Med-Surg Ch 30: Care of Patients With Disorders of the Gallbladder, Liver, and Pancreas

The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make? A. "Is there a reason that you want to have lithotripsy?" B. "Your doctor decides which procedure will be best." C. "Gallstones are usually treated with surgery. Tell me more about your concerns." D. "I understand that you are upset. Would you like to speak with a chaplain?"

"Gallstones are usually treated with surgery. Tell me more about your concerns." *Lithotripsy, or "shock wave" therapy, is rarely used for gallstones. The treatment of choice is gallbladder removal. By explaining that surgery is the treatment of choice but also asking the patient to elaborate, the nurse provides information and uses an open-ended statement to acknowledge the patient's feelings. Asking the patient to list the reasons that he wants lithotripsy is not therapeutic or effective since the patient requires a cholecystectomy. While the physician does choose which procedure is best indicated, the nurse should not dismiss the patient's concerns or deflect them and suggest that he speak with someone else

If the patient has a history of chronic cholecystitis, which comment is cause for the greatest concern? A. "I have back pain at the level of the shoulder blade." B. "I had nausea after eating a hamburger and fries." C. "I have generalized abdominal pain and fever." D. "I have discomfort in the right upper part of my abdomen."

"I have generalized abdominal pain and fever." *A chief concern for patients with chronic cholecystitis is infection and rupture of the gallbladder, leading to peritonitis that would be associated with generalized abdominal pain and fever. (1) Referred pain to the back does occur with acute attacks, and pain management is needed. (2) The patient should be reminded that fatty foods can cause nausea. (4) Discomfort in the right upper quadrant is considered a mild symptom of the chronic condition.

The nurse practices Universal Precautions to protect himself from which bloodborne types of hepatitis viruses? (Select all that apply.) A. Hepatitis A B. Hepatitis E C. Hepatitis C D. Hepatitis B D. Hepatitis D

1. Hepatitis C 2. Hepatitis B 3. Hepatitis D *Hepatitis B, C, and D are all transmitted by blood products and objects contaminated by blood products. Hepatitis A is transmitted by fecal-oral route; poor sanitation and contaminated water and shellfish; and often from infected food. Hepatitis E is transmitted by fecal-oral route and contaminated water or food.

The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found in which type(s) of body fluid(s) or secretions? (select all that apply) A. Semen B. Vaginal secretions C. Sweat D. Breast milk E. Human feces

1. Semen 2. Vaginal secretions 3. Breast milk 4. Human feces *HBV, HCV, HDV may cause chronic inflammation and necrosis of the tissue. HBV and HCV are transmitted by parenteral routes and sexually as they are present in semen, vaginal secretions, and saliva of carriers, as well as breast milk and human feces. HBV is not transmitted through sweat. Sexual partners of patients who are carriers of HBV and HCV are at high risk for contracting the virus

A 57-year-old man is admitted with a diagnosis of cirrhosis. The nurse is aware that he will most likely require which intervention(s)? (Select all that apply.) A. Vegetable-based proteins B. Bleeding precautions C. Diuretics D. Increased fluids E. Lactulose administration

1. Vegetable-based proteins 2. Bleeding precautions 3. Diuretics 4. Lactulose administration *Because the liver produces clotting factors and is now dysfunctional, risk for bleeding exists. The liver cannot metabolize proteins, especially albumin, properly. This leads to edema and ascites and requires diuretics, preferably potassium wasting. Ammonia buildup is likely; lactulose binds with this toxic metabolic by-product and allows for its excretion through the GI tract. Patients with liver disorders are at high risk for fluid volume excess.

The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2 F. The nurse anticipates that this patient will undergo workup for which problem? A. Cholecystitis B. Hepatitis C. Pancreatitis D. Gastroenteritis

Cholecystitis *Nausea and vomiting, fever, and leukocytosis occur with cholecystitis. Pain may be referred to the right clavicle, scapula, or shoulder. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea

The patient in the clinic has recently been diagnosed with viral hepatitis. The nurse anticipates that which test will be used to predict the virus's response to therapy? A. Enzyme immunoassay B. Genotype assay C. Western blot test D. Molecular assay

Genotype assay *The genotype assay can predict the patient's prognosis. The molecular assay detects viral nucleic acid. The enzyme immunoassay detects antibodies to various types of hepatitis. The Western blot test is used to screen for human immunodeficiency virus.

Which instructions should be given to a patient regarding preventing the spread of hepatitis A? (select all that apply) A. Bleach solutions must be used to clean the bathroom B. Somebody else should be doing the cooking right now C. No vaccination is available for hepatitis A D. Good hand hygiene reduces the likelihood of passing the virus

Good hand hygiene reduces the likelihood of passing the virus *Using bleach to clean the bathroom, having someone else cook, and ensuring good hand hygiene are important instructions for the patient with hepatitis A (see Home Care Considerations: Preventing the Spread of Hepatitis Virus for additional information). (3) Hepatitis A vaccination is available and recommended.

Fecal-oral transmission, acute onset

HAV

Transmission by contact with blood and body fluids, perinatal transmission from mother to infant

HBV

Most likely to lead to cirrhosis

HCV

Coexists with HBV

HDV

Prevalent in less developed countries

HEV

The nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology? A. Liver ischemia in hepatitis causes jaundice B. Increased bile production by the enlarged Kupffer cells causes jaundice C. The hepatitis virus destroys red blood cells and causes jaundice D. Hepatitis causes liver congestion that obstructs bile flow

Hepatitis causes liver congestion that obstructs bile flow *Congestion from the inflammation obstructs the bile from entering the duodenum and keeps it in the circulating volume

The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. The nurse recognizes that this finding likely results from which underlying problem? A. Increased amylase B. Retroperitoneal hemorrhage C. Inflammatory response to a pseudocyst D. Ascites

Retroperitoneal hemorrhage *A bluish tinge around the umbilicus or in the flank area indicates a retroperitoneal hemorrhage. Increased amylase levels, inflammatory response to a pseudocyst, and ascites do not result in a bluish tinge around the belly button

The physician has prescribed rifaximin (Xifaxan) for a patient with cirrhosis. The patient questions why he must take h is medication. Which response by the nurse is most appropriate? A. Rifaximin (Xifaxan) helps prevent infection B. Rifaximin (Xifaxan) helps reduce straining during a bowel movement. C. Rifaximin (Xifaxan) kills intestinal flora D. Rifaximin (Xifaxan) aids in reducing ascites

Rifaximin (Xifaxan) kills intestinal flora *Rifaximin (Xifaxan) decreases the bowel flora, colonic bacteria that breakdown protein. This treatment lowers the formation of ammonia. This medication may cause headaches or flatulence and is take twice daily with food

The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention? A. Shiny, tight abdomen B. Yellow sclera C. Confusion D. Paired horizontal bands on the fingernails

confusion *Mental confusion and coma result from hepatic encephalopathy. Encephalopathy occurs from liver failure that leads to circulating toxins. This finding is an indicator of deteriorating patient condition. Ascites and jaundice are expected findings in cirrhosis and do not necessarily indicate an urgent change in condition. Fingernails that feature horizontal bands in pairs that alternate with normal nail color due to hypoalbuminemia from cirrhosis; this finding does not indicate an urgent change in condition

A patient has cirrhosis of the liver and ascites. You should question which order? A. bed rest with bathroom privileges B. discontinue furosemide (Lasix) 80 mg C. Give 2-g sodium diet D. Fluid restriction 1500 mL/24 h

discontinue furosemide (Lasix) 80 mg *Medical treatment includes administration of diuretics, bed rest, sodium, and fluid restriction.

You are caring for a 57-year-old patient with ascites resulting from liver disease. You anticipate that the health care provider will use which therapeutic regimen to reduce portal hypertension? A. Vascular shunting of the portal venous systems B. Repeated abdominal paracentesis C. Diet restrictions and nutrient supplementation D. Fluid replacement therapy

Vascular shunting of the portal venous systems *Transjugular intrahepatic portosystemic shunt (TIPS) may be used to decrease pressure between portal and hepatic veins in the liver. (2) Paracentesis is a temporary measure that is used to relieve ascites. (3) Dietary modifications are aimed at symptom control and restoring function. (4) Fluids are likely to be restricted.

The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan? A. To visualize the location of gallstones B. To assess amounts of inflammation and swelling C. To diagnose abnormal contraction of the gallbladder D. To assess composition of gallstones

To diagnose abnormal contraction of the gallbladder *The HIDA scan can diagnose abnormal contractions of the gallbladder, which can occur in the presence of gallstones or a gallbladder that is not functioning properly

You are caring for a patient who underwent a recent liver transplantation. You reinforce the teaching related to self-care. While teaching topics are most important to address before discharge? (select all that apply) A. Reporting any kind of pain associated with fever and changes in stool color B. Location and meeting time of local support groups C. Use of strict hand hygiene in changing dressings D. The lifelong need to take antirejection medications

1. Reporting any kind of pain associated with fever and changes in stool color 2. Use of strict hand hygiene in changing dressings 3. The lifelong need to take antirejection medications *Reporting pain associated with fever and changes in stool color, using strict hand hygiene in changing dressings, and understanding the lifelong need to take antirejection medications are important teaching topics before discharge to address the risk for infection and organ rejection. (2) Support groups can be helpful after the patient has recovered from surgery; however, initially the immunosuppression requires limiting social contacts.

The nurse is caring for a patient with esophageal varices with a new order for vasopressin (Pitressin). The nurse reviews the patient's history and notes that the patient's comorbidities include coronary artery disease (CAD), type 2 diabetes, gastroesophageal reflux disease (GERD), and fibromyalgia. The nurse should immediately notify the physician about which component of the patient's history? A. CAD B. Diabetes Mellitus (DM) type 2 C. GERD D. Fibromyalgia

CAD *Vasopressin (Pitressin) is a potent medication that causes vasoconstriction and stops bleeding of esophageal varices. With the use of potent vasoconstrictors such as vasopressin (Pitressin), which constricts all vessels, the possibility of it causing a myocardial infarction (MI) is a very real concern and should be used most cautiously with the patient with CAD

The nurse is caring for a patient who underwent a cholecystectomy 3 days ago. Which assessment finding best indicates to the nurse that the bile flow is no longer obstructed from entering the bowel? A. Excessive flatus B. Dark brown stool C. Dark urine D. Increased appetite

Dark brown stool *Darkening of stools back to the normal color indicates that the bile has reached the duodenum

What are the three most common symptoms of cancer of the pancreas? A. Dark stools, food intolerance, and weight loss B. Jaundice, abdominal distention, and edema C. Pruritus, right upper quadrant pain, and weight gain D. Dark urine, jaundice, and weight loss

Dark urine, jaundice, and weight loss *Symptoms of pancreatic cancer include dark urine, jaundice, weight loss, epigastric pain, anorexia, vomiting, a dislike for red meat, glucose intolerance, clot formation, and clay-colored stools.

You are caring for a patient who underwent radical pancreaticoduodenectomy. Which postoperative complication would be most likely to occur and cause the greatest concern? A. Hypoglycemia B. Adhesions C. Hemorrhage D. Anorexia

Hemorrhage *Hemorrhage is a possibility with any major abdominal surgery. (1) Hyperglycemia is more likely than hypoglycemia. (2) Adhesions may develop eventually, but they are not a concern in the immediate postoperative period. (4) Anorexia may also occur, but the patient is likely to be NPO and receiving TPN.

The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis? A. Decreased aspartate aminotransferase (AST) B. Decreased alanine aminotransferase (ALT) C. Decreased gamma-glutamyl transpeptidase (GGT) D. Increase prothrombin time

Increase prothrombin time *During the acute phase of hepatitis, the patient will likely display prolonged prothrombin times. Levels of aspartate aminotransferase (AST), alanine aminotransferase, and GGT will be elevated

The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient? A. Instruct the patient to sit and lean forward B. Monitor intake and output C. Monitor laboratory values and note changes D. Check blood glucose values frequently

Instruct the patient to sit and lean forward *Pancreatitis causes abdominal pain that is usually acute, steady, and localized to the epigastrium or left upper quadrant. As it progresses, it spreads and radiates to the back and flank. Sitting and leaning forward may ease the pain. The severity of the pain may slowly decrease after 24 hr. Eating makes the pain worse. While monitoring intake and output and lab values are important actions, none of these actions actively address the patient's pain

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test? A. Liver biopsy B. Elevated aspartate aminotransferase (AST) C. Elevated alanine aminotransferase (ALT) D. Elevated lactate dehydrogenase (LDH)

Liver biopsy *Liver biopsy is the definitive test. AST, ALT, and LDH tests will be elevated, but they are not specific for cirrhosis

For which reason are patients with esophageal varices prone to hemorrhage? A. There is an accumulation of ammonia in the blood. B. They are no longer able to produce vitamin K. C. They have portal hypotension. D. There is poor circulation within the veins.

They are no longer able to produce vitamin K. *Esophageal varices are engorged veins (similar to varicose veins) that line the esophagus. They are the result of portal congestion and hypertension. The congestion can lead to massive bleeding when the vein walls rupture from increased pressure or esophageal irritation. Another factor in hemorrhage is that the liver is no longer able to make vitamin K. Ammonia buildup does not increase the patient's risk for hemorrhage.

In caring for a patient with hepatitis B, a nurse would employ which precautions? A. Standard Precautions B. Strict isolation C. Contact Precautions D. Surgical asepsis

Standard Precautions *Standard Precautions are needed to care for a patient with hepatitis B. Isolation and contact precautions are not indicated for this diagnosis unless this patient is experiencing active bleeding. Surgical asepsis is not required

A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate? A. "If you are having unprotected sexual intercourse with your partner, there is a relatively high risk for hepatitis A." B. "Hepatitis A is not transmitted as a result of close contact with an infected individual." C. "Hepatitis A transmission is associated with contact with infected body fluids." D. "Hepatitis A is relatively uncommon in our country and seen more in underdeveloped countries."

"Hepatitis A is not transmitted as a result of close contact with an infected individual." *Hepatitis A and hepatitis E viruses are transmitted primarily by the fecal-oral route. They are responsible for the epidemic forms of viral hepatitis. Hepatitis A virus can be transmitted by food handlers to customer or by mollusk shellfish from contaminated waters. Hepatitis B is transmitted via infected blood and body fluid. Hepatitis E virus infection is primarily seen in less developed countries

The nurse is caring for a patient with cirrhosis. The nurse is educating the patient about nutritional implications related to his diagnosis. Which statement indicates that the nurse's teaching has been successful? A. "I should eat lost of sweet potatoes and carrots for vitamin A." B. "I should choose proteins like cottage cheese and quinoa instead of chicken." C. "I should eat oysters and shellfish for a good source of copper." D. "I should eat red meat and dark, leafy vegetables to boost my iron stores."

"I should choose proteins like cottage cheese and quinoa instead of chicken." *Traditionally, limitation of dietary protein intake was prescribed; however, this approach is being challenged and the current recommendation is to manage encephalopathy with medications rather that to restrict protein. Vegetable proteins are preferred because they not contribute to encephalopathy. Substituting meat proteins for proteins sources like quinoa and cottage cheese is a good dietary choice. Patients with liver inflammation or cirrhosis should avoid taking large doses of vitamins and minerals. Vitamin A, iron, and copper can worsen the liver damage, so this patient should not try to increase intake of these vitamins and minerals

The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse's teaching has been successful? A. "I should call my doctor if I have any pain." B. "I should be able to go back to work tomorrow." C. "I should avoid fatty foods for a few weeks." D. "I should let these Steri-Strips fall off on their own."

"I should let these Steri-Strips fall off on their own." *The nurse should teach the patient to remove the bandages from the puncture site(s) the day after surgery and shower, leaving the Steri-Strips intact. Steri-Strips will fall off in 7 to 10 days. The patient should notify the physician in cases of severe abdominal pain that is not relieved by medication or is worsening. Return to work is probable at 1 week post-surgery. The patient should adhere to a low-fat diet for several weeks and slowly introduce fattier foods to determine if they cause unpleasant symptoms

A patient with high levels of serum ammonia asks, "Why do I have to continue taking lactulose?" What is the best response? A. "It destroys ammonia-producing bacteria in the intestines." B. "It reduces intestinal absorption of ammonia." C. "It corrects vitamin B1 deficiency." D. "It is used in preparation for a diagnostic test."

"It reduces intestinal absorption of ammonia." *Lactulose is used to induce diarrhea and prevent absorption of ammonia from the intestinal tract. (1) Neomycin is occasionally given orally or by enema to decrease the colonic bacteria. (3) Thiamine is given to correct vitamin B1 deficiency. (4) Lactulose does induce diarrhea, but it would not be the first choice for bowel preparation.

The nurse is caring for a patient being treated for new onset of gallstones. The patient asks the nurse if he will have to have surgery. How should the nurse respond? A. "You will have to have surgery if you continue to have gallstones." B. "Tell me more about your concern." C. "Treatment for gallstones may include diet modification and weight loss, medications, or surgery." D. "You need to ask the doctor about your concerns."

"Treatment for gallstones may include diet modification and weight loss, medications, or surgery." *The patient should be aware that treatment varies according to severity and frequency of symptoms in conjunction with the patient's response to various treatments. Conservative therapy includes low-fat diets and weight loss, along with restriction of alcohol intake. Oral medications may be given to dissolve gallstone. If the patient does not respond to this therapy, or if bile obstruction occurs, correction of the obstruction biliary tract is indicated. Gallbladder removal is indicated with patients with ongoing symptoms or complication. The nurse should not tell the patient that surgery is inevitable. The patient has already expressed his concern (whether he will require surgery.) The nurse can address the patient's concern and should not deflect them to the physician.

Before being discharged to home, a patient who has a laparoscopic cholecystectomy is given instructions regarding pain control. Which patient statements indicate successful teaching? (Select all that apply) A. "I will stay home and change positions frequently." B. "Opioids are the best medication for relieving pain." C. "I will continue my swimming routine for exercise." D. "Passing gas will relieve my pain." E. "Pain will become less as the gas in my abdomen is absorbed." F. "I will take NSAIDs for pain control."

1. "I will stay home and change positions frequently." 2. "Pain will become less as the gas in my *Being mobile and changing positions will allow for quicker absorption of the CO2 used during the procedure. The pressure of the gas in the abdomen increases pressure on surgical tissues; as the gas is absorbed, the pressure lessens and pain decreases. NSAIDs have an antiinflammatory effect, which further helps pain. They should be tried first along with nonpharmaceutical interventions. (2) Opioids may be needed for postoperative pain management, but they do not help inflammation and can cause constipation so are not the best first choice. (3) Although swimming is a great exercise and would help with dissipation of the CO2, the incisions should not be immersed in water. (4) The gas pain that is felt is from gas in the abdominal cavity; it is not in the intestine and is not available for removal as flatus.

The nurse is planning skin care of the patient with ascites. Which actions should the nurse include? (select all that apply) A. Bathe the patient in hot water B. Apply emollients to decrease itching C. Closely trim the patient's fingernails D. change the patient's position ever 1 to 2 h E. Coach the patient in deep-breathing exercises

1. Apply emollients to decrease itching 2. Closely trim the patient's fingernails 3. change the patient's position every 1 to 2 h *Applying emollients, cutting fingernails short, and changing the patient's position frequently are appropriate interventions. The nurse should bathe in tepid water. Deep breathing, although a good intervention in certain situations, has nothing to do with skin care

A patient with acute pancreatitis has a bluish discoloration around the umbilicus. What actions should you take? (place in priority order) A. Place head flat and feet elevated B. Notify health care provider C. Assess vital signs D. Verify patency of IV line

1. Assess vital signs 2. Place head flat and feet elevated 3. Verify patency of IV line 4. Notify health care provider *Bluish discoloration around the umbilicus for this patient suggests internal bleeding. The nurse would check vital signs first to assess the severity of the bleeding. Placing the patient flat with feet elevated will support the blood pressure. Patency of the IV line is crucial in being able to replace fluids. The provider needs to be notified. Another important action not given as an option is to call for help.

The nurse caring for patient recently admitted with acute pancreatitis. Which action(s) should the nurse include in the daily assessments? (select all that apply) A. Auscultate bowel sounds B. Carefully evaluate amount of food eaten after each meal C. Measure abdominal girth D. Monitor for effectiveness of pain control E. Monitor urine output

1. Auscultate bowel sounds 2. Measure abdominal girth 3. Monitor for effectiveness of pain control 4. Monitor urine output *The nurse should auscultate bowel sounds, measure abdominal girth to monitor for ascites, monitor for pain and evaluate effectiveness of pain control, and monitor urine output. In early acute pancreatitis, the patient should be kept NPO; measuring food is unecessary

A patient with advanced cirrhosis develops esophageal varices. The nurse anticipates that this complication will be addressed by which type of medication(s)? (select all that apply) A. Vasodilators B. Intravenous (IV) vasopressin (Pitressin) C. IV iron D. Beta blockers E. Vitamin K

1. Intravenous (IV) vasopressin (Pitressin) 2. Beta blockers 3. Vitamin K *Treatment options include administration of parenteral vasopressors such as vasopressin (Pitressin) to lower portal pressure, a beta blocker to lower blood pressure, and vitamin K to help rectify clotting factor deficiencies. Vasoconstrictors (not vasodilators) such as somatostatin (Zecnil) and octreotide (Sandostatin) are used to reduce portal blood flow, and iron may exacerbate liver failure

The nurse is speaking with a patient who has concern about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (select all that apply) A. Obesity B. Daily exercise regimen C. Diabetes Mellitus (DM) D. Taking cholesterol-lowering drugs E. Mexican American ethnicity

1. Obesity 2. Diabetes Mellitus (DM) 3. Taking cholesterol-lowering drugs 4. Mexican American ethnicity *Cholelithiasis is the presence of gallstones within the gallbladder or in the biliary tract. Obesity, DM, intake of cholesterol-lowering drugs, and Mexican American ethnicity are risk factors for the development of gallstones. A sedentary lifestyle is a risk factor for cholelithiasis

The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis, blocks the blood flow through the liver, it can lead to which complications? select all that apply) A. Portal hypertension B. Decrease in metabolic processes of the liver C. Decrease in clotting factors D. Increase in ascites E. Decrease in aldosterone

1. Portal hypertension 2. Decrease in metabolic processes of the liver 3. Decrease in clotting factors 4. Increase in ascites *Cirrhosis is a progressive, chronic disease of the liver. The destruction of normal hepatic structures and their replacement with necrotic tissue occur. Fibrous bands of connective tissue develop in the organ. The bands eventually constrict and partition the liver tissue into irregular nodules. If this process is halted before too much liver tissue is damaged, the liver tissue will regenerate. Late cirrhosis is considered irreversible. The outcomes of cirrhosis of the liver are failure of its cells to perform their functions and the development of portal hypertension. Aldosterone levels are increased rather than decreased

One goal of nursing care for a patient during the acute phase of pancreatitis is reduction of pain. Which nursing interventions help alleviate pain? (select all that apply) A. Reinforce use of the PCA pump B. Maintain IV fluids as ordered C. Provide a soft diet with additional fluids D. Administer dicyclomine (Bentyl) E. Give pancreatic enzymes F. Place the patient in a supine position

1. Reinforce use of the PCA pump 2. Maintain IV fluids as ordered 3. Administer dicyclomine (Bentyl) *Encouraging use of pain medications, maintaining intravenous fluids, and administering antispasmodics will help alleviate the pain. (3) The patient should not be given a diet but should remain NPO until after the acute phase. (5) Pancreatic enzymes are given once oral feeding has resumed. (6) The patient will likely be more comfortable in a knee-chest position.

A nurse is caring for a patient who is 4 h postoperative after a laparoscopic cholecystectomy. The patient report abdominal fullness and mild discomfort. After verifying that the patient's vital signs are stable, what action is most important for the nurse to take next? A. Ambulate the patient B. Notify the charge nurse C. Position the patient in High Fowler D. Administer the ordered PRN analgesic

Ambulate the patient *Retained carbon dioxide (CO2) used during a laparoscopic procedure causes "free air" pain, which may manifest as abdominal fullness and mild discomfort. Early and frequent ambulation helps the CO2 gas dissipate. The charge nurse does not require notification at this time. The nurse should position the patient upright after ambulation. If ambulation does not ease the patient's discomfort, the nurse should then administer the PRN analgesic as ordered

A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse anticipates that the health care provider will likely recommend which treatment? A. A prescription for a broad-spectrum antibiotic B. A prescription for an antiviral agent C. The first of the three immunizations for HBV D. An injection of hepatitis B immune globulin (HBIG)

An injection of hepatitis B immune globulin (HBIG) *HBIG will give immediate passive immunity. Immunization for HBV takes too long for immediate coverage. Oral medications are of little value at this stage