gallbladder​ disease nclex

A client with acute cholecystitis is experiencing nausea and vomiting. Which nursing action should the nurse use to address this​ client's nutritional​ status? (Select all that​ apply.)

​Rationale: Assessing height and​ weight, reviewing serum​ electrolytes, counseling on​ low-fat menu​ choices, and administering antiemetics as prescribed are all nursing actions that address the​ client's nutritional status. A​ high-protein, not​ low-protein, diet is used to treat cholecystitis.

The nurse is providing dietary teaching to a client with a history of gallstones. Which diet should the nurse​ recommend? (Select all that​ apply.)

​Rationale: A​ low-carbohydrate, low-fat,​ high-protein diet reduces symptoms of cholecystitis. While fasting and very​ low-calorie diets are​ contraindicated, a moderate reduction in caloric intake and increased activity levels promote weight loss

A client is experiencing severe upper abdominal pain and jaundice. Which finding on the cholescintigraphy should indicate to the nurse that the client has​ cholelithiasis?

​Rationale: Cholelithiasis is almost always caused by a gallstone lodged in the cystic duct. Accumulation of bile in the hepatic duct would not lead to cholecystitis. Neither the accumulation of fat nor a viral infection leads to cholecystitis.

The nurse is teaching a client with cholelithiasis about lifestyle modification. Which statement made by the client indicates that the​ nurse's teaching has been​ successful?

​Rationale: Obesity is commonly associated with the development of gallbladder disease. A balanced diet and exercise will help keep the​ client's weight within normal limits. There is no reason to eliminate salt from the diet. Ground beef is high in fat and should be limited. Frying adds additional fat and should be avoided.

A client is experiencing pain and nausea related to biliary colic. Which statement should the nurse make to manage this​ client's symptoms?​ (Select all that​ apply.)

​Rationale: Clinical therapies for treating biliary colic include administering​ analgesics, getting adequate​ rest, correcting fluid and electrolyte​ imbalances, and administering antiemetics.

A client scheduled for a cholecystectomy asks what caused the gallstones to develop. Which risk factor should the nurse list when responding to this​ client? (Select all that​ apply.)

​Rationale: The risk factors for developing gallbladder disorders include​ age, family history of​ gallstones, American Indian​ ethnicity, obesity,​ hyperlipidemia, female​ sex, pregnancy, diabetes​ mellitus, cirrhosis, ileal​ disease, and sickle cell disease. Men have a lower risk of developing gallbladder disorders.

A client is recovering from a laparoscopic cholecystectomy. Which nursing action should the nurse use to reduce this​ client's risk of​ infection? (Select all that​ apply.)

​Rationale: To reduce the risk of​ infection, the nurse will monitor vital​ signs, including​ temperature, every 4​ hours, because changes may be the first sign of infection. Assessment of the abdomen can reveal signs of a surgical wound infection.​ Turning, breathing, and incentive spirometry help prevent postsurgical atelectasis and subsequent pneumonia. Antibiotics are used to control infection. Fowler position may enhance the​ client's comfort but will have no effect on postsurgical infection.

The nurse is teaching a client with cholelithiasis about a new prescription for ursodiol. Which client statement indicates to the nurse that the teaching was​ successful?

​Rationale: Ursodiol is a bile acid. It is used to dissolve gallstones in clients who cannot have surgery to remove gallstones. Ursodiol is also used to prevent the formation of gallstones in clients who are overweight or who are losing weight very quickly. It works by decreasing the production of cholesterol and by dissolving the cholesterol in bile so that it cannot form stones. Ursodiol is generally well tolerated but can cause diarrhea or constipation.

A client with acute cholecystitis is experiencing jaundice. Which should the nurse consider as the reason for the​ jaundice?

​Rationale: When acute cholecystitis is accompanied by​ jaundice, partial common duct obstruction is​ likely, which is usually due to stones or inflammation.

The nurse is planning an educational program about development and prevention of gallstones for a community group. Which population should the nurse identify to be most at risk for developing​ gallstones?

​Rationale: Genetic considerations and risk factors vary depending on the nature of the inflammatory disorder. Female​ sex, being over the age of​ 40, American​ Indians, and Mexican Americans are most at risk for gallstones. Family history is also associated with increased risk.

The nurse evaluates a​ client's understanding of discharge teaching following a laparoscopic cholecystectomy. Which client statement indicates teaching has been​ effective? (Select all that​ apply.)

​Rationale: Clients from a laparoscopic cholecystectomy are often treated in day​ surgery, but discharge instructions should be similar to those for other clients who have had abdominal surgery.​ Therefore, they should be informed to be sure to increase their activity level when they return home. Clients should take pain medications with food to diminish irritation to the stomach lining. The client should follow a diet low in fat and high in​ fat-soluble vitamins.​ Therefore, including hot chocolate and whole milk would not be appropriate food choices.

The nurse is preparing health promotion teaching for a client with gallbladder disease. Which topic should the nurse include in the teaching​ session? (Select all that​ apply.)

​Rationale: Clients should be taught about the role of​ obesity, hyperlipidemia, and a​ high-cholesterol diet on gallstone​ formation; the importance of a​ high-fiber, low-fat, and​ low-cholesterol diet to reduce the incidence of gallbladder​ disorders; and the dangers of rapid weight loss. Hypolipidemia does not promote gallstone formation

A client with right upper quadrant abdominal pain asks why so many tests are being scheduled. Which is the reason that the nurse should give to this​ client? (Select all that​ apply.)

​Rationale: Diagnostic tests are used to identify the presence and location of​ gallstones, identify possible complications of the​ gallstones, and help differentiate gallbladder disorders from other disease processes. Diagnostic tests do not prevent the formation of gallstones but can give information necessary for treatments that prevent recurrence.

A client who is morbidly obese is diagnosed with acute cholelithiasis. Which nonpharmacologic therapy should the nurse expect to be prescribed for this​ client?

​Rationale: During an acute attack of​ cholecystitis, food should be eliminated and a nasogastric tube inserted to relieve nausea and vomiting. Parenteral nutrition is not indicated at this time. Once the client is eating​ again, dietary fat intake may be​ limited, especially if the client is obese. If bile flow is​ obstructed, fat-soluble vitamins​ (A, D,​ E, and​ K) and bile salts may need to be administered but this would be considered a pharmacologic therapy.

A client asks what causes gallstones to form. Which factor should the nurse explain as being present when these stones are​ formed? (Select all that​ apply.)

​Rationale: Gallstones are formed due to abnormal bile​ composition, an inflammation of the​ gallbladder, biliary​ stasis, and excess cholesterol. Rapid weight​ loss, not weight​ gain, is a factor that contributes to the formation of gallstones. Next Question

A client with cholelithiasis is not a surgical candidate at this time. Which pharmacologic treatment should the nurse expect to be prescribed for this​ client? (Select all that​ apply.)

​Rationale: Pharmacologic treatment for gallstones is used for clients who refuse surgery or for whom surgery is contraindicated. Medications used in the treatment of gallstones include​ ursodiol, chenodiol,​ antibiotics, cholestyramine, and opioid analgesics. Antipyretics are a pharmacologic treatment for​ fever, not cholelithiasis itself.

Which is a risk factor for gallbladder​ disease?

​Rationale: Rapid weight​ loss, hyperlipidemia​ (not hypolipidemia), and female​ (not male) gender are risk factors for gallbladder disease. Hypocalcemia is not a risk factor.

A​ middle-aged female client who is obese has been experiencing right upper quadrant abdominal pain for the past several hours. For which risk factors of gallstone development should the nurse assess this client during the health​ history? (Select all that​ apply.)

​Rationale: The formation of gallstones occurs when several factors are​ present, including abnormal bile​ composition, biliary​ stasis, inflammation of the​ gallbladder, and excess cholesterol. Excess cholesterol in bile is associated with​ obesity, a​ high-calorie and​ high-cholesterol diet, and drugs that lower serum cholesterol levels. Biliary colic is the pain described in cholelithiasis. This pain is localized to the epigastrium and the right upper quadrant of the abdomen. Biliary colic does not lead to the formation of gallstones.

A pregnant client of American Indian heritage experiences mild gastric distress and nausea after eating large meals and constant sharp abdominal pain. Which additional information should the nurse collect during the​ interview? (Select all that​ apply.)

​Rationale: The nurse should note current​ manifestations, including right upper quadrant​ (RUQ) abdominal​ pain, and its character and relationship to​ meals, duration, and​ radiation; nausea and​ vomiting; other​ symptoms; duration of​ symptoms; risk factors or previous history of​ symptoms; chronic diseases such as​ diabetes, cirrhosis, or​ IBD; current​ diet; and use of oral contraceptives or possibility of pregnancy.

The nurse prepares discharge teaching for a client recovering from a cholecystectomy. Which topic should the nurse include in this​ teaching? (Select all that​ apply.)

​Rationale: The nurse will instruct the client on the prescribed activity​ level, manifestations of postoperative complications that must be reported to the healthcare​ provider, pain control​ measures, and surgical incision care. A​ low-fat, not​ high-fat, diet must be followed by this client after discharge.