PrepU Assignment | Chapter 44 | Assessment and Management of Patients with Biliary Disorders

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms? "Place your shoulder in a sling to avoid moving it." "Take an over the counter analgesic as needed." "Apply a heating pad to your shoulder for 15 minutes hourly as needed." "Come into the emergency room as soon as possible."

"Apply a heating pad to your shoulder for 15 minutes hourly as needed."

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? "I can take a shower in a week." "I should remain on bed rest for several days." "I can drive after 2 weeks." "I should wash the site with mild soap and water."

"I should wash the site with mild soap and water."

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client? - "Inflammation spreads to the surrounding glands." - "Normal function returns after about 2 weeks." - "Inflammation is confined to only the pancreas." - "Tissue necrosis occurs within the pancreas."

- "Inflammation is confined to only the pancreas."

A client with calculi in the gallbladder is said to have - Choledocholithiasis - Cholecystitis - Cholelithiasis - Choledochotomy

- Cholelithiasis

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood glucose level does the nurse recognize as inadequate to sustain normal brain function? 50 mg/dL 90 mg/dL 70 mg/dL 30 mg/dL

30 mg/dL

This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States? 15% 25% 60% 75%

75%

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? Bile-stained vomiting Warm, dry skin Hypertension Weight loss

Bile-stained vomiting

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply. Clay-colored stools Persistent hiccups Dark urine Jaundice Weight gain

Clay-colored stools Dark urine Jaundice

The nurse is caring for a client with a history of recurrent episodes of acute pancreatitis. The nurse will anticipate preparing the client for which diagnostic test? Computed tomography (CT) scan Ultrasound Abdominal x-ray Endoscopy

Computed tomography (CT) scan

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? Excess fluid volume Ineffective gastrointestinal tissue perfusion Deficient fluid volume Decreased cardiac output

Deficient fluid volume

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? Ultrasound CT ERCP MRI

ERCP

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? Low-carbohydrate, high-potassium diet High-carbohydrate, high-protein, low-fat diet High-carbohydrate, low-protein, low-fat diet Low-sodium, high-potassium, low-fat diet

High-carbohydrate, low-protein, low-fat diet

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? Improve nutritional status during recovery. Eliminate the need for nasogastric intubation. Increase respiratory effectiveness. Decrease the amount of postoperative analgesia needed.

Increase respiratory effectiveness.

Which is a gerontological consideration associated with the pancreas? Increased rate of pancreatic secretion Increased calcium absorption Increased bicarbonate output Increased amount of fibrous material

Increased amount of fibrous material

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? Encourage the client to ambulate frequently. Place the client in semi-Fowler's position. Instruct the client on the proper use of an incentive spirometer. Encourage the client to deep breathe and cough.

Place the client in semi-Fowler's position.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? Providing generous servings at mealtime Limiting I.V. fluid intake according to the physician's order Reserving a site for a peripherally inserted central catheter (PICC) Providing the client with plenty of P.O. fluids

Reserving a site for a peripherally inserted central catheter (PICC)

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? Self-digestion of the pancreas by its own proteolytic enzymes Use of loop diuretics to increase the incidence of pancreatitis Fibrosis and atrophy of the pancreatic gland Calcification of the pancreatic duct, leading to its blockage

Self-digestion of the pancreas by its own proteolytic enzymes

The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:

Serum lipase

The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? Jaundice Mental agitation Severe abdominal pain Fever

Severe abdominal pain

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? Muscle spasm related to hypokalemia Muscle pain related to referred pain manifestations Tetany related to hypercalcemia Tetany related to hypocalcemia

Tetany related to hypocalcemia

The nurse is caring for a client with symptoms of gallbladder disease. Which diagnostic test will the nurse anticipate preparing the client for to confirm the diagnosis? Cholescintigraphy Oral cholecystography Ultrasound Abdominal x-ray

Ultrasound

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: can digest high-fat foods. are at risk for gallbladder contraction. cannot tolerate high-glucose concentration. are at risk for hepatic encephalopathy.

cannot tolerate high-glucose concentration.

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? - High glucose concentration in the blood - Dry mouth, which makes the client thirsty - Acetone in the urine - Frequent vomiting, leading to loss of fluid volume

- Frequent vomiting, leading to loss of fluid volume

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: - light amber urine. - black, tarry stools. - circumoral pallor. - yellow sclerae.

- yellow sclerae.

A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply. -"It can evaluate the presence and location of ductal stones and aid in stone removal." - "It is used in the diagnostic evaluation of acute pancreatitis." - "It can assess for ecchymosis in the body." - "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." - "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."

-"It can evaluate the presence and location of ductal stones and aid in stone removal." - "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." - "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? Assessing the color of the sclera every shift Clamping the T-tube immediately after surgery Placing the client in the semi-Fowler position immediately after surgery Placing the client on NPO (nothing by mouth) status for 2 days after surgery

Assessing the color of the sclera every shift

A nurse admits a woman reporting severe right upper quadrant pain after eating dinner. What client risk factors lead the nurse to suspect gallbladder disease? Select all that apply. Multiparous Smoking History of diabetes mellitus Older than 40 years old Obese

Multiparous History of diabetes mellitus Older than 40 years old Obese

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? Encouraging frequent visits from family and friends Positioning the client on the side with the knees flexed Administering an analgesic once per shift, as ordered, to prevent drug addiction Administering frequent oral feedings

Positioning the client on the side with the knees flexed

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for? X-ray Cholecystography Ultrasonography Oral cholecystography

Ultrasonography

The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? Coffee Toast Oatmeal Orange slices

coffee

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? - "Maintain a high-fat diet and drink at least 3 L of fluid a day." - "Maintain a high-fat, high-carbohydrate diet." - "Maintain a high-carbohydrate, low-fat diet." - "Maintain a high-sodium, high-calorie diet."

- "Maintain a high-carbohydrate, low-fat diet."

A client is diagnosed with a disorder that affects pancreatic digestive enzymes, and their typsin levels are elevated. The client has jaudice and verbalizes severe abdominal pain. The nurse most likely anticipates which condition? Cholecysitis Choledochostomy Acute pancreatitis Steatorrhea

Acute pancreatitis

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient? The patient is developing a paralytic ileus. The patient has developed renal failure. The patient requires more pain medication. The patient has developed peritonitis.

The patient has developed peritonitis.

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? To decrease metabolism To relieve nausea and vomiting To depress the central nervous system and increase the pain threshold To reduce gastric and pancreatic secretions

To reduce gastric and pancreatic secretions

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? Vitamin B Vitamin K Oral bile acids Potassium

vitamin-K

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? Fatigue Diarrhea Hypertension Weight loss

weight loss

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? - Use incentive spirometry every hour. - Instruct the client to cough only when necessary. - Monitor pulse oximetry every hour. - Withhold analgesics unless necessary.

- Use incentive spirometry every hour.

The digestion of carbohydrates is aided by - lipase. - trypsin. - secretin. - amylase.

- amylase.

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? - Frequent changes of positions - Perform chest physiotherapy - Suction the patient every 4 hours - Placing the patient in the prone position

- Frequent changes of positions

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? Performing range-of-motion (ROM) leg exercises hourly while the client is awake Assisting the client to ambulate the evening of the operative day Teaching the client to choose low-fat foods from the menu Assisting the client to turn, cough, and deep breathe every 2 hours

Assisting the client to ambulate the evening of the operative day

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? Fat digestion Carbohydrate digestion Protein digestion Protein synthesis

Carbohydrate digestion

A nurse is caring for a client with mild acute pancreatitis. Which health care provider prescriptions will the nurse question as it relates to evidence-based practices in the treatment of acute pancreatitis? Select all that apply. Initiate enteral feedings if tolerated. Full liquid diet as tolerated. No feedings per registered dietitian recommendations. Nasogastric tube to intermittent wall suction for relief of nausea. Nasogastric tube to intermittent wall suction for removal of gastric secretions.

- Initiate enteral feedings if tolerated. - Full liquid diet as tolerated. - Nasogastric tube to intermittent wall suction for removal of gastric secretions.

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? - Withhold oral feedings. - Administer enteral or parenteral nutrition. - Carry out wound care as prescribed. - Maintain the client in a semi-Fowler's position.

- Maintain the client in a semi-Fowler's position.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? - Maintaining adequate nutritional status - Teaching about the disease and its treatment - Preventing fluid volume overload - Relieving abdominal pain

- Relieving abdominal pain

Which term most precisely refers to the incision of the common bile duct for removal of stones? Choledochoduodenostomy Choledocholithotomy Choledochotomy Cholecystostomy

Choledocholithotomy

Which is a clinical manifestation of cholelithiasis? Clay-colored stools Epigastric distress before a meal Abdominal pain in the upper left quadrant Nonpalpable abdominal mass

Clay-colored stools

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is mostappropriate for a client with this diagnosis? Keeping the client supine to increase comfort Withholding all oral intake, as ordered, to decrease pancreatic secretions Administering meperidine, as ordered, to relieve severe pain Limiting I.V. fluids, as ordered, to decrease cardiac workload

Withholding all oral intake, as ordered, to decrease pancreatic secretions

A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. - "The pancreas enlarges and atrophies with age." - "The pancreas develops fibrous material with age." - "The pancreas develops fatty deposits with age." - "The pancreas decreases secretion of enzymes with age." - "The pancreas decreases bicarbonate secretion with age."

- "The pancreas develops fibrous material with age." - "The pancreas develops fatty deposits with age." - "The pancreas decreases secretion of enzymes with age." - "The pancreas decreases bicarbonate secretion with age."

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? - Monitor pulse oximetry every hour. - Withhold oral feedings for the client. - Reposition the client every 2 hours. - Instruct the client to avoid coughing.

- Reposition the client every 2 hours.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? - Serum potassium - Serum bilirubin - Serum amylase - Serum calcium

- Serum amylase

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right? Pigment Pearl Patterned Pixelated

pigment

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? - To prevent the occurrence of fibrosis - To drain the pancreatic bed - To avoid inflammation of the pancreas - To aid opening up of pancreatic duct

- To avoid inflammation of the pancreas

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? "The tube helps control fluid and electrolyte imbalance." "The tube allows toxins to be removed." "The tube allows the gastrointestinal tract to rest." "The tube provides relief from nausea and vomiting."

"The tube allows the gastrointestinal tract to rest."

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client?

"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."

The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? - "How much alcohol do you consume in a day?" - "How many meals do you eat every day?" - "How often and how long do you exercise each day? - "When was the last time you took acetaminophen?"

- "How much alcohol do you consume in a day?"

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? - Acute pain related to biliary spasms - Deficient knowledge related to prevention of disease recurrence - Imbalanced nutrition: Less than body requirements related to biliary inflammation - Anxiety related to unknown outcome of hospitalization

- Acute pain related to biliary spasms

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? - Increases in the rate of pancreatic secretion - Decreases in the physiologic function of major organs - Increases in the bicarbonate output by the kidneys - Development of local complications

- Decreases in the physiologic function of major organs

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? - Increased serum calcium levels - Elevated urine amylase levels - Decreased white blood cell count - Decreased liver enzyme levels

- Elevated urine amylase levels

A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply. Encourage bed rest to decrease the client's metabolic rate. Allow the client to have sips of clear liquids. Teach the client about the correlation between alcohol intake and pain. Withhold oral feedings to limit the release of secretin.

- Encourage bed rest to decrease the client's metabolic rate. - Teach the client about the correlation between alcohol intake and pain. - Withhold oral feedings to limit the release of secretin.

A client whose glucose levels were within normal limits is now concerned because their blood glucose levels have been trending from 210 mg/dL to 330 mg/dL since surgery. Which hormone(s) will the nurse explain is causing the increase in blood glucose level? Select all that apply. - Glucagon - Epinephrine - Insulin - Thyroid hormone - Adrenocorticosteroids

- Glucagon - Epinephrine - Thyroid hormone - Adrenocorticosteroids

Clinical manifestations of common bile duct obstruction include all of the following except: - Pruritus - Jaundice - Light-colored urine - Clay-colored feces

- Light-colored urine

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? - gavage - instillation - lavage - decompression

- decompression

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? 13 to 18 6 to 12 1 to 2 3 to 5

6 to 12

A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give? 6 to 12 months 1 to 2 months 6 to 8 months 3 to 5 months

6 to 12 months

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? Providing mouth care Maintaining nothing-by-mouth (NPO) status Administering morphine I.V. as ordered Placing the client in a semi-Fowler's position

Administering morphine I.V. as ordered

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? Acute hepatitis and alcohol consumption Malnutrition and acute pancreatitis Caffeine consumption and acute pancreatitis Alcohol consumption and smoking

Alcohol consumption and smoking

A nurse is reviewing the health care provider orders for a client admitted with acute pancreatitis. The health care provider has ordered intravenous calcium chloride infusions for the client. What does the nurse understand is the reason for this order? Calcium binds to proteins in the blood when pancreatic enzymes are released. Calcium is unable to form when pancreatic enzymes are elevated. Calcium binds to fatty acids when auto digestion of the pancreas occurs. Calcium is unable to enter the blood when auto digestion of the pancreas occurs.

Calcium binds to fatty acids when auto digestion of the pancreas occurs.

Which foods should be avoided following acute gallbladder inflammation?

Cheese

A nurse is caring for a client who was admitted with pain, tenderness, and rigidity of the upper right abdomen, suggesting a gall bladder issue. The client has also been experiencing nausea and vomiting for the past 3 days. The admitting service is planning for tests to be conducted in the morning. Diagnostic - Implications for Testing Laboratory Assessments - (Potassium is decreased indicating the presence of a gallstone/ Cholesterol is elevated in biliary obstruction/ Acidosis allows for definitive diagnosis of the condition) Ultrasonography - (It is used to visualize calculi in the gallbladder./ it can provide a definitive diagnosis hepatic cancer/ It requires the client to be sedated prior to the test) Cholescintigraphy - (The radioactive dye allows for visualization of the biliary tract./ High frequency sound will produce images of pancreatic structures/ A series of x ray images from different angles will create images of the soft tissues of the gallbladder)

Diagnostic - Implications for Testing Laboratory Assessments - Cholesterol is elevated in biliary obstruction Ultrasonography - It is used to visualize calculi in the gallbladder. Cholescintigraphy - The radioactive dye allows for visualization of the biliary tract.

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? It visualizes the gallbladder and bile duct. It visualizes the biliary structures and pancreas via endoscopy. It shows the sizes of the abdominal organs and detects any masses. It visualizes the liver and pancreas.

It visualizes the gallbladder and bile duct.

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? Monitor for reports of nausea and vomiting Auscultate the abdomen for bowel sounds every 4 hours Measure blood glucose concentration every 4 to 6 hours Measure abdominal girth every shift

Measure blood glucose concentration every 4 to 6 hours

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should the nurse administer to the client before surgery? Vitamin C Oral bile acids Potassium Packed red blood cells

Packed red blood cells

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? Pain with abdominal distention and hypotension Presence of easy bruising and bradycardia Adventitious breath sounds and hypertension Presence of blood in the client's stool and recent hypertension

Pain with abdominal distention and hypotension

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? Tetany Shock MODS Pancreatic necrosis

Pancreatic necrosis

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? Appendicitis Pancreatitis Gastric ulcer Cholecystitis

Pancreatitis

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? Pancreatitis can atrophy the diaphragm and alter the breathing pattern. Pancreatitis causes alterations to hemoglobin, impairing oxygenation. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation.

Pancreatitis can elevate the diaphragm and alter the breathing pattern.

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? Maintaining a high-Fowler's position Administering oral analgesics around the clock Allowing a clear liquid diet during the acute phase Providing intensive insulin therapy

Providing intensive insulin therapy