Med-Surg Week 8

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."

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."

The nurse is teaching a patient with chronic pancreatitis about pancreatic-enzyme replacement therapy. Which statement by the patient indicates a correct understanding of the teaching?

"I may spread the capsule contents over applesauce, mashed fruit, or rice cereal."

The nurse is teaching a patient about extracorporeal shockwave lithotripsy. What statement by the patient indicates a need for further teaching?

"I will sit in 12 inches of water."

A patient with acromegaly is prescribed bromocriptine mesylate therapy. What does the nurse tell the patient about this treatment?

"The drug must be stopped during pregnancy."

A patient has developed syndrome of inappropriate antidiuretic hormone (SIADH). What is the appropriate nursing intervention?

Administer conivaptan

A patient presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na 130 mEq/L, K 5.6 mEq/L, and glucose 72 mg/dL. Which is the first intervention that the nurse should anticipate?

Administer insulin and dextrose in normal saline to shift potassium into cells.

What manifestations does the nurse expect to find in a patient with gonadotropin deficiency? Select all that apply.

Amenorrhea Breast atrophy Decreased axillary hair

Which laboratory findings are consistent with a patient diagnosed with hyperaldosteronism? Select all that apply.

Arterial pH 7.48 Serum sodium 148 mEq/L

What nursing interventions should be implemented for a patient diagnosed with diabetes insipidus (DI)? Select all that apply.

Assess mucous membranes Perform strict urinary intake and output assessments

Which interventions are appropriate for a patient with a pituitary tumor who has developed syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply.

Restrict fluid intake Assess liver function Administer tolvaptan

Which clinical manifestations are found in a patient with deficiency of growth hormone? Select all that apply.

Decreased bone density Increased serum cholesterol level

While reviewing the lab reports of a patient, the nurse finds a urinary specific gravity of 1.001, osmolarity of 60mOsm/kg, and a decrease in antidiuretic hormone (ADH) levels. Which condition does the nurse anticipate in the patient?

Diabetes insipidus (DI)

What laboratory findings are consistent with a diagnosis of Cushing's disease? Select all that apply.

Elevated serum cortisol Increased serum sodium Decreased serum potassium

What manifestation does the nurse expect to find during the assessment of a patient with pheochromocytoma? Select all that apply.

Increased abdominal pressure Profuse sweating or diaphoresis Intermittent episodes of hypertension

A male patient with hypopituitarism is receiving sex steroid replacement therapy with androgens. The nurse recognizes that which assessment findings indicate effective treatment? Select all that apply.

Increased libido Increased muscle mass Increased bone strength

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.

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

A patient has an external drain attached to a percutaneous transhepatic biliary catheter that is to be drained and measured every 4 hours. At 1600, the nurse notes a reduction in bile drainage from when she emptied the drain at 0800 and 1200. Which nursing action is correct?

Notify the provider that the drain is not functioning correctly.

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

Nutrition habits Correct 4 Sedentary lifestyle Correct 5 Mexican-American populations

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

Perfusion and other signs of shock

As part of the pathophysiologic process during acute pancreatitis, proteolysis results in which effect?

Thrombosis and gangrene of the pancreas

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

The patient is being seen by the primary care provider for thyroid-stimulating hormone (TSH) deficiency. What assessment findings are consistent with this diagnosis? Select all that apply.

Weight gain Scalp alopecia Slowed cognition

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."

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 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."

A patient has developed acute pancreatitis caused by gallstones in the biliary system. Which is the highest priority instruction for this patient to avoid further attacks of pancreatitis?

"See your health care provider immediately when experiencing symptoms of a gallbladder attack."

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."

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."

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."

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.

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

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

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

Chronic

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

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)

A patient who has undergone a laparoscopic cholecystectomy reports mild postoperative abdominal bloating and discomfort. Which nursing action is correct?

Encourage the patient to ambulate in the hall

A patient diagnosed with cholelithiasis has a gallstone lodged in the common bile duct. What assessment findings are consistent with this diagnosis? Select all that apply.

Icterus Jaundice

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

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

Jaundice Darkened urine Clay-colored stools

The nurse is reviewing the lab results of a patient diagnosed with cholecystitis. Elevations in which results would prompt the nurse to suspect abnormal liver function in this patient. Select all that apply.

Lactate dehydrogenase Serum alkaline phosphate Aspartate aminotransferase

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.

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

Lipase

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

Middle-aged thin adult who has had a laparoscopic cholecystectomy

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 patient who has undergone an open cholecystectomy 12 hours prior has a Jackson-Pratt (JP) drain. The nurse empties the drainage and notes bile-stained serosanguineous fluid. Which nursing action is correct?

Record the amount and color of the fluid and continue to monitor the patient.

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

Respiratory rate of 8 breaths/minute

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 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 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

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

Ursodeoxycholic acid

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

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

White blood cell count

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

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

Aging Obesity Diabetes mellitus

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

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with Addison's disease with a potassium level of 6.0 mEq/L and a sodium level of 127 mEq/L

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with Conn's syndrome with a blood pressure of 210/106 mm Hg and tremors

The nurse is educating the patient on what to expect after laparoscopic cholecystectomy. Which statement made by the patient reflects a need for further education?

"I should avoid moving my legs as I recover from surgery to prevent injury."

A patient diagnosed with diabetes insipidus (DI) has received education about the diagnoses. Which statement by the patient indicates an understanding of the teaching?

"I will need to change positions slowly to avoid getting lightheaded."

Which symptom of chronic pancreatitis also occurs with acute pancreatitis?

Abdominal pain

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

Abscess or pseudocyst

A patient admitted for cholecystitis presents with the following vital signs: blood pressure 145/92, pulse 108, and temperature of 101.8°F. What action by the nurse is priority?

Administer PRN ketorolac (IV)

A patient suspected of having cholecystitis presents with severe upper epigastric pain radiating to the right shoulder. The patient is vomiting and has abdominal distention. What findings do these symptoms indicate?

Biliary colic

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

Consistency and number of stools

A patient who has just undergone a Whipple procedure for pancreatic cancer has frank blood and an increased output from the biliary drainage tubes. What action by the nurse is priority?

Contact the surgeon

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

Contrast-enhanced computed tomography

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.

A patient is diagnosed with adrenal gland hypofunction. The nurse is monitoring the patient's cortisol and aldosterone levels. Which condition is the nurse observing for in the patient?

H

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

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

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 the MD

The patient presents to the emergency department with recurrent right upper quadrant abdominal pain following meals. Additional symptoms include belching and indigestion. Cholecystitis is diagnosed. Which comorbidities prompt the nurse to suspect the patient is suffering from calculous cholecystitis? Select all that apply.

Impaired gallbladder motility Abnormal metabolism of cholesterol

The nurse is assessing a patient with syndrome of inappropriate antidiuretic hormone (SIDAH). Which finding should the nurse anticipate in the patient?

Increase in urinary osmolarity

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 has undergone a transsphenoidal hypophysectomy. Which intervention should the nurse implement to avoid increasing intracranial pressure (ICP) in the patient?

Instruct the patient not to strain during a bowel movement.

In acute pancreatitis, what does elevated serum lipase indicate?

Pancreatic cell injury

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

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

A patient admitted for cholecystitis who is scheduled for a cholecystectomy in 6 hours reports pain of 3/10 and requests pain medication. Vital signs are blood pressure 120/68, pulse 86, and temperature of 98.9° F. What medication does the nurse anticipate administering?

Ketorolac IV

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

Liver function White blood cells Alkaline phosphate

A patient has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the patient about this therapy, the nurse advises the patient not to mix enzyme preparations with foods containing which element?

P

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

Palliative

Which patient does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use?

Patient with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week

What medications would the nurse plan to administer to a patient diagnosed with hyperaldosteronism? Select all that apply.

Potassium Spironolactone

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

Pregnancy

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

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

Ranitidine Omeprazole

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

A patient is admitted with a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). What finding is priority to report to the health care provider?

Serum sodium of 115 mEq/L

What teaching should be provided for a patient diagnosed with Addison's disease who is going to be taking a cortisol replacement? Select all that apply.

Take it twice a day. Monitor weight daily. Take the medication with food.

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 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.

What manifestations does the nurse expect in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply.

Water retention Full, bounding pulse Decreased sodium serum level

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

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

Venous emboli

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

Vomiting Eructation Blumberg's sign

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 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."

The nurse is caring for a patient recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The patient asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response?

"Type 1 diabetes can occur when the pancreas is destroyed by disease."

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."

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

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

Assess the serum calcium level

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

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

The nurse is preparing a patient for a laparoscopic cholecystectomy. After reinforcing the surgeon's preoperative teaching, what other information should the nurse include in teaching?

Discuss postoperative pain medications, deep-breathing, and leg exercises.

The nurse is preparing a patient for a magnetic resonance cholangiopancreatography (MRCP) scan. Which contrast medium does the nurse tell the patient will be administered prior to the procedure?

Gadolinium

Which diagnostic results lead the nurse to suspect that a patient may have gallbladder disease?

Increased WBC count, visualization of calcified gallstones, edema of the gallbladder wall

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.

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

The nurse is caring for a patient with chronic pancreatitis. What assessment findings are related to this disease process? Select all that apply.

Jaundice Polydipsia Polyphagia

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

A patient reports severe mid-epigastric pain radiating to the left flank and back. The nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen and periumbilical area. The nurse suspects which cause of acute pain in this patient?

Pancreatitis

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

A patient with a history of chronic pancreatitis presents with left upper quadrant pain, fever, and a palpable mass. A diagnosis of pancreatic abscess is made. Which intervention is most likely to promote a positive patient outcome?

Placement of a percutaneous drain in the pancreatic abscess

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

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

Pregnancy Prolonged fasting Family history of gallstones

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

Protein malabsorption

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 attempting to position a patient having an acute attack of pancreatitis in the most comfortable position possible. Which position is appropriate for this patient?

Side-lying position, with knees drawn up to the chest