CH. 54 - GI

For which of the following patients would the nurse anticipate extracorporeal shock wave lithotripsy for removal of gallstones? A. A client with a history of cholesterol based gallstones B. A morbidly obese client C. A client with minimal ejection on HIDA scan D. A client with acalculous cholecystitis

A. A client with a history of cholesterol based gallstones ESWL is evidenced to be effective in removal of cholesterol based stones. Acalculous disease is without stones, and obesity and impaired function are contraindications due to ineffectiveness.

The preceptor asks the nursing student why Morphine is prescribed for the patient undergoing HIDA scan. What is the student's best response? A. To increase gallbladder visualization B. To control acute abdominal pain C. To improve pulmonary perfusion D. To slow the patient's respiratory rate

A. To increase gallbladder visualization Morphine can delay gallbladder emptying and improve visualization.

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min. B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain. C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography. D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL (13.1 mmol/L).

A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min.

A nurse recognizes that an 80 year old female patient who takes solumedrol for an acute exacerbation of COPD, HCTZ for hypertension, and Lasix for symptoms associated with heart failure has how many risk factors for Drug Induced Pancreatitis? A. 2 B. 3 C. 5 D. 6

C. 5 5: Elderly, furosemide, hydrochlorothiazide, female, and immunosuppressed by steroids.

A nurse is assessing a patient suspected of having acute cholecystitis. Which information about the last meal would best align with this diagnosis? A. A clear liquid diet for 18 hours B. NPO due to chronic nausea C. A large fatty meal an hour before onset of pain D. A low fat consistent carb diet

C. A large fatty meal an hour before onset of pain Gallbladder attacks often occur following a large or high fat meal.

A patient presents in the fetal position and is suspected of having acute pancreatitis. Knowing the patient will be in the supine position for a CT, which intervention does the nurse prioritize? A. Application of oxygen B. Auscultation of lung sounds C. Administration of IV hydromorphone D. Placing an NG tube to prevent vomiting

C. Administration of IV hydromorphone Evidence of pain is the only symptom described and pancreatic pain is worsened when lying flat (as in a CT scanner)

While assessing a patient who presented with severe boring abdominal pain, the nursed notes bruising around the umbilicus. Which term correctly identifies this finding. A. Grey-Turner's sign B. Blumberg's sign C. Cullen's sign D. Kehr's sign

C. Cullen's sign

A client who had a Whipple surgical procedure develops an internal fistula between the pancreas and stomach. For which complication would the nurse monitor? A. Peptic ulcer disease B. Cirrhosis C. Peritonitis D. Chronic pancreatitis

C. Peritonitis

The nurse is caring for a patient awaiting a gallbladder ultrasound. When asked why the patient must be NPO for the study, what is the nurse's best response? A. To prevent vomiting associated with gallbladder disease. B. To decrease risk of aspiration during the procedure C. Stomach contents can interfere with imaging D. Your doctor must order a diet

C. Stomach contents can interfere with imaging

The patient admitted with cholecystitis due to cholelithiasis asks, "Why is my poop so white?" Which is the nurse's appropriate response? A. "The color of stool varies based on diet and is insignificant." B. "The disease is limiting the amount of bile your gallbladder produces." C. "The high fiber carbohydrate, low fat diet has changed the consistency of your stool." D. "The gallstones are blocking digestive fluids that add the color to your bowel movement"

D. "The gallstones are blocking digestive fluids that add the color to your bowel movement" Gallstones are blocking bile entry into the GI tract. The gallbladder does not make bile but stores it.

After completing a patient assessment, nurse is highly suspicious of acute cholecystitis. Which of the following would be most helpful to include in the recommendation portion of an SBAR to the provider? A. A complete set of vital signs B. Trending of previous lab results C. A contrast enhanced CT scan D. An abdominal ultrasound

D. An abdominal ultrasound An abdominal ultrasound is the best initial test to confirm acute cholecystitis. Vital signs and previous lab results would be in the assessment portion of SBAR, and a contrast CT is not indicated.

Which teaching will the nurse provide when discharging a client with chronic pancreatitis? A. Weight reduction and daily exercise regimen B. Relaxation techniques and stress management C. Constipation precautions including daily laxative use D. Dietary adjustments to avoid high-fat foods, caffeine, and alcohol

D. Dietary adjustments to avoid high-fat foods, caffeine, and alcohol

When caring for a client whose condition is too unstable to undergo sedation for ERCP, which radiologic study does the nurse anticipate as a diagnostic equivalent alternative? A. HIDA scan B. Abdominal ultrasound C. CT without contrast D. MRCP

D. MRCP The MRCP can visualize all the structures of the biliary system viewed by ERCP.

The nurse is caring for a patient diagnosed with acute pancreatitis. Which of the following would be called to the provider? A. Serum potassium 3.7mmOl/L B. Serum sodium 144 mEq/L C. WBC 10,000/ microliter D. Serum Calcium 6.6 mg/dl

D. Serum Calcium 6.6 mg/dl The low calcium level should be reported. The other values are WNL.

The nurse is caring for a patient diagnosed with acalculous cholecystitis. Which of the following can be omitted from the teaching plan for this patient? A. Cardiovascular risk factors B. Effects of biliary stasis C. Signs and symptoms of infection D. Treatments for cholelithiasis

D. Treatments for cholelithiasis The nurse can omit teaching about cholelithiasis because acalculous disease is without stones. The patient may experience any or all of the other options.

The nurse is caring for a female patient with acute cholecystitis. Which statement by the patient indicates an urgent need for further teaching? A. "The pain is a symptom of the bile from my liver being obstructed by stones." B. "I'm not concerned. Gallbladder attacks happen everyday to someone. It's not like it can hurt me." C. "I have been on a high fiber, low fat diet, and drink plenty of water." D. "I understand I can have my gallbladder removed with no visible scars at all."

B. "I'm not concerned. Gallbladder attacks happen everyday to someone. It's not like it can hurt me." Gallbladder disease can lead to life-threatening complications if untreated. The pain is a symptom of bile stasis; a high fiber diet low in fat is recommended, and the NOTES procedure affords female patients a Lap-cholecystectomy with no externally visible incision.

While reading a physician's note, the nurse understands that the patient grimaced on palpation of the right upper abdomen during inspiration. Which of the following terms describe this impression? A. (+) Ker's sign B. (+) Murphy's sign C. (+) Cullen's sign D. (+) Blumberg's sign

B. (+) Murphy's sign Murphy's sign indicates patient wincing or grimace with RUQ abdominal palpation. Ker's sign is peritoneal pain radiation to the shoulder, Blumberg's sign is peritoneal pain exacerbation with stretching, and Cullen's sign is bruising around the umbilicus.

After evaluating vital signs reported by the CNA, which patient would the nurse see first? A. A 57 year old with chronic pancreatitis and abdominal pain at 6/10 B. A 23 yo with acute pancreatitis and an oral temp of 103.4F C. A 34 year old with acute pancreatitis with a BP of 106/ 74 D. A 42 year old with a respiratory rate of 26 after showering

B. A 23 yo with acute pancreatitis and an oral temp of 103.4F We must be alert to symptoms of pancreatic abscess such as fever.

When caring for a patient diagnosed with pancreatic cancer, the nurse understands that the course of treatment will be guided by which of the following? A. Physician preference B. Biopsy results C. The degree of metastasis D. Analgesia for pain control

B. Biopsy results

The nurse is preparing and SBAR report to alert the provider of suspected pancreatitis. Which of the following is a symptom associated with acute pancreatitis? A. Intermittent epigastric pain that improves when lying flat. B. Constant gnawing mid-abdomen pain that is worse while lying supine C. Right upper quadrant pain accompanied by severe nausea D. Retro peritoneal pain in the lower back and flanks

B. Constant gnawing mid-abdomen pain that is worse while lying supine Pancreatic pain is described as gnawing or boring pain in the mid-abdomen that worsens when lying supine or stretching abdominal muscles.

Which of the following anastomosis is not included in the Whippie procedure? A. Choledochojejunostomy B. Hepaticojejunostomy C. Pancreatojejunostomy D. Gastrojejunostomy

B. Hepaticojejunostomy