Ch. 50 PrepU
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:
Serum lipase
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?
6 to 12
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?
Acute pain related to biliary spasms
A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review?
Serum bilirubin level greater than 1.0 mg/dL
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 boardlike and no bowel sounds are detected. What is the major concern for this patient?
The patient has developed peritonitis.
Which enzyme aids in the digestion of fats?
Lipase
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis?
Pancreatic necrosis
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
Pancreatitis
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
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 his diagnosis?
Recent weight loss and temperature elevation
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 reduce gastric and pancreatic secretions
The digestion of carbohydrates is aided by
amylase.
A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?
"Maintain a high-carbohydrate, low-fat diet."
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 allows the gastrointestinal tract to rest."
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?
30 mg/dL
Which foods should be avoided following acute gallbladder inflammation?
Cheese
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?
Elevated urine amylase levels
Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels?
Frequent vomiting, leading to loss of fluid volume
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction?
Gray
Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?
Hot roast beef sandwich with gravy
A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam?
It visualizes the gallbladder and bile duct.
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?
Maintain the client in a semi-Fowler's position.
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?
Measure blood glucose concentration every 4 to 6 hours
The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis?
Muscle twitching and finger numbness
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 can elevate the diaphragm and alter the breathing pattern.
When caring for a client with acute pancreatitis, the nurse should use which comfort measure?
Positioning the client on the side with the knees flexed
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?
Reposition the client every 2 hours.
The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status?
To avoid inflammation of the pancreas
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?
Decreases in the physiologic function of major organs
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."
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
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?
Carbohydrate digestion
A client with calculi in the gallbladder is said to have
Cholelithiasis
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?
Dysfunction of the pancreatic islet cells
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
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
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?
Impaired nutrition: less than body requirements
A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for?
Ultrasonography
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?
Use incentive spirometry every hour.
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
