Exam 8

A client is recovering from an acute episode of alcoholism that included esophageal involvement. What are the components of a therapeutic diet that are MOST appropriate for the nurse to include in the teaching plan for this client? SELECT ALL THAT APPLY.

1. soft diet 4. High-protein diet 6. HIgh-carbohydrate diet

A nurse is preparing a teaching plan for a client with a history of cholelithiasis. Which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?

2. Bile flow into the intestine is obstructed.

The nurse detects an epigastric mass while assessing a patient with acute pancreatitis. The patient describes epigastric pain that radiates to his back. What does the nurse suspect?

b. Pancreatic pseudocyst

Which patient is at low risk for the development of gallbladder disorders?

Patient who is 20 years old and male.

The daughter of a patient with cholelithiasis has heard that there is a genetic disposition for cholelithiasis. The daughter asks the nurse about the risk factors. How does the nurse respond?

"Hormone replacement therapy has been associated with increased risk for cholecystitis.

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. which nursing action should be included in the plan of care?

1. Encouraging expression of concerns 3. Teaching the importance of getting rest

A client is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. The nurse is providing discharge teaching about how many days the client should wait to engage in certain activities. Place in order from first to last.

3. Performing light exercise 4. Getting out of bed in a chair 2. Driving a car 1. Showering 5. Lifting objects of more than 10 lbs.

Disseminated intravascular coagulation (DIC) is a complication of pancreatitis. What pathophysiology leads to this complication?

Consumption of clotting factors and microthrombi formation.

Thiamine (vitamin b12) and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan?

Neuronal activity.

The nurse on a medical-surgical unit is caring for several patients with acute cholecystitis. Which task is best to delegate to the unlicensed assistive personnel (UAP)?

Obtain patients' vital signs.

A patient is admitted to the patient care unit with obstructive jaundice. Which sign/symptom does the nurse expect to find upon assessment of the patient?

Pruritus

The nurse has instructed a patient in the recovery phase of acute pancreatitis about diet therapy. Which statement by the patient indicates that teaching has been successful?

c. "I will avoid eating chocolate and drinking coffee."

Which statement about the care of a patient with a Jackson-Pratt (JP) drain after a traditional cholecystectomy is true?

d. Serosanguineous drainage stained with bile is expected for 24 hours.

The nurse is administering ketorolac (Toradol) to a 78-year-old patient for mild to moderate pain management. Which assessment finding indicates the patient is experiencing a side effect of this drug?

a. Abdominal bloating and cramping

Which are common manifestiations of acute cholecystitis?

a. Anorexia c. Eructation e. Jaundice f. Rebound tenderness

Which abnormal laboratory findings are cardinal findings in acute pancreatitis? (Select all that apply.)

a. Elevated serum lipase b. Increased serum amylase d. Elevated serum elastase

The patient with acute pancreatitis experiences abdominal pain. What is the best intervention to begin management of this pain?

a. IV opioids by means of patient-controlled analgesia (PCA)

Which statements are true regarding laparoscopic cholecystectomy? (Select all that apply.)

a. Laparoscopic cholecystectomy is considered the "gold standard" and is performed far more often than the traditional open approach. c. Removing the gallbladder with the laparoscopic technique reduces the risk of wound complications. d. Patients who have their gallbladders removed by the laparoscopic technique should be taught the importance of early ambulation to promote absorption of carbon dioxide.

The nurse is caring for a patient with pancreatic cancer who had a Whipple procedure. Which interventions and assessments does the nurse implement? (Select all that apply.)

a. Place the patient in semi-Fowler's position. b. Place the NG tube on intermittent suction. d. Keep the patient NPO e. Check blood glucose often.

Which are potential cardiovascular complications for a patient after surgery for a Whipple procedure? (Select all that apply).

a. Thrombophlebitis c. MI d. HF

Which statements about pancreatic cancer are accurate? (select all that apply)

a. Venous thromboembolism (VTE) is a common complication of pancreatic cancer b. Pancreatic cancer often presents in a slow and vague manner. d. There are no specific blood tests to diagnose pancreatic cancer. f. Chronic pancreatitis predisposes a patient to pancreatic cancer.

Which factor renders a patient the least likely to benefit from ESWL for the treatment of gallstones?

a. height 5 feet 10 inches, 325 lbs

The nurse is teaching a patient and family how to prevent exacerbations of chronic pancreatitis. Which teaching point does the nurse include?

b. Avoidance of alcohol and nicotine

The nursing student is caring for a patient with chronic pancreatitis who is receiving pancreatic enzyme replacement therapy. Which statement by the student indicates the need for further study concerning this therapy?

c. "If the patient has difficulty swallowing the enzyme preparation, I will crush it and mix it with foods."

The patient comes to the ED with severe abdominal pain in the midepigastric area. The patient states that the pain began suddenly, is continuous, radiates to his back, and is worst when he lies flat on his back. What condition does the nurse suspect?

c. Acute pancreatitis

What is the most common and serious complication after a Whipple procedure?

c. Fistula development

The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient has a heart rate of 118/minute, is pale, diaphoretic, and describes extreme fatigue. What is the nurse's priority action at this time?

c. Notify the patient's health care provider.

The female patient is to have her gallbladder removed by natural orifice transluminal endoscopic surgery. What does the nurse teach about this surgery?

c. The surgeon will use a vaginal approach to remove your gallbladder.

For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? SELECT ALL THAT APPLY.

1. Dark urine 2. Yellow Skin 4. Clay-colored stool

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? SElECT ALL THAT APPLY.

1. Ecchymosis 2. Yellow sclera 5. Pain in right upper quadrant

Which condition is most likely to be treated with antibiotics?

d. Acute necrotizing pancreatitis

The health care provider has assessed a patient's abdomen and found rebound tenderness on deep palpation. What does the nurse recognize?

d. Blumberg's sign

A client wit ha history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "What is a pseudocyst?" What info should the nurse include in a response to this question?

3. Dilated space of necrotic tissue and blood

Which type of drug is used to treat acute severe biliary pain?

d. Opioids (Morphine)

After removal of the gallbladder, a patient experiences abdominal pain with vomiting for several weeks. What does the nurse recognize?

d. Postcholecystectomy syndrome

Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopancreatography (ERCP)?

Bilirubin level

A client is admitted with a tentative diagnosis of pancreatitis. the medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? SELECT ALL THAT APPLY.

2. Administer analgesics 3. Teach relaxation exercises 5. Monitor cardiac rate and rhythm

The patient is to continue pancreatic enzyme therapy (PERT) after discharge. Which statement indicates that the patient understands teaching about this therapy?

b. "I will take the enzymes after I take my ranitidine (Zantac)."

Which are manifestations of pancreatic cancer? (Select all that apply.)

b. Anorexia and weight loss c. Splenomegaly d. Ascites e. Leg or calf pain f. Weakness and fatigue

Which diagnostic test is the most accurate in verifying a diagnosis of acute pancreatitis?

b. Lipase

The patient with acute cholecystitis had a pacemaker. Which diagnostic test is contraindicated?

b. Magnetic resonance cholangiopancreatography (MRCP)

A patient is scheduled for tests to verify the medical diagnosis of cholecystitis. For which diagnostic test does the nurse provide patient teaching?

b. Ultrasonography of the right upper quadrant

A patient with acute pancreatitis is at risk for the development of paralytic (adynamic) ileus. Which action provides the nurse with the best indication of bowel function?

c. Asking the patient if he or she has passed flatus or had a stool.

A client is returned to the surgical unit after an abdominal cholecystectomy. What is the main reason why the nurse should assess for clinical indicators of respiratory complications?

2. Incision is in close proximity to the client's diaphragm.

Before a cholecystectomy vitamin K is prescribed. Which element, formed in the presence of vitamin K, should the nurse determine is the purpose of administering this medication?

2. Prothrombin

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "what does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding?

4. Increases enzyme secretion and pancreatic duct pressure that causes back flow of enzymes into the pancreas.

The nurse is evaluating electrolyte values for a patient with acute pancreatitis and notes that the serum calcium is 6.8 mEq/L. How does the nurse interpret this finding?

b. A result of the body not being able to use bound calcium.

The nurse is caring for an older adult patient with acute biliary pain. Which drug order does the nurse question?

b. Meperidine (Demerol)