain that is located in the right A) Upper quadrant and radiates to the left scapula and shoulder B) Upper quadrant and radiates to the right scapula and shoulder C) Lower quadrant and radiates to the umbilicus D) Lower quadrant and radiates to the back

B) Upper quadrant and radiates to the right scapula and shoulder During an acute "gallbladder attack," the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatomes in the body.

Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client? A) "Jaundice is associated with pressure ulcer formation." B) "Jaundice impairs urea production, which produces pruritus." C) "Jaundice produces pruritus due to impaired bile acid excretion." D) "Jaundice leads to decreased tissue perfusion and subsequent breakdown."

C) "Jaundice produces pruritus due to impaired bile acid excretion." Jaundice is a symptom characterized by increased bilirubin concentration in the blood. Bile acid excretion is impaired, increasing the bile acids in the skin and causing pruritus.

Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system? A) Ultrasonography. B) MRI C) Endoscopic retrograde cholangiopancreatography (ERCP) D) Computed tomography scan (CT scan)

C) Endoscopic retrograde cholangiopancreatography (ERCP) ERCP permits direct visualization of the pancreatic and common bile ducts. Its therapeutic value is in retrieving gallstones from the distal and common bile ducts and dilating strictures.

Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful? A) 4-6 small meals of low-carbohydrate foods daily B) High-fat, high-carbohydrate meals C) Low-fat, high-carbohydrate meals D) High-fat, low protein meals

C) Low-fat, high-carbohydrate meals For the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbohydrates.

Which of the following symptoms best describes Murphy's sign? A) Periumbilical ecchymosis exists B) On deep palpitation and release, pain in elicited C) On deep inspiration, pain is elicited and breathing stops D) Abdominal muscles are tightened in anticipation of palpation

C) On deep inspiration, pain is elicited and breathing stops Murphy's sign is elicited when the client reacts to pain and stops breathing. It's a common finding in clients with cholecystitis.

A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care? A) Measuring serum potassium for hyperkalemia B) Assessing the client for hypervolemia C) Measuring the client's weight weekly D) Documenting precise intake and output

D) Documenting precise intake and output For the client with ascites receiving diuretic therapy, careful intake and output measurement is essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances.

Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to exhibit? A) Jaundice, dark urine, and steatorrhea B) Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration C) Ecchymosis petechiae, and coffee-ground emesis D) Nausea, vomiting, and anorexia

D) Nausea, vomiting, and anorexia Acute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following: anorexia, nausea, and vomiting; biliary colic; tenderness and rigidity the right upper quadrant (RUQ) elicited on palpation (e.g., Murphy's sign); fever; fat intolerance; and signs and symptoms of jaundice.

A client being treated for chronic cholecystitis should be given which of the following instructions? A) Increase rest B) Avoid antacids C) Increase protein in diet D) Use anticholinergics as prescribed

D) Use anticholinergics as prescribed Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.