Chapter 44

Acalculous cholescystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply) A. Fasting B. Hypothyroidism C. Parenteral nutrition D. Prolonged immobility E. Streptococcus pneumoniae F. Absence of bile in the intestines

A. Fasting C. Parenteral nutrition D. Prolonged immobility

Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all that apply) A. Obesity B. Age over 40 C. Multiparous female D. History of excessive gallbladder disease E. Family history of gallbladder disease F. Use of estrogen or oral contraceptives

A. Obesity B. Age over 40 C. Multiparous female E. Family history of gallbladder disease F. Use of estrogen or oral contraceptives

Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? A. Return to work in 2-3 weeks B. Be hospitalized for 3-5 days post-op C. Have a T-tube placed in the common duct to provide bile drainage D. Have up to four small abdominal incisions covered with small dressings

D. Have up to four small abdominal incisions covered with small dressings

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. A lower-fat diet may be better tolerated for several weeks. B. Do not return to work or normal activities for 3 weeks. C. Bile-colored drainage will probably drain from the incision. D. Keep the bandages on and the puncture site dry until it heals.

A. A lower-fat diet may be better tolerated for several weeks Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery. Normal activities can be gradually resumed as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test? A. It is noninvasive and is a very reliable method of detecting gallstones B. It is used only when other tests cannot be used because of allergy to contract media C. It will outline the gallbladder and the ductal system to enable visualization of stonesD. It is an adjunct to liver function tests to determine whether the gallbladder is inflamed

A. It is noninvasive and is a very reliable method of detecting gallstones

What must the nurse do to care for a T-tube in a patient following a cholecystectomy? A. Keep the tube supported and free of kinks B. Attach the tube to low, continuous suction C. Clamp the tube when ambulating the patient D. Irrigate the tube with 10mL sterile saline every 2-4 hours

A. Keep the tube supported and free of kinks

What treatment for acute cholecystitis will prevent further stimulation of the gallbladder? A. NPO with NG suction B. Incisional cholecystectomy C. Administration of antiemetics D. Administration of anticholinergics

A. NPO with NG suction

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K E. Vitamin B

A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.

A patient with an obstruction of the common bile duct has clay-colored fatty stools, among other manifestations. What is the pathophysiologic change that causes this clinical manifestation? A. Soluble bilirubin in the blood excreted into the urine B. Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion C. Contraction of the inflamed gallbladder and obstructed ducts, stimulated by cholecystokinin when fats enter the duodenum D. Obstruction of the common duct prevents bile drainage into the duodenum, resulting in congestion of bile in the liver and subsequent absorption into the blood

B. Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? A. Prevent all oral intake. B. Control abdominal pain. C. Provide enteral feedings. D. Avoid dietary cholesterol.

B. Control abdominal pain. Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis.

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response? A. A low-fat diet will prevent the development of further gallstones and should be continued B. Yes, because you will not have a gallbladder to store bile, you will not be able to digest fats adequately C. A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile D. Removal of the gallbladder will eliminate the source of your pain associated with fat intake, so you may eat whatever you like

C. A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy? A. Low-grade fever of 100° F and dehydration B. Abscess in the right upper quadrant of the abdomen C. Activated partial thromboplastin time (aPTT) of 54 seconds D. Multiple obstructions in the cystic and common bile duct

C. Activated partial thromboplastin time (aPTT) of 54 seconds An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration; the abscess can be assessed, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.

During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in teaching? A. Keep the incision area clean and dry for at least one week B. Report the need to take pain medication for shoulder pain C. Report any bile colored or purulent drainage from the incision D. Expect some post-op N/V for a few days

C. Report any bile colored or purulent drainage from the incision