Chapter 59: AQ

Which is the primary risk factor for chronic calcifying pancreatitis?

Alcoholism

The nurse is assessing a patient's alcohol intake to determine whether it is the underlying cause of the patient's attacks of pancreatitis. Which question does the nurse ask to elicit this information?

"Tell me more about your alcohol intake."

Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas?

Lipase

The nurse is preparing to administer the prescribed dose of pancrelipase to a patient with chronic pancreatitis. What pancreatic enzymes make up this medication? Select all that apply.

Lipase Amylase Protease

The nurse is providing dietary education to a patient diagnosed with cholecystitis. What foods chosen by the patient indicate that the teaching has been effective? Select all that apply.

Low-fat foods High-fiber foods Low-carbohydrate foods Low-fat, high-fiber, low-carbohydrate choices are indicated for patients with cholecystitis. The patient should follow a lower calorie rather than high-calorie diet. Low-protein foods are not indicated.

The nurse is teaching a female patient about cholecystectomy via a natural orifice transluminal endoscopic surgery. What statement by the patient indicates that the teaching has been effective?

"A small incision will be made in my vagina to access my gallbladder."

A patient receiving chenodiol acid for cholelithiasis has just received teaching about the medication. What statement by the patient indicates that the teaching was effective?

"If I have diarrhea, I will call my doctor." The patient should contact the health care provider if diarrhea occurs. The medication can only be taken for 2 years. The patient should take chenodiol acid with milk or food, not on an empty stomach. The patient will need to have a gallbladder ultrasound every 6 months for the first year of therapy, not 2 months.

The nurse is providing postoperative teaching to a patient scheduled for a laparoscopic cholecystectomy. What instructions should be included?

"Introduce high-fat foods one at a time."

A patient who underwent a traditional cholecystectomy is concerned that the drainage in the Jackson-Pratt drain is now green. What statement by the nurse is most appropriate?

"It is normal for the first 24 hours."

A patient with an internal/external biliary drainage tube contacts the health care provider's office to report jaundice and leakage around the catheter site. What instructions should the nurse provide?

"Reconnect the drainage bag."

What interventions are necessary in a patient with acute pancreatitis who is at risk for paralytic ileus? Select all that apply.

Ask if patient has passed flatus Maintain a patent nasogastric (NG) tube

The patient diagnosed with acute pancreatitis has a positive Chvostek's sign. What action by the nurse is priority?

Assess the serum calcium level

What dietary suggestions are indicated for a patient who is in the healing phase after acute pancreatitis? Select all that apply.

Bland foods Low-fat foods Small, frequent meals

A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis?

Chronic Patients with chronic cholecystitis are more likely to have jaundice and icterus caused by obstruction of bile flow, causing increased circulating levels of bilirubin. Patients with acute cholecystitis present with abdominal pain. Acalculous cholecystitis and calculous cholecystitis are both types of acute cholecystitis.

The nurse is reviewing the laboratory results for a patient with acute pancreatitis. Which findings does the nurse expect to find in the report? Select all that apply.

Decrease in albumin level Increase in serum glucose level Increase in blood urea nitrogen (BUN)

The nurse is planning discharge teaching for a patient following a cholecystectomy. Which symptoms of post-cholecystectomy syndrome should the patient be taught to report? Select all that apply.

Diarrhea Vomiting Epigastric pain

A patient is admitted to the hospital for treatment for acute pancreatitis. The patient's spouse asks the nurse when the patient will be allowed to eat. The nurse bases her response upon which understanding of care of a patient with acute pancreatitis?

Food is withheld during the acute phase to reduce enzyme secretion.

What diet does the health care provider prescribe for a patient during the healing phase of acute pancreatitis? Select all that apply.

High protein Low fat meal High carbohydrates

The patient presents to the emergency department with severe abdominal pain. The nurse is reviewing the patient's lab results. What laboratory findings would prompt the nurse to suspect a diagnosis of acute pancreatitis? Select all that apply.

Increased serum amylase Decreased serum calcium Increased alanine aminotransferase

A patient who has had acute mid-epigastric pain for 3 days has elevated glucose, bilirubin, serum lipase, and a threefold increase in alanine aminotransferase. The serum amylase is normal. What does the nurse suspect about the possible cause of this patient's pain?

It is caused by acute biliary pancreatitis.

Which symptoms present in a patient with acute pancreatitis indicate complications? Select all that apply.

Jaundice Darkened urine Clay-colored stools

The nurse is assessing a patient in the emergency department. Which assessment findings, if present in the patient, would prompt the nurse to suspect a pancreatic pseudocyst? Select all that apply.

Jaundice Palpable epigastric mass Epigastric pain radiating to the back

A patient with acute pancreatitis continues to be unable to eat 48 hours after onset of the illness. The nurse notifies the provider to discuss which intervention to provide nutrition for this patient?

Jejunal tube feedings

Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin?

Kallikrein

The nurse expects which patient will be discharged to the home environment first?

Middle-aged thin adult who has had a laparoscopic cholecystectomy

A patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach?

Normal weight Patients who undergo extracorporeal shock wave lithotripsy must be of normal weight and have cholesterol-based, smaller gallstones and good gallbladder function. Iodine is not used in this procedure. The presence of infection and serum cholesterol levels are not factors to consider in candidates for this procedure.

Which patients are suitable candidates for extracorporeal shock wave lithotripsy (ESWL) to treat gallstones? Select all that apply.

Patient with normal body weight Patient with cholesterol-based stones Patient with good gallbladder function ESWL is used for patients who have small stones and for those who are not good surgical candidates. Patients who are within normal weight range, have cholesterol-based stones, and good gallbladder function are suitable candidates for this procedure. ESWL is not used for patients with severe biliary obstruction or cancer of the gallbladder.

Which factor is considered a risk factor in the development of cholelithiasis?

Pregnancy In pregnancy, hormone levels (progesterone and estrogen) are altered, which delays muscular contraction of the gallbladder and decreases the rate of bile emptying, thus increasing the risk for cholelithiasis. Similarly, hormonal changes and hormonal replacement therapy make women over 40 years, not under, more susceptible to the development of cholelithiasis. Obese women, not those with a low BMI, are at a high risk of developing cholelithiasis because of impaired fat metabolism and increased cholesterol. Anemia is not associated with the development of gallstones.

A patient is diagnosed with acute pancreatitis. Which test is a sensitive indicator of biliary obstruction in this disorder?

Serum alanine aminotransferase

The nurse is reviewing lab values of a patient diagnosed with cholecystitis. Elevations in which additional labs would prompt the nurse to suspect pancreatic involvement? Select all that apply.

Serum lipase Serum amylase

A patient with an external transhepatic biliary catheter has had a reduction in drainage. What does this finding indicate?

The catheter is not working. A reduction in drainage of an external transhepatic biliary catheter indicates that the catheter is not working. A reduction in drainage would not be related to the decrease in biliary secretions. It would not indicate that the patient needs to change positions. The patient does not need to take medication.

A patient who has acute pancreatitis is ordered to receive ranitidine. The nurse explains that this drug is given for which purpose?

To decrease gastric acid secretion that often occurs with pancreatitis

The patient has severe biliary obstruction. What type of surgery does the nurse anticipate this patient requiring in order to explore the ducts for patency?

Traditional cholecystectomy Patients with severe biliary obstruction whose ducts will need to be explored will need a traditional cholecystectomy. A transhepatic biliary catheter placement is not a surgical procedure to treat cholecystectomy. A laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery will not provide visualization of the ducts.

The nurse understands that which patient is at highest risk for developing gallstones?

Obese female on hormone replacement therapy Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk.

Which is a priority nursing assessment for the patient with severe acute pancreatitis?

Perfusion and other signs of shock

A patient who has just undergone a laparoscopic cholecystectomy is complaining of shoulder pain. What is most likely the cause of this pain?

Carbon dioxide gas Between 3 and 4 L of carbon dioxide gas are inserted into the abdomen during laparoscopic surgery. The patient may experience pain in the shoulder after this procedure. Lack of mobility would not cause this type of pain. Positioning after surgery would not cause this much pain. Gallstones are removed with surgery, so there would not be pain from gallstones after the surgery.

The nurse suspects that a patient may have acute pancreatitis as evidenced by which group of laboratory results?

Elevated lipase, elevated white blood cell count, elevated glucose

What findings should be reported to the health care provider prior to a patient having magnetic resonance cholangiopancreatography? Select all that apply.

Pacemaker Implantable cardioverter-defibrillator

A patient with chronic pancreatitis linked to alcoholism tells the nurse that absolute abstention from alcohol is impossible, but states an intention to consume only one alcoholic beverage a day. Which response by the nurse is correct?

Recommend that the patient contact an alcoholic support group

What finding is most concerning for a patient who has just undergone an open cholecystectomy?

Respiratory rate of 8 breaths/minute

What elevated blood level indicates inflammation in a patient diagnosed with cholecystitis?

White blood cell count The white blood cell count is indicative of inflammation. The lactate dehydrogenase, serum alkaline phosphate, and aspartate aminotransferase are significant for abnormalities in the liver.

The nurse is providing teaching about pancreatic enzyme replacement to a patient diagnosed with chronic pancreatitis. What statement by the patient indicates need for further teaching?

"I will take the pancreatic enzyme half an hour before meals."

A patient has been discharged to home after being hospitalized with an acute episode of pancreatitis. The patient, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the patient's spouse expresses frustration to the home health nurse regarding the patient's refusal. What is the nurse's best response?

"I'll get you some information on the support group Al-Anon."

A patient admitted with a diagnosis of pancreatitis is questioning the NPO order. What statement by the nurse is most appropriate?

"This reduces pancreatic enzyme secretion."

The nurse is preparing to instruct a patient with chronic pancreatitis who is to begin taking pancrelipase. Which instruction does the nurse include when teaching the patient about this medication?

"Wipe your lips after taking pancrelipase."

Which possible complication of chronic pancreatitis presents as a painful, palpable mass in the left upper quadrant?

Abscess or pseudocyst

A patient with cholecystitis reports pain in the right upper abdominal quadrant after a meal. The nurse assesses the patient and notes a heart rate of 115 beats/min, pallor, and diaphoresis. Which nursing action is correct?

Administer an analgesic medication.

A patient who has undergone an open cholecystectomy reports mild to moderate nausea. Which nursing action is correct?

Administer an antiemetic as prescribed as soon as possible.

A patient who has undergone a laparoscopic cholecystectomy is complaining of upper chest and shoulder pain. What action by the nurse is most appropriate?

Administer heat

A patient is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this patient?

Administer opioid analgesic medication.

To monitor the effectiveness of pancreatic enzyme therapy, what does the nurse assess?

Consistency and number of stools

What imaging will provide the most reliable diagnosis of acute pancreatitis?

Contrast-enhanced computed tomography

When performing an abdominal assessment on a patient diagnosed with pancreatitis, the nurse notes gray-blue discoloration around the periumbilical area, a dull sound on percussion, and normal bowel sounds. What action by the nurse is priority?

Document the findings

A patient diagnosed with chronic cholecystitis developed jaundice and clay-colored stools. For which other signs and/or symptoms should the patient be assessed? Select all that apply.

Icterus Steatorrhea

Which finding is expected in a patient who has a liver function abnormality?

Increase in serum levels of alkaline phosphatase Alkaline phosphatase is an enzyme found in the liver, kidneys, and bones. An increase in serum levels of alkaline phosphatase indicates a liver function abnormality. An increased level of WBCs indicates inflammation or infection. When the liver is not functioning normally, the level of lactate dehydrogenase and aspartate aminotransferase are increased, not decreased.

A patient scheduled for a cholecystectomy because of gallstones causing cholecystitis reports a pain level of 4 on a 0-to-10 pain scale. Which analgesic medication does the nurse anticipate will be prescribed for the patient?

Ketorolac Ketorolac may be used for mild to moderate pain. Acute biliary pain requires opioid analgesia, such as morphine or hydromorphone. In the past, meperidine was the drug of choice for acute biliary pain because it was thought to cause fewer spasms of the sphincter of Oddi, which blocks bile flow. However, this drug breaks down into a toxic metabolite and can cause seizures, especially in older adults. All opioids may cause some degree of sphincter spasm.

A patient has been diagnosed with Stage 4 metastatic pancreatic cancer. Which management strategy is typical for this type of cancer?

Palliative

What are risk factors for cholecystitis? Select all that apply.

Pregnancy Prolonged fasting Family history of gallstones

The nurse is caring for a patient diagnosed with acute pancreatitis who has had increased pain and guarding along with the following vital signs: blood pressure 108/60, pulse 125, temperature of 103.8°F, and an O 2 saturation of 95% on 2 L via nasal cannula. The nurse suspects the patient has a pancreatic abscess. After contacting the health care provider, what should the nurse do first?

Prepare the patient for pancreatic drainage

Which set of assessment findings indicates to the nurse that a patient may have acute pancreatitis?

Presence of jaundice, pain worsening when lying supine

A patient who has undergone an open Whipple procedure for pancreatic cancer has a heart rate of 110 beats/min, blood pressure of 90/62 mm Hg, and urine output less than 1 ml/kg/hr. The nurse notifies the surgeon to report which postoperative complication?

Shock

The patient recently diagnosed with acute pancreatitis complains of severe pain despite intravenous narcotic pain medication. Into which position should the nurse assist the patient in order to help decrease pain?

Side lying

The nurse is teaching a patient with gallbladder disease about diet modification. Which meal does the nurse suggest to the patient?

Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this patient. Steak, french fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a patient with gallbladder disease.

What findings are consistent with a diagnosis of acute cholecystitis? Select all that apply.

Vomiting Eructation Blumberg's sign

An older patient diagnosed with cholecystitis presents with acute confusion and minimal pain. The family is concerned that the patient is confused and wants to know why the patient did not have other symptoms associated with cholecystitis. What statement by the nurse is most appropriate?

"Older patients often don't have expected symptoms of cholecystitis."

A patient is in the healing stage of pancreatitis. The patient asks the nurse how to go about planning daily menus based around some favorite foods. Which meal is most appropriate for this patient?

A scoop of mildly seasoned chicken salad served with crackers

When caring for a patient with pancreatic cancer who is having severe pain, which intervention is the priority?

Administration of high-dose opioid analgesics when the patient reports pain

Which patient characteristics are risk factors for cholelithiasis? Select all that apply.

Aging Obesity Diabetes mellitus The risk for developing gallstones increases with age. Obesity increases the risk for cholelithias is due to impaired fat metabolism or increased cholesterol. Diabetes mellitus increases the chances of cholelithiasis due to higher levels of fatty acids. Neither depression nor vitamin deficiency cause cholelithiasis; they do not interfere with bile production and storage.

The nurse is caring for a patient who has been admitted multiple times for pancreatitis. The patient has inflammation and fibrosis of the tissue and diminished pancreatic function. What assessment is priority for this patient?

Alcohol consumption

A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition?

Chronic cholecystitis Fever, yellowing of the skin and eyes, clay-colored stools, and dark urine are symptoms of chronic cholecystitis. These symptoms occur when repeated episodes of cystic duct obstruction cause chronic inflammation. Peritonitis is an infection of the peritoneal cavity in which the patient presents with a hard, distended abdomen. Patients with malnutrition are underweight for their height and have low albumin. Patients with a vitamin deficiency do not display these symptoms; symptoms are always dependent upon the vitamin in which the patient is deficient.

Which factors increase the risk of developing pancreatic cancer? Select all that apply.

Cirrhosis Smoking Chronic pancreatitis

The nurse in the emergency department is assessing a patient. Which assessment findings, if present in the patient, would prompt the nurse to suspect chronic cholecystitis? Select all that apply.

Icterus Jaundice Cholangitis

The patient is evaluated for use of extracorporeal shockwave lithotripsy for treatment of cholelithiasis. What findings should the nurse notify the health care provider about?

Poor gallbladder function A patient scheduled for extracorporeal shockwave lithotripsy should have normal gallbladder function, so poor gallbladder function should be reported. A BMI of 27 indicates normal weight, which is necessary for this procedure. Upper abdominal pain is expected in a patient who has gallstones. A patient with cholesterol-based stones is an appropriate candidate for this procedure.

A patient is undergoing extracorporeal shockwave lithotripsy. The patient complains of pain in the abdomen. What action by the nurse is appropriate?

Let the patient know this is normal when the stones are breaking up and moving. The patient may experience pain during extracorporeal shockwave lithotripsy when the stones are breaking up and moving. This is not an indication to reposition the patient. The patient will not be placed under conscious sedation. The interventionist would not stop the procedure.

A patient has undergone a Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which interventions does the nurse implement to prevent complications? Select all that apply.

Monitor mental status. Measure blood glucose levels. Assess bowel sounds and stools.

Which of the following factors may be associated with the development of cholelithiasis? Select all that apply.

Nutrition habits Sedentary lifestyle Mexican-American populations A familial or genetic tendency appears to play a role in the cholelithiasis, but this may be partially related to familial nutrition habits (excessive dietary cholesterol intake) and sedentary lifestyles. The highest frequency of gallstone production lies among the American-Indian and Mexican-American populations. Development of gallstones is not related to smoking or normal weight loss.

A patient with chronic pancreatitis has edema of the feet, legs, and hands. This is a sign of which problem associated with chronic pancreatitis?

Protein malabsorption

What medications are administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply.

Ranitidine Omeprazole

The nurse is caring for a patient who underwent an open cholecystectomy 2 hours ago. What finding would require immediate intervention?

Refusal to cough and deep breathe

A patient is diagnosed with pancreatic cancer. Which is a common complication that the patient can develop?

Venous emboli

The nurse is providing discharge teaching to a patient who is being discharged home after hospitalization for acute pancreatitis. Which statement by the patient indicates a need for further teaching?

"I may have caffeine and chocolate in moderation."

A patient receiving chenodiol for cholelithiasis has just received teaching about the medication. What statement by the patient indicates the teaching was effective?

"I will need to have gallbladder ultrasound every 6 months for a year."

A patient diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response?

"This type of gallbladder inflammation is associated with severe dehydration." This type of gallbladder inflammation is associated with hypovolemia. Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed.

What labs should the nurse review for a patient suspected of having cholecystitis? Select all that apply.

Liver function White blood cells Alkaline phosphate Liver function, white blood cells, and alkaline phosphate are often elevated in patients with cholecystitis. Hematocrit and platelets are not often abnormal, and therefore are not diagnostic.

The nurse is caring for a patient with acute pancreatitis. The patient is complaining of shortness of breath and orthopnea. The patient's vital signs are: blood pressure 140/80, pulse 110, oxygen saturation 90% on room air, and temperature 99.8° F. What complication does the nurse suspect?

Pleural effusion

A nurse is assessing a patient who presents with severe abdominal pain radiating at times to the shoulder. The nurse notes the patient's skin and sclera are yellow in appearance. The patient reports a sedentary lifestyle and experiences rebound tenderness when tested for Blumberg sign. What does the nurse suspect?

The patient has chronic cholecystitis because jaundice and icterus are common in this form of the disease.

A patient with chronic pancreatitis has developed a pseudocyst that has not resolved after 8 weeks, and the provider plans a percutaneous drainage procedure. The patient asks the nurse why this is necessary since it does not seem to be causing problems. Which complication does the nurse explain the procedure will prevent?

Hemorrhage

Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis, in order to dissolve remaining stone fragments?

Ursodeoxycholic acid Ursodeoxycholic acid is administered to dissolve remaining fragments of stones after ESWL. Ketorolac, morphine, and bethanechol are not indicated for dissolution of stones.

A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this procedure?

Vagina Surgical removal of the gallbladder in women is most often accomplished via the vagina because it is easily decontaminated with betadine or other antiseptic, and it allows easy access into the peritoneal cavity. The surgeon makes a small internal incision through the cul-de-sac of Douglas, between the rectum and uterine wall, to access the gallbladder. The mouth and rectum do not provide easy access into a woman's peritoneal cavity. The umbilicus is used for removing the gallbladder in laparoscopic cholecystectomy.