Gastro 3 quiz

2. Which clients would be best to assign to the new RN? (select all) 1. ms. h 2. ms. d 3. ms. t 4. mr. a 5. mr. k 6. mr. r

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250. A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? SELECT ALL 1. Ecchymosis 2. Yellow sclera 3. Dark brown stools 4. Straw-colored urine 5. Pain in right upper quadrant

1. Ecchymosis 2. Yellow sclera 5. Pain in right upper quadrant

24. Which condition is most likely to be treated with antibiotics? a. cancer of the gallbladder b. Acute cholelithiasis c. chronic pancreatitis d. acute necrotizing pancreatitis

d. acute necrotizing pancreatitis

5. Which are common manifestations of acute cholecystitis? SELECT ALL a. Anorexia b. ascites c. Eructation d. Steatorrhea e. Jaundice f. Rebound tenderness

a. Anorexia c. Eructation e. Jaundice f. Rebound tenderness

20. The pt with acute pancreatitis experiences abdominal pain. What is the best intervention to begin management of this pain? a. IV opioids by means of PCA b. Oral opioids such as morphine sulfate given as needed c. Intramuscular opioids given every 6 hours d. Oral hydromorphone (dilaudid) given twice a day

a. IV opioids by means of PCA

1. A pt is admitted to the patient care unit with obstructive jaundice. Which S&S does the nurse expect to find upon assessment of the pt? a. Pruritus b. Pale urine in increased amounts c. Pink discoloration of sclera d. Dark, tarry stools

a. Pruritus

27. Which statements about pancreatic cancer are accurate? SELECT ALL a. VTE is a common complication of pancreatic cancer b. Pancreatic cancer often presents in a slow and vague manner c. The most common concern of the patient with pancreatic cancer is pain d. There are no specific blood tests to dx pancreatic cancer e. Chemotherapy is the treatment of choice for pancreatic cancer f. Chronic pancreatitis predisposes a pt to pancreatic cancer

a. VTE is a common complication of pancreatic cancer b. Pancreatic cancer often presents in a slow and vague manner d. There are no specific blood tests to dx pancreatic cancer f. Chronic pancreatitis predisposes a pt to pancreatic cancer

12. Which factor renders a pt the least likely to benefit from Extracorporeal Shock Wave Lithotripsy for the treatment of gallstones? a. height 5 ft 10 inches, 325 lbs b. Cholesterol-based stones c. Height 5 ft 7 inches, 138 lbs d. Small gallstones

a. height 5 ft 10 inches, 325 lbs

33. The pt is to continue pancreatic enzyme replacement therapy (PERT) after discharge. Which statement indicates that the pt understands teaching about this therapy? a. I will take the enzymes before meals with a full glass of water b. I will take the enzymes after I take my ranitidine (Zantac) c. I will mix the enzymes with chopped meat d. I will chew the capsules before swallowing the enzymes

b. I will take the enzymes after I take my ranitidine (Zantac)

11. The nurse is caring for an older adult pt with acute biliary pain. Which drug order the the nurse question? a. Ketorolac (Toradol) b. Meperidine (Demerol) c. Morphine d. Hydromorphone (Dilaudid)

b. Meperidine (Demerol)

22. Which diagnostic test is the most accurate in verifying a dx of acute pancreatitis? a. trypsin b. lipase c. alkaline phosphatase d. Alanine aminotransferase

b. lipase

2. The daughter of a pt with cholelithiasis has heard that there is a genetic disposition for cholelithiasis. The daughter asks the nurse about the risk factors. How does the nurse respond? a. "There is no evidence that first-degree relatives have an increased risk of this disease." b. "Cholecystitis is seen more frequently in pts who are underweight." c. "Hormone replacement therapy has been associated with increased risk for cholecystitis." d. "Pts with DM are at increased risk for cholecystitis."

c. "Hormone replacement therapy has been associated with increased risk for cholecystitis."

25. The nurse has instructed a pt in the recovery phase of acute pancreatitis about diet therapy. Which statement by the pt indicates that teaching has been successful? a. "I will eat the usual three meals a day that I am used to." b. "I am eating tacos for my first meal back home." c. "I will avoid eating chocolate and drinking coffee." d. "I will limit the amount of protein in my diet."

c. "I will avoid eating chocolate and drinking coffee."

21. The pt comes to the ER with severe abdominal pain in the mid-epigastric area. The pt states that the pain began suddenly, is continuous, radiates to his back, and is worst when he lies flat on his back. What condition does the nurse suspect? a. acute cholecystitis b. Pancreatic cancer c. Acute pancreatitis d. Pancreatic pseudocyst

c. Acute pancreatitis

23. A pt with acute pancreatitis is at risk for the development of paralytic (adynamic) ileus. Which action provides the nurse with the best indication of bowel function? a. observing contents of the NG drainage b. Weighing the pt every day at the same time c. Asking the pt if he or she has passed flatus or had a stool d. Obtaining a computed tomography (CT) scan of the abdomen with contrast medium

c. Asking the pt if he or she has passed flatus or had a stool

30. What is the most common and serious complication after a Whipple procedure? a. DM b. wound infection c. Fistula development d. bowel obstruction

c. Fistula development

3. Which pt is at low risk for the development of gallbladder disorders? a. Pt with sickle cell anemia b. Pt who is Mexican American c. Pt who is 20 years old and male d. Pt with a hx of prolonged parenteral nutrition

c. Pt who is 20 years old and male

15. The female pt is to have her gallbladder removed by natural orifice transluminal endoscopic surgery. What does the nurse teach about the surgery? a. The surgeon will use powerful shock waves to break up the gallstones b. The surgeon will insert a trans-hepatic biliary catheter to open blocked bile ducts c. The surgeon will use a vaginal approach to remove your gallbladder d. The surgeon will inject ursodeoxycholic acid to dissolve any remaining gallstone fragments

c. The surgeon will use a vaginal approach to remove your gallbladder

14. Mr. A reluctantly discloses to you that his financial and social situations are problematic. Which aspect of his situation has the most impact on discharge teaching on wound care and other follow-up issues? 1. he is homeless and has no family in the city 2. he has no money for the prescribed medications 3. he has no transportation to the follow-up appointment 4. he cannot read or write very well

1

287. A client who had surgery for a ruptured appendix develops peritonitis. What clinical finding related to peritonitis should the nurse expect the client to exhibit? SELECT ALL 1. Fever 2. Hyperactivity 3. Extreme hunger 4. Urinary retention 5. Abdominal muscle rigidity

1 Fever 5. Abdominal muscle rigidity

22. A client underwent an exploratory laparotomy 2 days ago. The physician should be called immediately for which physical assessment finding? 1. Abdominal distention and rigidity 2. Displacement of the NG tube by the client 3. Absent or hypoactive bowel sounds 4. Nausea and occasional vomiting

1. Abdominal distention and rigidity

251. For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? SELECT ALL 1. Dark urine 2. Yellow skin 3. Pain on urination 4. Clay-colored stool 5. Coffee-ground vomitus

1. Dark urine 2. Yellow skin 4. Clay-colored stool

7. The HCP has assessed a pt's abdomen and found rebound tenderness on deep palpation. What does the nurse recognize? a. Steatorrhea b. Eructation c. Biliary colic d. Blumberg's sign

d. Blumberg's sign

252. Before a cholecystectomy vit K is prescribed. Which element, formed in the presence of vit K, should the nurse determine is the purpose of administering this medication? 1. Bilirubin 2. Prothrombin 3. Thromboplastin 4. Cholecystokinin

2. Prothrombin

247. Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopanreatography (ERCP)? 1. Urine output 2. Bilirubin level 3. Blood pressure 4. Serum glucose

2. bilirubin level

254. A client with a hx of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "what is a pseudocyst?" what information should the nurse include in a response to this question? 1. Malignant growth 2. Pocket of undigested food particles 3. Dilated space of necrotic tissue and blood 4. Sack filled with fluid and pancreatic enzymes

3. Dilated space of necrotic tissue and blood

286. An 18 year old is admitted with an acute onset of right lower quadrant pain at McBurney's point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis? 1. Urinary retention 2. Gastric hyperacidity 3. Rebound tenderness 4. Increased lower bowel motility

3. Rebound tenderness

18. You are providing postoperative care for a client who underwent laparoscopic cholecystectomy. What should be reported immediately to the physician? 1. The client cannot void 5 hours postoperatively 2. The client reports shoulder pain 3. The client reports RUQ pain 4. Output does not equal input for the first few hours

3. The client reports RUQ pain

4. Which reporting tasks are appropriate to delegate to the UAP? (select all) 1. reporting on the condition of ms. t's perineal area after application of ointment 2. reporting of the quality and color of NG drainage for ms. d 3. reporting whether mr. r's blood pressure is below 100/60 mmHg 4. reporting if any of the clients indicate pain 5. reporting if mr. a is seen leaving the unit to smoke a cigarette

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248. A client is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. The nurse is providing discharge teaching about how many days the client should wait to engage in certain activities. Place in order the activities from the first to the last in which the client may engage. 1 _________ Showering 2 _________Driving a car 3 ________ Performing light exercise 4 ________ Getting out of bed in a chair 5 ________ Lifting objects of more than ten pounds

4 3 1 2 5

18. During the shift, the following events happen at the same time. Indicate the order in which you will attend to these situations. 1. ms. h calls for an antiemetic after vomiting bile 2. mr. a wants to know when he will be discharged 3. mr. k's family wants to speak to the physician 4. mr. r is walking down the hall, threatening to leave

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9. Which type of drug is used to treat acute severe biliary pain? a. Acetaminophen (tylenol) b. NSAIDS (Ibuprofen) c. Antiemetics (Compazine) d. Opioids (Morphine)

d. Opioids (Morphine)

16. After removal of the gallbladder, a pt experiences abdominal pain with vomiting for several weeks. What does the nurse recognize? a. Chronic cholecystitis b. Recurrence of acute cholecystitis c. Unremoved gallstones d. Postcholecystectomy syndrome

d. Postcholecystectomy syndrome

14. Which statement about the care of a pt with a Jackson-Pratt (JP) drain after a traditional cholecystectomy is true? a. The pt is maintained in the prone position b. When the pt is allowed to eat, the JP drain is clamped continuously c. The JP drain is irrigated every hour for the first 24 hours d. Serosanguineous drainage stained with bile is expected for 24 hours

d. Serosanguineous drainage stained with bile is expected for 24 hours

19. Disseminated intravascular coagulation (DIC) is a complication of pancreatitis. What pathophysiology leads to this complication? a. Hypovolemia b. Peritoneal irritation and seepage of pancreatic enzymes c. disruption of alveolar-capillary membrane d. consumption of clotting factors and microthrombi formation

d. consumption of clotting factors and microthrombi formation

289. Where would you assess for appendicitis?

right lower quadrant

8. You are observing the nursing student perform an abdominal assessment on Ms. D. For which actions will you intervene? (select all) 1. palpating for abdominal distention with the index finger 2. auscultating for bowel sounds with the NG tube attached to low wall suction 3. performing the physical assessment before asking about pain 4. checking the NG collection canister for quantity and quality of drainage 5. inspecting for visible signs of peristaltic waves or abdominal distention 6. checking for skin turgor over the lower abdominal area

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5. The night nurse gives a brief and incomplete report. Which question do you pose to the night shift nurse to help determine the priority actions for ms. h (36, r. upper quadrant pain, "good night")? 1. "what are her vital signs?" 2. "is she going to surgery or radiology this morning?" 3. "is she still having pain?" 4. "does she need any morning medications?"

2

23. You must rearrange the room assignments for several clients. Which two clients would be best to put in the same room? 1. 35 year old woman with copious intractable diarrhea and vomiting 2. 43 year old woman who underwent cholecystectomy 2 days ago 3. 53 year old woman with pain related to alcohol-associated pancreatitis 4. 62 year old woman with colon cancer receiving chemotherapy and radiation

2. 43 year old woman who underwent cholecystectomy 2 days ago 3. 53 year old woman with pain related to alcohol-associated pancreatitis

249. A nurse is preparing a teaching plan for a client with a hx of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan? 1. Fatty foods are hard to digest 2. Bile flow into the intestine is obstructed 3. The liver is manufacturing inadequate bile 4. There is inadequate closure of the ampulla of Vater

2. Bile flow into the intestine is obstructed

11. Ms. t is discouraged and dispirited about her ulcerative colitis. She is resistant to TPN because "i'm being kept alive with tubes." which explanation will encourage ms. t to continue with the TPN therapy? 1. "it will help you regain your weight" 2. "it will create a positive nitrogen balance" 3. "your physician has ordered this important therapy for you" 4. "your bowel can rest and the diarrhea will increase"

4

19. You find the new RN in the bathroom crying. She tells you, "i'm a terrible nurse. I'm so disorganized and so far behind. I'm going to quit. I hate this job." what is the best thing to do? 1. send her on a break off the unit 2. offer to take one of her clients 3. ask the UAP to help her out 4. calm her down and help her prioritize

4

4. The nurse on a med-surg unit is caring for several pts with acute cholecystitis. Which task is best to delegate to the UAP? a. Obtain pt's VS b. Determine if any foods are not tolerated c. Assess what measures relieve the abdominal pain d. Ask the pts to describe their daily activity or exercise routines

a. Obtain pt's VS

35. Which abnormal laboratory findings are cardinal findings in acute pancreatitis? SELECT ALL a. elevated serum lipase b. increased serum amylase c. decreased serum trypsin d. elevated serum elastase e. elevated serum glucose

a. elevated serum lipase b. increased serum amylase d. elevated serum elastase

29. The nurse is caring for a pt with pancreatic cancer who had a Whipple procedure. Which interventions or assessments does the nurse implement? SELECT ALL a. place the pt in the semi-fowlers position b. place the NG tube on intermittent suction c. monitor NG drainage, which should be bile-tinged and contain blood d. keep the pt NPO e. check blood glucose often

a. place the pt in the semi-fowlers position b. place the NG tube on intermittent suction d. keep the pt NPO e. check blood glucose often

34. Which are potential cardiovascular complications for a pt after surgery for a Whipple procedure? SELECT ALL a. thrombophlebitis b. PE c. MI d. HF e. renal failure

a. thrombophlebitis c. MI d. HF

31. What are manifestations of pancreatic cancer? SELECT ALL a. light-colored urine and dark-colored stools b. Anorexia and weight loss c. Splenomegaly d. Ascites e. Leg or calf pain f. Weakness and fatigue

b. Anorexia and weight loss c. Splenomegaly d. Ascites e. Leg or calf pain f. Weakness and fatigue

26. The nursing student is caring for a pt with chronic pancreatitis who is receiving pancreatic enzyme replacement therapy. Which statement by the student indicates the need for further study concerning this therapy? a. The enzymes will be administered with meals b. the pt will take the drugs with a glass of water c. If the pt has difficulty swallowing the enzyme preparation, i will crush it and mix it with foods d. The effectiveness of pancreatic enzyme treatment is monitored by the frequency and fat content of stools

c. If the pt has difficulty swallowing the enzyme preparation, i will crush it and mix it with foods

17. Because of mr. k's advanced age, which complications of enteral feedings may occur? (select all) 1. hyperglycemia 2. hypotension 3. aspiration 4. diarrhea 5. fluid overload

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20. What information regarding mr. r, who has acute pancreatitis, is appropriate to report to the physician? (select all) 1. hematocrit is decreased by more than 10% 2. calcium level is less than 9 mg/dL 3. partial oxygen pressure (PO2) is less than 60 mmHg. 4. pain is unrelieved by medication 5. blood type is O positive

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3. Which tasks will you delegate to the UAP? (select all) 1. assisting mr. t with perineal care after diarrheal episodes 2. measuring vital signs every 2 hours for mr. r 3. transporting ms. h off the unit for a procedure 4. gently cleansing the nares around ms. d's NG tube 5. removing mr. a's dressing

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23. What tasks should be accomplished toward the end of the shift before leaving for the day? (Select all) 1. complete documentation on all assigned clients 2. admit a new client from the ED 3. check all IV sites and total IV fluids 4. ask the UAP to obtain vital sign values for all clients 5. briefly check and assess every client 6. thank ancillary staff for their help 7. complete mr. r's transfer to the ICU

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13. The UAP asks, "why can't ms. t get out of bed and do things for herself? she's only 29." what is your best response? 1. "the physician ordered bed rest for a few days" 2. "decreasing activity helps to decrease the diarrhea" 3. "acute exacerbations require decreased GI motility" 4. "she is too depressed and malnourished"

2

16. You are teaching the nursing student about enteral feedings for clients such as mr. k, who has a PEG tube. in the postoperative period, when can enteral feedings be started? 1. within 6-8 hours after the procedure 2. when bowel sounds are present, usually within 24 hours 3. when the client reports feeling hungry 4. on a schedule determined by pharmacy

2

257. A client is admitted with a tentative dx of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? SELECT ALL 1. Provide a low-fat diet 2. Administer analgesics 3. Teach relaxation exercises 4. Encourage walking in the hall 5. Monitor cardiac rate and rhythm 6. Observe for signs of hypercalcemia

2. Administer analgesics 3. Teach relaxation exercises 5. Monitor cardiac rate and rhythm

253. A client is returned to the surgical unit after an abdominal cholecystectomy. What is the MAIN reason why the nurse should assess for clinical indicators of respiratory complications? 1. Length of time required for surgery is prolonged 2. Incision is in close proximity to the client's diaphragm 3. Client's resistance is lowered because of bile in the blood 4. Bloodstream is invaded by microorganisms from the biliary tract

2. Incision is in close proximity to the client's diaphragm

288. A client had surgery for a perforated appendix with localized peritonitis. In which position should the nurse place this client? 1. Sims 2. Semi-fowlers 3. Trendelenburg 4. Dorsal recumbent

2. Semi-fowlers

10. Ms. D reports feeling weak. she seems more confused compared with her baseline. you observe that the NG drainage container has a large amount of watery bile-colored fluid. which lab values will you check first? 1. blood urea nitrogen and creatinine levels 2. platelet count and wbc count 3. sodium level, potassium level, and pH of blood 4. bilirubin level, hematocrit, and hemoglobin level

3

12. Ms. t is receiving sulfasalazine (Azulfidine) 500 mg by mouth every 6 hours for treatment of ulcerative colitis. Which assessment finding concerns you the most? 1. urine discoloration 2. nausea and vomiting 3. decreased urine output 4. headache

3

15. While you are teaching mr. a about dressing changes, he says, "when you live on the street, you can't do everything the way you nurses do in the hospital." what is the most important thing to emphasize in helping him to accomplish self-care? 1. "use new sterile field for supplies" 2. "maintain a sterile field for supplies" 3. "wash your hands before a dressing change" 4. "discard any opened packages of unused gauze"

3

22. The physician arrives while you are caring for mr. r. Based on mr. r's change of status (refer to questions 20 and 21), before the physician leaves, which order should you advocate for? 1. perform additional lab tests and continue monitoring 2. prepare mr. r for emergency surgery 3. prepare mr. r for transfer to the ICU 4. reestablish NG suction and apply restraints

3

6. Ms. H's physician told her that she would probably need a laparoscopic cholecystectomy; however, the hepatobiliary iminodiacetic acid scan and laboratory results are still pending. Ms. H asks, "what should i expect?" What is the best intervention at this point? 1. describe the surgical procedure 2. call the physician to come and speak with her 3. provide some written material about gallbladder disease and options 4. explain general postoperative care, such as coughing and deep breathing exercises

3

9. You are unable to locate Ms. d's morning vital signs. The new nurse who is assigned to the client says she assumed that the UAP would take and record them. The UAP tells you she thought that the nursing student was supposed to do that. The nursing student says that no one told her to take ms. d's vital signs. what should you do first? 1. take ms. d's vital signs yourself, reassess the client, and write an incident report 2. talk to the nursing instructor and find out if the student was expected to take ms. d's morning vital signs 3. ask the UAP to take ms. d's vitals now, record them, and report the values to the new nurse 4. advise the new nurse to take ms. d's vital signs herself and remind her that the nurse is ultimately responsible

3

21. The physician has been paged and is en route to see mr. r with acute pancreatitis. The client is increasingly agitated and confused. He pulls out his IV line and NG tube and removes the oxygen nasal cannula. His skin is pale and clammy. Pulse rate is 140 BPM and BP is 140/60 mmHg. List in order of priority the following steps in caring for mr. r. 1. restart IV line 2. reinsert NG tube 3. stay with client 4. replace nasal cannula for supplemental oxygen 5. have a colleague gather equipment, including a pulse oximeter and nonrebreather mask 6. check the blood glucose level 7. continuously monitor vital signs

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255. A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "what does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? 1. Promotes the formation of calculi in the cystic duct 2. Stimulates the pancreas to secrete more insulin than it can immediately produce 3. Alters the composition of enzymes so they are capable of damaging the pancreas 4. Increases enzyme secretion and pancreatic duct pressure that causes back-flow of enzymes into the pancreas

4. Increases enzyme secretion and pancreatic duct pressure that causes back-flow of enzymes into the pancreas

7. All of these clients must receive their routine morning medications. Which client should receive his or her medication last? 1. ms. h (36, r. upper quadrant pain, "good night") 2. ms. d (60, vomiting & mid-abd. pain, NG, IV, NPO) 3. ms. t (29, wasted & malnourished, diarrhea, TPN through central line) 4. mr. a (26, discharging in afternoon) 5. mr. k (85, A&O x 2, PEG, family asks a lot of questions and argues) 6. mr. r (57, periumbilical pain, no pain relief, NPO, NG, IV, belligerent & confused, elevated WBC & glucose)

5

Case Study: 6 clients Ms. H - 36, r. upper quadrant pain that radiates to r. shoulder, hx of gallstones, acute cholecystitis, "had a good night" Ms. D - 60, vomiting & pain in midabdomen related to bowel obstruction, abd. pain has improved since NG tube, has IV fluids and on NPO status Ms. T - 29, wasted and malnourished, severe diarrhea, predefecation abd. pain and generalized tenderness to palpation, TPN through central line Mr. A - 26, discharged in afternoon, wants review of wound care instructions before he leaves Mr. K - 85, frail but A&O x 2, transferred from extended care to receive a percutaneous endoscopic gastrostomy (PEG) tube that was placed 5 days ago, large family that ask a lot of questions and argue continuously with each other and staff, he has stable vitals Mr. R - 57, periumbilical pain, pain is severe despite meds and radiates to back, admitted w/ acute pancreatitis, NPO w/ NG tube and IV line, he is belligerent and confused, WBC & blood glucose levels increased 1. The night shift nurse has just finished giving you report on the 6 clients. Which client has the highest acuity level and is at greatest risk for shock during your shift? 1. ms. h (36, r. upper quadrant pain, "good night") 2. ms. d (60, vomiting & mid-abd. pain, NG, IV, NPO) 3. ms. t (29, wasted & malnourished, diarrhea, TPN through central line) 4. mr. a (26, discharging in afternoon) 5. mr. k (85, A&O x 2, PEG, family asks a lot of questions and argues) 6. mr. r (57, periumbilical pain, no pain relief, NPO, NG, IV, belligerent & confused, elevated WBC & glucose)

6

10. The nurse is administering ketorolac (toradol) to a 78 yo pt for mild to moderate pain management. Which assessment finding indicates the pt is experiencing a side effect of this drug? a. Abdominal bloating and cramping b. Ventricular cardiac dysrhythmias c. Decreased urinary output d. Jaundice

a. Abdominal bloating and cramping

13. Which statements are true regarding laparoscopic cholecystectomy? SELECT ALL a. Laparoscopic cholecystectomy is considered the gold standard and is performed far more often than the traditional open approach. b. Pts with chronic lung disease or HF who are unable to tolerate the oxygen used in the laparoscopic procedure are examples of pts who have the open approach (Abdominal laparotomy) c. Removing the gallbladder with the laparoscopic technique reduces the risk of wound complications d. Pts who have their gallbladders removed by the laparoscopic technique should be taught the importance of early ambulation to promote absorption of CO2 e. Use of laparoscopic cholecystectomy puts the pt at increased risk for bile duct injuries

a. Laparoscopic cholecystectomy is considered the gold standard and is performed far more often than the traditional open approach. c. Removing the gallbladder with the laparoscopic technique reduces the risk of wound complications d. Pts who have their gallbladders removed by the laparoscopic technique should be taught the importance of early ambulation to promote absorption of CO2

18. The nurse is evaluating electrolyte values for a pt with acute pancreatitis and notes that the serum calcium is 6.8 mEq/L. How does the nurse interpret this finding? a. Within normal limits considering the dx of acute pancreatitis b. A result of the body not being able to used bound calcium c. A protective measure that will reduce the risk of complications d. Full compensation of the parathyroid gland

b. A result of the body not being able to used bound calcium

32. The nurse is teaching a pt and family how to prevent exacerbations of chronic pancreatitis. Which teaching point does the nurse include? a. Moderation in the use of caffeinated beverages b. Avoidance of alcohol and nicotine c. Consume a bland, high-fat, low-protein diet d. Regular exercise, stressing aerobic activities

b. Avoidance of alcohol and nicotine

17. The pt with acute cholecystitis had a pacemaker. Which diagnostic test is contraindicated? a. ERCP b. Magnetic resonance cholangiopancreatography (MRCP) c. Ultrasonography of the RUQ d. Hepatobiliary (HIDA) scan

b. Magnetic resonance cholangiopancreatography (MRCP)

28. The nurse detects an epigastric mass while assessing a pt with acute pancreatitis. The pt describes epigastric pain that radiates to his back. What does the nurse suspect? a. Liver cirrhosis b. Pancreatic pseudocyst c. Gallstones d. Chronic pancreatitis

b. Pancreatic pseudocyst

8. A pt is scheduled for tests to verify the medical dx of cholecystitis. For which diagnostic test does the nurse provide pt teaching? a. extracorporeal shock wave lithotripsy (ESWL) b. Ultrasonography of the RUQ c. Endoscopic retrograde cholangiopancreatography (ERCP) d. Serum level of aspartate aminotransferase (AST)

b. Ultrasonography of the RUQ

6. The nurse is assessing a pt with acute cholecystitis whose abdominal pain is severe. The pt has a HR of 118, is pale, diaphoretic, and describes extreme fatigue. What is the nurse's priority action at this time? a. Instruct the UAP to check a complete set of VS b. Auscultate the pt's abdomen in all four quadrants c. Notify the pt's HCP d. Administer the ordered opioid analgesic

c. Notify the pt's HCP