Exam II Prep U Ch. 44

Clinical manifestations of common bile duct obstruction include all of the following except:

Jaundice Clay-colored feces Light-colored urine Pruritus

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?

Sepsis Pleural effusion Disseminated intravascular coagulopathy Edema and inflammation

The digestion of carbohydrates is aided by

trypsin. secretin. lipase. amylase.

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective?

"I should remain on bed rest for several days." "I can drive after 2 weeks." "I can take a shower in a week." "I should wash the site with mild soap and water."

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms?

Place the client in semi-Fowler's position. Instruct the client on the proper use of an incentive spirometer. Encourage the client to deep breathe and cough. Encourage the client to ambulate frequently.

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client?

"Normal function returns after about 2 weeks." "Inflammation spreads to the surrounding glands." "Tissue necrosis occurs within the pancreas." "Inflammation is confined to only the pancreas."

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms?

"Take an over the counter analgesic as needed." "Place your shoulder in a sling to avoid moving it." "Apply a heating pad to your shoulder for 15 minutes hourly as needed." "Come into the emergency room as soon as possible."

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment?

"The tube provides relief from nausea and vomiting." "The tube allows toxins to be removed." "The tube helps control fluid and electrolyte imbalance." "The tube allows the gastrointestinal tract to rest."

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:

can digest high-fat foods. cannot tolerate high-glucose concentration. are at risk for gallbladder contraction. are at risk for hepatic encephalopathy.

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve?

1 to 2 3 to 5 6 to 12 13 to 18

A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give?

1 to 2 months 3 to 5 months 6 to 12 months 6 to 8 months

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?

1 to 4 months 4 to 6 months 6 to 12 months Over 1 year

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood glucose level does the nurse recognize as inadequate to sustain normal brain function?

70 mg/dL 50 mg/dL 90 mg/dL 30 mg/dL

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system?

Administer enteral or parenteral nutrition. Withhold oral feedings. Carry out wound care as prescribed. Maintain the client in a semi-Fowler's position.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure?

Administering frequent oral feedings Encouraging frequent visits from family and friends Positioning the client on the side with the knees flexed Administering an analgesic once per shift, as ordered, to prevent drug addiction

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?

Appendicitis Pancreatitis Peptic ulcer Cholecystitis

What concepts does the nurse understand about gerontologic considerations related to acute pancreatitis? Select all that apply.

As the client ages, there is an increased risk for the development of acute pancreatitis. As the client ages, there is an increased mortality rate for acute pancreatitis. As the client ages, the size of the pancreas decreases, increasing the risk of developing acute pancreatitis. As the client ages, the pattern of complications related to acute pancreatitis changes. As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome.

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy?

Assessing the color of the sclera every shift Placing the client on NPO (nothing by mouth) status for 2 days after surgery Placing the client in the semi-Fowler position immediately after surgery Clamping the T-tube immediately after surgery

Which term most precisely refers to the incision of the common bile duct for removal of stones?

Choledochotomy Choledocholithotomy Cholecystostomy Choledochoduodenostomy

A client with calculi in the gallbladder is said to have

Cholecystitis Cholelithiasis Choledocholithiasis Choledochotomy

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?

Decreased white blood cell count Elevated urine amylase levels Decreased liver enzyme levels Increased serum calcium levels

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?

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

A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ?

Digests carbohydrates in the jejunum Controls the flow of trypsin to digest proteins Releases bile in response to cholecystokinin Serves as a storage unit for glucagon

Which is a clinical manifestation of cholelithiasis?

Epigastric distress before a meal Clay-colored stools Abdominal pain in the upper left quadrant Nonpalpable abdominal mass

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired?

Fat digestion Protein digestion Protein synthesis Carbohydrate digestion

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis?

Fibrosis and atrophy of the pancreatic gland Use of loop diuretics to increase the incidence of pancreatitis Self-digestion of the pancreas by its own proteolytic enzymes Calcification of the pancreatic duct, leading to its blockage

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?

Gavage lavage decompression instillation

A client with acute pancreatitis is prescribed hydromorphone 2 mg intranvenously every 4 hours as needed for severe pain. Which assessment will the nurse prioritize for this client?

Heart sounds Development of nausea Bleeding tendency Bowel sounds

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?

High-carbohydrate, low-protein, low-fat diet Low-carbohydrate, high-potassium diet High-carbohydrate, high-protein, low-fat diet Low-sodium, high-potassium, low-fat diet

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority?

Maintaining normal respiratory function Achieving adequate fluid and electrolyte balance Maintaining satisfactory pain control Developing no acute complications from the pancreatitis

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis?

Malnutrition and acute pancreatitis Alcohol consumption and smoking Acute hepatitis and alcohol consumption Caffeine consumption and acute pancreatitis

The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is:

Mental agitation Severe abdominal pain Fever Jaundice

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority?

Nausea Disturbed body image Impaired nutrition: less than body requirements Anxiety

The nurse is caring for a client with symptoms of gallbladder disease. Which diagnostic test will the nurse anticipate preparing the client for to confirm the diagnosis?

Oral cholecystography Abdominal x-ray Ultrasound Cholescintigraphy

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis?

Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. Pancreatitis can atrophy the diaphragm and alter the breathing pattern. Pancreatitis causes alterations to hemoglobin, impairing oxygenation. Pancreatitis can elevate the diaphragm and alter the breathing pattern.

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?

Pigment Pixelated Pearl Patterned

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?

Placing the patient in the prone position Frequent changes of positions Suction the patient every 4 hours Perform chest physiotherapy

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate?

Reserving a site for a peripherally inserted central catheter (PICC) Providing the client with plenty of P.O. fluids Limiting I.V. fluid intake according to the physician's order Providing generous servings at mealtime

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test?

Serum potassium Serum bilirubin Serum amylase Serum calcium

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis?

Shock MODS Tetany Pancreatic necrosis

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?

Teaching about the disease and its treatment Maintaining adequate nutritional status Relieving abdominal pain Preventing fluid volume overload

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this?

Tetany related to hypocalcemia Tetany related to hypercalcemia Muscle pain related to referred pain manifestations Muscle spasm related to hypokalemia

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?

The patient has developed renal failure. The patient is developing a paralytic ileus. The patient requires more pain medication. The patient has developed peritonitis.

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?

To depress the central nervous system and increase the pain threshold To decrease metabolism To reduce gastric and pancreatic secretions To relieve nausea and vomiting

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis?

Weight loss Diarrhea Fatigue Hypertension

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is mostappropriate for a client with this diagnosis?

Withholding all oral intake, as ordered, to decrease pancreatic secretions Limiting I.V. fluids, as ordered, to decrease cardiac workload Keeping the client supine to increase comfort Administering meperidine, as ordered, to relieve severe pain

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

yellow sclerae. circumoral pallor. black, tarry stools. light amber urine.

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client?

"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation."

The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client?

"When was the last time you took acetaminophen?" "How many meals do you eat every day?" "How often and how long do you exercise each day? "How much alcohol do you consume in a day?"

This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States?

75% 60% 25% 15%

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?

Monitor pulse oximetry every hour. Instruct the client to avoid coughing. Withhold oral feedings for the client. Reposition the client every 2 hours.

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?

Administering morphine I.V. as ordered Providing mouth care Placing the client in a semi-Fowler's position Maintaining nothing-by-mouth (NPO) status

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis?

Administering oral analgesics around the clock Providing intensive insulin therapy Maintaining a high-Fowler's position Allowing a clear liquid diet during the acute phase

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis?

Adventitious breath sounds and hypertension Presence of easy bruising and bradycardia Pain with abdominal distention and hypotension Presence of blood in the client's stool and recent hypertension

A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply.

Assist the client to a semi-Fowler position Administer a low-fat diet Administer electrolytes Administer pain-relieving medication Administer plasma

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client?

Assisting the client to turn, cough, and deep breathe every 2 hours Assisting the client to ambulate the evening of the operative day Performing range-of-motion (ROM) leg exercises hourly while the client is awake Teaching the client to choose low-fat foods from the menu

A client is being tested to determine the presence of an insulinoma. Which symptoms will the nurse expect to assess in this client? Select all that apply.

Blood glucose level of 46 mg/dl Blood pressure reading of 156/92 mm Hg Mental confusion Generalized weakness Seizure activity

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have?

Hypertension Weight loss Warm, dry skin Bile-stained vomiting

The nurse is caring for a client experiencing pain related to chronic pancreatitis. When developing a care plan for alternative strategies to opoid usage, which approaches will the nurse include? Select all that apply.

Ibuprofen Amitriptyline Methylprednisolone Vitamin E Tetracycline

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan?

Improve nutritional status during recovery. Decrease the amount of postoperative analgesia needed. Eliminate the need for nasogastric intubation. Increase respiratory effectiveness.

Which is a gerontological consideration associated with the pancreas?

Increased rate of pancreatic secretion Increased amount of fibrous material Increased calcium absorption Increased bicarbonate output

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas?

Increases in the rate of pancreatic secretion Decreases in the physiologic function of major organs Development of local complications Increases in the bicarbonate output by the kidneys

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?

Monitor pulse oximetry every hour. Use incentive spirometry every hour. Withhold analgesics unless necessary. Instruct the client to cough only when necessary.

A client with severe acute pancreatitis has been on nothing by mouth status for two days. Which nutrition will the nurse expect to be prescribed for this client?

Parenteral nutrition Clear liquids Diet as tolerated Enteral feedings

The nurse is caring for a client with a history of recurrent episodes of acute pancreatitis. The nurse will anticipate preparing the client for which diagnostic test?

Ultrasound Abdominal x-ray Computed tomography (CT) scan Endoscopy

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition?

Ultrasound MRI CT ERCP