Exam 4 (Chapter 50) Assessment and MGMT of Pt's w/Biliary Disorders

5. A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a. Edema and inflammation b. Pleural effusion c. Sepsis d. Disseminated intravascular coagulopathy

a. Edema and inflammation

8. When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions should the nurse provide? Select all that apply. a. Encouraging bed rest to decrease the metabolic rate b. Assisting the patient to the prone position c. Withholding oral feedings to limit the release of secretin d. Administering parenteral opioid analgesics as ordered e. Administering prophylactic antibiotics

a. Encouraging bed rest to decrease the metabolic rate c. Withholding oral feedings to limit the release of secretin d. Administering parenteral opioid analgesics as ordered

13. When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? a. Frequent changes of positions b. Placing the patient in the prone position c. Perform chest Physiotherapy d. Suction a patient every 4 hours

a. Frequent changes of positions

6. A 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. Severe abdominal pain b. fever c. Jaundice d. Mental agitation

a. Severe abdominal pain

15. What is the major concern for the nurse when caring for a patient with chronic pancreatitis? a. Pain b. Weight loss c. Nausea d. Mental status changes

b. Weight loss

The capacity of the gallbladder for bile storage is _______________ mL.

30 to 50

Laparoscopy

Visualizes the pancreas via endoscopy

Digestive enzymes are secreted by the pancreas: ______________ aids in the digestion of carbohydrates, _____________ aids in protein digestion, and ___________ aids in the digestion of fats.

Amylase; trypsin; lipase

A patient is scheduled for an outpatient laparoscopic cholecystectomy. Because the patient will only be at the hospital for less than a day, intensive education is necessary. What should the nurse include in the education?

Because of the short Hospital stay with uncomplicated laparoscopic cholecystectomies, it is important to provide patient education about managing post-operative pain and Reporting signs and symptoms of intra-abdominal complications, including loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation

The most serious complication after a laparoscopic cholecystectomy is_______________ _________ ___________.

Bile duct injury

_____________ is the cause of more than 90% of cases of acute cholecystitis.

Calculous cholecystitis

Describe what occurs when a gallstone obstructs the cystic duct

If a gallstone and struck the suspect, the gallbladder becomes distended, inflamed, and eventually infected (acute cholecystitis)

Bile is stored in the___________.

Gallbladder

Endoscopic ultrasound (EUS)

Identifies small tumors and facilitates fine needle aspiration biopsy

Statistics show that there is a greater incidence of gallbladder disease for women who are________, ____________, and __________.

Multiparous, obese, over 40

A major cause of morbidity and mortality in patients with acute pancreatitis is__________.

Pancreatic necrosis

Percutaneous cholecystostomy has been used in the treatment and diagnosis of acute cholecystitis in patients who are poor risk for any surgical procedure for general anesthesia. What type of patients with these conditions?

Patients with sepsis or severe cardiac, Renal, pulmonary or liver failure

The major stimulus for increased bicarbonate secretion from the pancreas is_________.

Secretin

Why does jaundice occur in patients with gallbladder disease?

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.

Endoscopic retrograde cholangiopancreatography

Visualizes the biliary structure

Cholecystogram, cholangiogram

Visualizes the gallbladder and bile duct

Celiac axis arteriography

Visualizes the liver and pancreas

10. 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

a. 30 mg/dL

9. 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. An abnormal glucose tolerance b. Glucosuria c. Hyperglycemia d. Elevated lipase level e. Hypoglycemia

a. An abnormal glucose tolerance b. Glucosuria c. Hyperglycemia

2. 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. Pruritus d. Jaundice e. Pain in the left upper abdominal quadrant

b. Clay colored feces c. Pruritus d. Jaundice

7. The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level with the nurse determine is an early indicator? a. Serum calcium b. Serum lipase c. Serum bilirubin d. Serum amylase

b. Serum lipase

1. A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? a. Serum ammonia concentration of 90 mg/dL b. Serum albumin concentration of 4.0 g/dL c. Serum bilirubin level greater than 1.0 mg/dL d. Serum globulin concentration of 2.0 g/dL

c. Serum bilirubin level greater than 1.0 mg /dL

14. 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 board like and no bowel sounds are detected. What is the major concern for this patient? a. The patient requires more pain medication b. The patient is developing a paralytic ileus c. The patient has developed peritonitis d. The patient has developed renal failure

c. The patient has developed peritonitis

11. 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 depress the central nervous system and increase the pain threshold c. To reduce gastric and pancreatic secretions d. How to relieve nausea and vomiting

c. To reduce gastric and pancreatic secretions

The endocrine secretions of the pancreas are ____________________, _________________, and ________________.

insulin, glucagon, somastostatin

4. A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic acid for treatment of small gallstones. The patient as the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give? a. 1 - 2 months b. 3 - 5 months c. 6 - 8 months d. 6 - 12 months

d. 6 - 12 months

12. 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. High carbohydrate, high protein, low fat diet c. Low carbohydrate, high potassium diet d. High carbohydrate, low protein, low fat diet

d. High carbohydrate, low protein, low fat diet

3. A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for? a. X-ray b. Oral cholecystography c. Cholecystography d. Ultra sonography

d. Ultra sonography