cholecystitis Nclex questions

a nurse is doing preop teaching for a client who will have a cholecystectomy. the nurse teaches that special care must be taken to prevent what postop complication? 1. hypostatic pneumonia 2. thrombosis 3. hemorrhage 4. paralytic ileus

1. hypostatic pneumonia: the incision is located below the ribcage; therefore the coughing and deep breathing necessary to prevent pneumonia are especially difficult post op

a client has had gallbladder attacks in the past and is considered at risk for gallstone formation. the nurse should check that the clients diet is: 1. high in antacids and calcium 2. low in cholesterol 3. high in protein and carbohydrates 4. free of electrolytes

2. low in cholesterol: biliary calculi are high in cholesterol, therefore the cholesterol intake of the client should be limited

Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse's teaching has been successful? A. 4-6 small meals of low-carbohydrate foods daily B. High-fat, high-carbohydrate meals C. Low-fat, high-carbohydrate meals D. High-fat, low protein meals

3. Answer: C. Low-fat, high-carbohydrate mealsFor the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis.

a postop cholecystectomy client is receiving a clear liquid diet. which foods are allowed? 1. jello, cream of chick soup, milk 2. oatmeal, oj, vanilla pudding 3. water, coffee or tea, sherbert, pureed bananas 4. a grape popsicle, plain gelatin, apple juice, water

4. a grape popsicle, plain gelatin, apple juice, water

two days after her cholecystectomy, a client has been experiencing nausea and vomiting. the client has a t tube in place. for what electrolyte imbalance will the nurse monitor? 1. hypernatremia 2. hyperkalemia 3. hypervolemia 4. hypokalemia

4. hypokalemia: gastric secretions are high in postassium

a nurse is teaching a client about choledocholithiasis. the nurse explains that the term means 1. infection of the bile duct 2. stones in the hepatic and bile duct 3. inflammation of the gallbladder 4. stones in the gallbladder

4. stones in the hepatic and bile duct

A nurse is reviewing nutrition teaching for a client who has cholecystitis. Which of the following food choices can trigger cholecystitis?A. Brownie with nutsB. Bowl of mixed fruitC. Grilled turkeyD. Baked potato

A. CORRECT: Foods that are high in fat, such as a brownie with nuts, can cause cholecystitis.

A nurse is completing preoperative teaching for a client who will undergo a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. "The scope will be passed through your rectum." B. "You may have shoulder pain after surgery." C. "The T-tube will remain in place for 1 to 2 weeks." D. "You should limit how often you walk for 1 to 2 weeks."

B. CORRECT: Shoulder pain occurs due to free air that is introduced into the abdomen during laparoscopic surgery.

A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Take baths rather than showers. B. Clamp T-tube for 1 to 2 hr before and after meals. C. Keep the drainage system above the level of the gallbladder. D. Expect to have constipation. E. Empty drainage bag every 8 hr.

B. CORRECT: The T-tube should be clamped 1 to 2 hr before and after meals to assess tolerance to food postcholecystectomy, and prior to removal.E. CORRECT: The drainage bag attached to the T-tube should be emptied every 8 hr.

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions? A. "This medication will help me digest fats and fat-soluble vitamins." B. "I will apply the medicated lotion sparingly to the areas where I itch." C. "The medication is a powder and needs to be mixed with milk or juice." D. "I should take this medication on an empty stomach at the same time each day."

C. "The medication is a powder and needs to be mixed with milk or juice." For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.

A nurse is reviewing a new prescription for ursodiol (Ursodeoxycholic Acid) with a client who has cholelithiasis. Which of the following should be included in the teaching? A. This medication reduces biliary spasms. B. This medication reduces inflammation in the biliary tract. C. This medication dilates the bile duct to promote passage of bile. D. This medication dissolves gall stones.

D. CORRECT: Ursodiol is a bile acid that gradually dissolves cholesterol-based gall stones.

Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to exhibit? A. Jaundice, dark urine, and steatorrhea B. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration C. Ecchymosis petechiae, and coffee-ground emesis D. Nausea, vomiting, and anorexia

D. Nausea, vomiting, and anorexiaAcute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following: anorexia, nausea, and vomiting; biliary colic; tenderness and rigidity the right upper quadrant (RUQ) elicited on palpation (e.g., Murphy's sign); fever; fat intolerance; and signs and symptoms of jaundice. Ecchymosis, petechiae, and coffee-ground emesis are clinical manifestations of esophageal bleeding. The coffee-ground appearance indicates old bleeding. Jaundice, dark urine, and steatorrhea are clinical manifestations of the icteric phase of hepatitis.

the nurse reinforces teaching for a pt after a cholecystectomy on a low fat diet. the nurse will know that the pt understands the diet if which of the following menu items is selected? a. roast chick rice gelatin dessert b. cream of chick soup, milk, gelatin dessert c. meat loaf, mashed potatoes with small amount of gravy, green beans d. turkey and cheese sandwich on whole grain bread, apply, milk

a: roast chicken, rice, and gelatin dessert is a low fat meal

Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture sites for 48 hours. b. reporting any bile-colored drainage or pus from any incision. c. using over-the-counter antiemetics if nausea and vomiting occur. d. emptying and measuring the contents of the bile bag from the T tube every day.

b Rationale: The following discharge instructions are taught to the patient and caregiver after a laparoscopic cholecystectomy: First, remove the bandages on the puncture site the day after surgery and shower. Second, notify the surgeon if any of the following signs and symptoms occur: redness, swelling, bile-colored drainage or pus from any incision; and severe abdominal pain, nausea, vomiting, fever, or chills. Third, gradually resume normal activities. Fourth, return to work within 1 week of surgery. Fifth, resume a usual diet, but a low-fat diet is usually better tolerated for several weeks after surgery.

the nurse is caring for a pt who had an open cholecystectomy 24 hrs ago. which of the follwing actions should the nurse take to assist the pt to maintain an effective breathing pattern? select all that apply a. place in a supine position b. provide analgesics for pain c. encourage coughing and deep breathing d. monitor bowel sounds e. assist with splinting during coughing f. maintain bedrest for 48 hrs after

bce: pain relief allows comfortable breathing, preventing shallow respiration's and guarding, splinting makes coughing more comfortable, encouraging coughing and deep breathing to keep lung clear

the nurse is collecting data for a pt who develops jaundice and dark, amber colored urine. the nurse recognizes that which of the following is most likely the cause? a. encephalopathy b. pancreatitis c. bile duct obstruction d. cholecystitis

c: bile duct obstruction can result in jaundice and dark aber colored urine due to bile blockage

The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that a. shock-wave therapy should be tried initially. b. once gallstones are removed, they tend not to recur. c. the disorder can be successfully treated with oral bile salts that dissolve gallstones. d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic.

d Rationale: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis.

a 38 y/o woman was admitted with a medical dx of cholecystitis. the nurse would expect the hx of her present illness to include intolerance to which nutrient? 1.carbohydrates 2. fat 3. protein 4. vitamin c

fat: inflammation of the gallbladder, presence of gallstones, or both interfere with movement of the bile from the liver or gallbladder into the small intestine, where it promotes the digestion of fats

a 32 y/o client had a cholecystectomy 2 hrs ago. the client weighs 250 lbs and had general anesthesia. the client is c/o pain. priority nursing dx at this time: 1. alteration in comfort 2. high risk for airway impairment 3. alteration in fluid volume 4. knowledge deficit

high risk for airway impairment: the airway is of highest priority in postop clients after general anesthesia