Chapter 54: Concepts of Care for Patients With Problems of the Biliary System and Pancreas

A client is admitted to the emergency department with possible acute pancreatitis. What is the nurse's priority assessment at this time? A. Respiratory assessment B. Cardiovascular assessment C. Abdominal assessment D. Pain intensity assessment

A. Respiratory assessment

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

The nurse is caring for a client who recently had an external percutaneous transhepatic biliary catheter placed for severe biliary obstruction. What is the nurse's priority intervention when caring for this client? A. Keeping the biliary drainage bag below the level of the catheter-insertion site B. Checking the client's blood glucose frequently to monitor for diabetes C. Managing pain with continuous opioid patient-controlled analgesia (PCA) D. Capping the catheter if it starts to leak around the insertion site

A. Keeping the biliary drainage bag below the level of the catheter-insertion site

The nurse is planning care for a client who had a laparoscopic Whipple surgery. For which complications will the nurse assess? Select all that apply. A. Bleeding B. Wound infection C. Intestinal obstruction D. Diabetes mellitus E. Abdominal abscess

A, B, C, D, E

A client was admitted to the hospital yesterday with a diagnosis of acute pancreatitis. What assessment findings will the nurse expect for this client? Select all that apply. A. Severe boring abdominal pain B. Jaundice C. Nausea and/or vomiting D. Decreased serum amylase level E. Leukocytosis F. Dyspnea

A, B, C, E, F

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

The nurse is caring for a client who had a Whipple surgical procedure yesterday. For what serum laboratory test results would the nurse want to monitor frequently and carefully? A. Blood glucose B. Blood urea nitrogen C. Phosphorus D. Platelet count

A. Blood glucose

The nurse is caring for a client who states that her mother had "gallbladder problems" and wonders if she is at risk for this disorder. What major risk factor places women most at risk for gallbladder disease? A. Obesity B. Birth control pills C. Infertility D. Advanced age

A. Obesity

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.

The nurse is teaching a preoperative client who is scheduled for a laparoscopic cholecystectomy ("lap chole"). What statement by the client indicates a need for further teaching? A. "I will likely need oral pain medications for the first few days after my surgery." B. "I should only be hospitalized for 2 to 3 days after my surgery." C. "I will probably not be at risk for complications from this surgery." D. "I should be able to go back to work in the next week or so."

B. "I should only be hospitalized for 2 to 3 days after my surgery."

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."

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

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

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Assist the client to assume a position of comfort. B. Administer opioid analgesic medication. C. Do not administer food or fluids by mouth. D. Measure intake and output every shift.

B. Administer opioid analgesic medication.

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

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

B. Hepaticojejunostomy

A client with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which priority laboratory finding will the nurse assess? A. Lipase level B. Total bilirubin C. Liver function tests D. White blood cell count

B. Total bilirubin

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

A client is preparing to have a hepatobiliary scan (HIDA scan). What health teaching would the nurse include about what the client can expect during the test? A. "This test measures how inflamed your gallbladder and liver may be." B. "You may eat and drink as much as you'd like before you have this test." C. "You will have to lie still for some time while the camera is very close to your body." D. "I need to know if you are allergic to shellfish because the contrast will be iodine-based."

C. "You will have to lie still for some time while the camera is very close to your body."

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

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

A young adult client admitted with a diagnosis of cholecystitis from cholelithiasis has severe abdominal pain, nausea, and vomiting. Based on these assessment findings, which client problem is the highest priority for nursing intervention at this time? A. Anxiety B. Risk for dehydration C. Acute pain D. Malnutrition

C. Acute pain

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

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 nurse is teaching a client with gallbladder disease about diet modification. Which meal would the nurse suggest to the client? A. Sausage and scrambled eggs B. Steak and french fries C. Turkey sandwich on wheat bread D. Fried chicken and mashed potatoes

C. Turkey sandwich on wheat bread

Which statement by the client who is prescribed to take pancreatic enzyme replacements indicates a need for further teaching by the nurse? A. "I need to take the enzymes at every meal and with snacks." B. "After taking the enzymes, I should drink a glass of water." C. "I should wipe my mouth in case any of the enzyme got on my lips." D. "I should chew each capsule carefully so that it works in my stomach."

D. "I should chew each capsule carefully so that it works in my stomach."

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"

Which client is more likely to develop gallstones? A. 42-year-old Caucasian female with colon cancer B. 51-year-old African-American male with a history of hypertension C. 63-year-old Hispanic/Latino female with a history of irritable bowel syndrome D. 70-year-old American-Indian female with obesity

D. 70-year-old American-Indian female with obesity

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

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

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. High fat B. High fiber C. Carbohydrates D. Protein

D. Protein

When caring for a client with acute pancreatitis, which assessment finding requires immediate nursing intervention? A. Heart rate of 105 beats/min B. Serum glucose of 136 mg/dL C. Blood pressure of 102/76mm Hg D. Respiratory rate of 28breaths/min

D. Respiratory rate of 28breaths/minC

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 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