Assessment and Management of Patients With Biliary Disorders

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

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

Choice Multiple question - Select all answer choices that apply. The nurse admits a woman reporting severe right upper quadrant pain after eating Christmas dinner. The nurse suspects gallbladder disease. Statistics show that incidence of gallbladder disease is greater for women who are a) Older than 40 years b) Obese c) Thin d) Multiparous

• Multiparous • Obese • Older than 40 years Explanation: Two to three times more women than men develop cholesterol stones and gallbladder disease; affected women are usually older than 40 years, multiparous, and obese.

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) Anxiety related to unknown outcome of hospitalization b) Acute pain related to biliary spasms c) Deficient knowledge related to prevention of disease recurrence d) Imbalanced nutrition: Less than body requirements related to biliary inflammation

Acute pain related to biliary spasms Explanation: 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 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) Placing the client in a semi-Fowler's position b) Administering morphine I.V. as ordered c) Providing mouth care d) Maintaining nothing-by-mouth (NPO) status

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

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

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

Which nursing action is most appropriate for a client hospitalized with acute pancreatitis? a) Withholding all oral intake, as ordered, to decrease pancreatic secretions b) Limiting I.V. fluids, as ordered, to decrease cardiac workload c) Administering meperedine, as ordered, to relieve severe pain d) Keeping the client supine to increase comfort

Withholding all oral intake, as ordered, to decrease pancreatic secretions Explanation: The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Typically, this client requires a nasogastric tube to decompress the stomach and GI tract. Although pancreatitis may cause considerable pain, it's treated with I.M. meperidine (Demerol), not morphine, which may worsen pain by inducing spasms of the pancreatic and biliary ducts. No clinical evidence supports the use of meperidine for pain relief in pancreatitis, and, in fact, accumulation of its metabolites can cause CNS irritability and possibly seizures. Pancreatitis places the client at risk for fluid volume deficit from fluid loss caused by increased capillary permeability. Therefore, this client needs fluid resuscitation, not fluid restriction. A client with pancreatitis is most comfortable lying on the side with knees flexed.

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) 7 months c) Over 1 year d) 1 month

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

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic? a) Ensure that the client rests. b) Administer analgesics to the client. c) Avoid administering antispasmodics. d) Ensure that the client has eaten a full meal.

Administer analgesics to the client. Explanation: The pain of acute cholecystitis may be so severe that the client requires analgesics. During an attack of biliary colic, the nurse should ensure that the client rests. The nurse should not give the client a full meal; instead, the nurse should monitor the client's ability to digest a bland liquid diet. The nurse should also administer antispasmodics or analgesics as prescribed to relieve pain and discomfort.

Which of the following is clinical manifestation of cholelithiasis? a) Nonpalpable abdominal mass b) Epigastric distress prior to a meal c) Upper left quadrant abdominal pain d) Clay-colored stools

Clay-colored stools Explanation: The patient with gallstones has clay-colored stools, and excruciating upper right quadrant pain that radiates to the back or right shoulder. The patient develops a fever and may have a palpable abdominal mass.

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) Use incentive spirometry every hour. c) Instruct the client to cough only when necessary. d) Withhold analgesics unless necessary.

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

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) Inability for the liver to reabsorb serum glucose b) Ingestion of foods high in sugar c) Dysfunction of the pancreatic islet cells d) Renal failure

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

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: a) Pleural effusion b) Sepsis c) Edema and inflammation d) Disseminated intravascular coagulopathy

Edema and inflammation Explanation: 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.

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) Increased serum calcium levels b) Elevated urine amylase levels c) Decreased liver enzyme levels d) Decreased white blood cell count

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

Which of the following enzymes aids in the digestion of fats? a) Lipase b) Amylase c) Secretin d) Trypsin

Lipase Explanation: Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

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) NPO status postop for 2 days d) Observe color of sclera

Observe color of sclera Explanation: 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.

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right? a) Pixelated b) Patterned c) Pearl d) Pigment

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

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Maintaining adequate nutritional status b) Teaching about the disease and its treatment c) Preventing fluid volume overload d) Relieving abdominal pain

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

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.

They cannot tolerate high-glucose concentration. Explanation: 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.

The digestion of carbohydrates is aided by a) trypsin. b) secretin. c) amylase. d) lipase.

amylase. Explanation: 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.

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) yellow sclerae. d) black, tarry stools.

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