MEDSURG TEST #2: CH 43 - Liver Cancer/Transplant, Pancreas and Gallbladder Problems

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 3 Dark brown stool 4 Straw-colored urine 5 Pain in right upper quadrant

1 Ecchymosis 2 Yellow sclera 5 Pain in right upper quadrant

A client is admitted with the diagnosis of acute pancreatitis. For which clinical manifestations should a nurse assess the client? (Select all that apply.) 1 Jaundice 2 Acute pain 3 Hypertension 4 Hypoglycemia 5 Increased amylase

1 Jaundice 2 Acute pain 5 Increased amylase

A client reports experiencing nausea, dyspnea, and right upper quadrant pain unrelieved by antacids. The pain occurs most often after eating in fast-food restaurants. Which diet should the nurse instruct the client to follow? 1 Low fat 2 Low carbohydrate 3 Soft textured and bland 4 High protein and kilocalories

1 Low fat

A client with cholelithiasis has a laser laparoscopic cholecystectomy. Postoperatively it is most appropriate for the nurse to: 1 Maintain the client's nothing by moth status for the first 24 hours 2 Monitor the client's abdominal incision for bleeding 3 Offer clear carbonated beverages to the client 4 Ambulate the client when the client is alert and oriented

4 Ambulate the client when the client is alert and oriented

You are caring for a post-operative cholecystectomy client. What should be reported immediately to the physician? A. The client reports severe RUQ tenderness. B. The client cannot void 4 hours post-operatively. C. Output does not equal input for the first few hours. D. The client reports shoulder pain.

A. The client reports severe RUQ tenderness.

For Rico who has chronic pancreatitis, which nursing intervention would be most helpful? A. Allowing liberalized fluid intake B. Counseling to stop alcohol consumption C. Encouraging daily exercise D. Modifying dietary protein

B. Counseling to stop alcohol consumption

Nursing management of the patient with acute pancreatitis includes (SATA) a. checking for signs of hypocalcemia b. providing a diet low in carbs c. giving insulin based on a sliding scale d. observing stools for signs of steatorrhea e. monitoring for infection, particularly respiratory tract infections

a. checking for signs of hypocalcemia e. monitoring for infection, particularly respiratory tract infections

in planning care for a patient with metastatic liver cancer, the nurse should include interventions that a. focus primarily on symptomatic and comfort measures b. reassure the patient that chemo offers a good prognosis c. promote the patients confidence that surgical excision of the tumor will be successful d. provide information necessary for the patient to make decisions regarding liver transplants

a. focus primarily on symptomatic and comfort measures

The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest priority patient outcome is a. maintaining normal respiratory function. b. expressing satisfaction with pain control. c. developing no ongoing pancreatic disease. d. having adequate fluid and electrolyte balance.

a. maintaining normal respiratory function.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

alcohol abuse

The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect? a. Hematochezia b. Left upper abdominal pain c. Ascites and peripheral edema d. Temperature over 102o F (38.9o C)

b. Left upper abdominal pain

The nurse is caring for a 36-year-old patient with pancreatic cancer. Which nursing action is the highest priority? a. Offer psychologic support for depression. b. Offer high-calorie, high-protein dietary choices. c. Administer prescribed opioids to relieve pain as needed. d. Teach about the need to avoid scratching any pruritic areas.

c. Administer prescribed opioids to relieve pain as needed.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis? a. Calcium b. Bilirubin c. Amylase d. Potassium

c. Amylase

Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

d. Palpable abdominal mass

A 51-year-old woman had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to a. choose low-fat foods from the menu. b. perform leg exercises hourly while awake. c. ambulate the evening of the operative day. d. turn, cough, and deep breathe every 2 hours.

d. turn, cough, and deep breathe every 2 hours.

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 2 Administering antibiotics as prescribed 3 Teaching the importance of getting rest 4 Explaining that everything will be all right

1 Encouraging expression of concerns

A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery? 1 Vitamins 2 Whole bran 3 Cod liver oil 4 Amino acids

2 Whole bran

The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase (Viokase). The nurse evaluates that teaching is understood when the client states, "I will take them: 1 At bedtime." 2 With meals." 3 One hour before meals." 4 On arising each morning."

2 With meals."

A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client? 1 Prone 2 Supine 3 Left Sims 4 Right side-lying

3 Left Sims

Which of the following laboratory tests indicates a diagnosis of pancreatitis? A. Lipase 230 IU/L B. Calcium 6.0 mEq/L C. Blood glucose 65 mg/dL D. WBC count 5,000/mm3

A. Lipase 230 IU/L

When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? A. Transports fatty acids into the brush border B. Breaks down fat into fatty acids and glycerol C. Triggers cholecystokinin to contract the gallbladder D. Breaks down protein into dipeptides and amino acids

B. Breaks down fat into fatty acids and glycerol

Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? A. Administration of vasopressin and insertion of a balloon tamponade B. Preparation for a paracentesis and administration of diuretics C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day

C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction

The client with pancreatitis may exhibit Cullen's sign on physical examination. Which of the following data best describes Cullen's sign? A. Jaundiced sclera B. Pain that occurs with movement C. Bluish discoloration of the left flank area D. Bluish discoloration of the periumbilical area

D. Bluish discoloration of the periumbilical area

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following? a. "I can expect yellow-green drainage from the incision for a few days." b. "I can remove the bandages on my incisions tomorrow and take a shower." c. "I should plan to limit my activities and not return to work for 4 to 6 weeks." d. "I will always need to maintain a low-fat diet since I no longer have a gallbladder."

b. "I can remove the bandages on my incisions tomorrow and take a shower."

When providing discharge teaching for a patient after a laparoscopic cholecystectomy, what information should the nurse include? a. Do not return to work or normal activities for 3 weeks. b. A lower-fat diet may be better tolerated for several weeks. c. Bile-colored drainage will probably drain from the incision. d. Keep the bandages on and the puncture site dry until it heals.

b. A lower-fat diet may be better tolerated for several weeks.

A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? a. Immediately start enteral feeding to prevent malnutrition. b. Insert an NG and maintain NPO status to allow pancreas to rest. c. Initiate early prophylactic antibiotic therapy to prevent infection. d. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

b. Insert an NG and maintain NPO status to allow pancreas to rest.

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of a. antibiotics. b. NPO status. c. antispasmodics. d. proton pump inhibitors.

b. NPO status.

Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis? a. The patient's urine is bright yellow. b. The patient's stools are tan colored. c. The patient has increased pain after eating. d. The patient complains of chronic heartburn.

b. The patient's stools are tan colored.

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 OTC antiemetics is N/V occur d. emptying and measuring the contents of the bile bag from the T tube every day

b. reporting any bile-colored drainage or pus from any incision

The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates understanding of 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."

The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase) a. at bedtime. b. in the morning. c. with each meal. d. for abdominal pain.

c. with each meal.

A client with chronic pancreatitis is being discharged from the hospital. Which of the following statements by the client demonstrates that the client understands how to take prescribed pancreatic enzyme replacements? a.) "I must take capsules three times daily spaced about 8 hours apart." b.) "I must take the medication when I wake up and before bed." c.) "I must take the medication with meals and snacks." d.) "I must take the capsules every 4 hours while awake."

c.) "I must take the medication with meals and snacks."

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices

d. Fewer episodes of bleeding varices

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

d. Muscle twitching and finger numbness

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. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. What is the priority expected client outcome in response to therapy at this time? 1 Report decreased pain. 2 Remain in fluid balance. 3 Lose four pounds a week. 4 Join Alcoholics Anonymous

1 Report decreased pain.

A client with cholecystitis is placed on a low fat, high protein diet. What nutrient should the nurse teach the client is included with this diet? 1 Skim milk 2 Boiled beef 3 Poached eggs 4 Steamed broccoli

1 Skim milk

A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice? 1 Yellow sclera 2 Pain on urination 3 Dark brown stools 4 Coffee-ground emesis

1 Yellow sclera

A client is to be discharged after a laparoscopic cholecystectomy. What statement indicates to the nurse that the client understands the discharge instructions? 1 "The bandages must be changed every day." 2 "I may have mild shoulder pain for about a week." 3 "The surgical sites should not be bathed for a week." 4 "I will remain on a full liquid diet for two more days."

2 "I may have mild shoulder pain for about a week."

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.) 1 Provide a low fat diet. 2 Administer analgesics. 3 Teach relaxation exercises. 4 Encourage walking in the hall. 5 Monitor cardiac rate and rhythm. 6 Observe for signs of hypercalcemia

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

The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. What would be appropriate to include in the dietary plan? 1 Soft-textured foods to reduce the digestive burden 2 Low-cholesterol foods to avoid further formation of gallstones 3 Increased protein intake to promote tissue healing and improve energy reserves 4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

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? 1 Promotes the formation of calculi in the cystic duct 2 Stimulates the pancreas to secrete more insulin than it can immediately produce 3 Alters the composition of enzymes so they are capable of damaging the pancreas 4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer? a. A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia b. A 72-yr-old African American man who has smoked cigarettes for 50 years c. A 23-yr-old man who has cystic fibrosis-related pancreatic enzyme insufficiency d. A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus

b. A 72-yr-old African American man who has smoked cigarettes for 50 years

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What is the nurse's priority? a. Prevent all oral intake. b. Control abdominal pain. c. Provide enteral feedings. d. Avoid dietary cholesterol.

b. Control abdominal pain.

A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? a. Starvation b. Pancreatitis c. Systemic sepsis d. Diabetic ketoacidosis

b. Pancreatitis

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart.

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. the explanation includes the information that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum c. removal of part of the pancreas, part of the stomach, and the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.

c. removal of part of the pancreas, part of the stomach, and the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

d. Abdominal pain is decreased.

A patient with cholelithiasis is being prepared for surgery. Which patient assessment represents a contraindication for a cholecystectomy? a. Low-grade fever of 100°F and dehydration b. Abscess in the right upper quadrant of the abdomen c. Multiple obstructions in the cystic and common bile duct d. Activated partial thromboplastin time (aPTT) of 54 seconds

d. Activated partial thromboplastin time (aPTT) of 54 seconds

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? a. Spiral CT scan b. A PET/CT scan c. Abdominal ultrasound d. Cancer-associated antigen 19-9

d. Cancer-associated antigen 19-9