PU CH.44
A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a. Gallbladder b. Cystic duct c. Duodenum d. Common bile duct
A
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. Laboratory Assessment: 1. Potassium is decreased indicating the presence of a gallstone. 2. Acidosis allows for definitive diagnosis of the condition 3. Cholesterol is elevated in biliary obstruction Ultrasonography: 4. It can provide definitive diagnosis hepatic cancer 5. It is used to visualize calculi in the gallbladder 6. It requires the client to be sedated prior to the test Cholescintigraphy: 7. High-frequency sound will produce images of pancreatic structures 8. The radioactive dye allows for visualization of the biliary tract 9. A series of x-ray images from different angles will create images of the soft tissues of the gallbladder
3, 5, 8
The nurse knows that the serum amylase concentration returns to normal within which time frame? a. 12 hours b. 24 hours c. 36 hours d. 48 hours
48
A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? a. Withholding all oral intake, as ordered, to decrease pancreatic secretions b. Administering meperidine, as ordered, to relieve severe pain c. Limiting I.V. fluids, as ordered, to decrease cardiac workload d. Keeping the client supine to increase comfort
A
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? a. Pain with abdominal distention and hypotension b. Adventitious breath sounds and hypertension c. Presence of easy bruising and bradycardia d. Presence of blood in the client's stool and recent hypertension
A
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? a. Acute pain related to biliary spasms b. Deficient knowledge related to prevention of disease recurrence c. Anxiety related to unknown outcome of hospitalization d. Imbalanced nutrition: Less than body requirements related to biliary inflammation
A
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? a. It visualizes the gallbladder and bile duct. b. It visualizes the liver and pancreas. c. It shows the sizes of the abdominal organs and detects any masses. d. It visualizes the biliary structures and pancreas via endoscopy.
A
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? a. Bile-stained vomiting b. Hypertension c. Weight loss d. Warm, dry skin
A
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. b. light amber urine. c. circumoral pallor. d. black, tarry stools.
A
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? a. Gray b. Black c. Red d. Green
A
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? a. Maintain the client in a semi-Fowler's position. b. Administer enteral or parenteral nutrition. c. Carry out wound care as prescribed. d. Withhold oral feedings.
A
A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action? a. Contact the health care provider b. Auscultate the bowel sounds c. Ask the client the last bowel movement date d. Prepare to insert a nasogastric tube to intermittent suction
A
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? a. Self-digestion of the pancreas by its own proteolytic enzymes b. Calcification of the pancreatic duct, leading to its blockage c. Fibrosis and atrophy of the pancreatic gland d. Use of loop diuretics to increase the incidence of pancreatitis
A
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? a. 30 mg/dL b. 50 mg/dL c. 70 mg/dL d. 90 mg/dL
A
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? a. decompression b. instillation c. gavage d. lavage
A
Clinical manifestations of common bile duct obstruction include all of the following except: a. Light-colored urine b. Clay-colored feces c. Pruritus d. Jaundice
A
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? a. 6 to 12 b. 1 to 2 c. 3 to 5 d. 13 to 18
A
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? a. Place the client in semi-Fowler's position. b. Encourage the client to deep breathe and cough. c. Instruct the client on the proper use of an incentive spirometer. d. Encourage the client to ambulate frequently.
A
The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? a. Coffee b. Toast c. Oatmeal d. Orange slices
A
A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply. a. Diabetes b. Cystic fibrosis c. Obesity d. Changes in weight e. Sickle cell disease
A, B, C, D
Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Select all that apply. a. Dark urine b. Weight gain c. Clay-colored stools d. Jaundice e. Pruritus
A, C, D, E
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. a. "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." b. "It is used in the diagnostic evaluation of acute pancreatitis." c. "It can evaluate the presence and location of ductal stones and aid in stone removal." d. "It can assess for ecchymosis in the body." e. "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."
A, C, E
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? a. Protein digestion b. Protein synthesis c. Carbohydrate digestion d. Fat digestion
C
A client with severe abdominal pain and an abnormal computed tomography (CT) scan, which shows an enlarged pancreas, has been andmitted to a medical unit today. The nurse anticipates including which actions in the client's plan of care? Select all that apply. a. Maintain nothing by mouth (NPO) diet. b. Encourage ambulation as tolerated. c. Provide oral hygiene and gargling solutions. d. Administer pain relief measures. e. Assess current nutrtional status. f. Use a pain scale throughout treatment.
A, D, F
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? a. "The tube helps control fluid and electrolyte imbalance." b. "The tube allows the gastrointestinal tract to rest." c. "The tube allows toxins to be removed." d. "The tube provides relief from nausea and vomiting."
B
A client with calculi in the gallbladder is said to have a. Choledochotomy b. Cholelithiasis c. Cholecystitis d. Choledocholithiasis
B
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? a. Pancreatitis causes alterations to hemoglobin, impairing oxygenation. b. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. c. Pancreatitis can elevate the diaphragm and alter the breathing pattern. d. Pancreatitis can atrophy the diaphragm and alter the breathing pattern.
C
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? a. Inability for the liver to reabsorb serum glucose b. Ingestion of foods high in sugar c. Renal failure d. Dysfunction of the pancreatic islet cells
D
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? a. Patterned b. Pixelated c. Pearl d. Pigment
D
The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is: a. Fever b. Jaundice c. Mental agitation d. Severe abdominal pain
D
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? a. Low-sodium, high-potassium, low-fat diet b. High-carbohydrate, high-protein, low-fat diet c. Low-carbohydrate, high-potassium diet d. High-carbohydrate, low-protein, low-fat diet
D
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Gastric ulcer b. Appendicitis c. Cholecystitis d. Pancreatitis
D
The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? a. Assisting the client to turn, cough, and deep breathe every 2 hours b. Teaching the client to choose low-fat foods from the menu c. Performing range-of-motion (ROM) leg exercises hourly while the client is awake d. Assisting the client to ambulate the evening of the operative day
A
The nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelithiasis can interfere with the absorption of a. Vitamin A b. Vitamin B6 c. Vitamin B12 d. Vitamin C
A
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a. cannot tolerate high-glucose concentration. b. are at risk for hepatic encephalopathy. c. can digest high-fat foods. d. are at risk for gallbladder contraction.
A
What is the most appropriate nursing diagnosis for the client with acute pancreatitis? a. Deficient fluid volume b. Decreased cardiac output c. Excess fluid volume d. Ineffective gastrointestinal tissue perfusion
A
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a. Positioning the client on the side with the knees flexed b. Encouraging frequent visits from family and friends c. Administering an analgesic once per shift, as ordered, to prevent drug addiction d. Administering frequent oral feedings
A
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? a. Increased serum calcium levels b. Elevated urine amylase levels c. Decreased liver enzyme levels d. Decreased white blood cell count
B
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? a. Providing mouth care b. Administering morphine I.V. as ordered c. Maintaining nothing-by-mouth (NPO) status d. Placing the client in a semi-Fowler's position
B
Which enzyme aids in the digestion of fats? a. Amylase b. Lipase c. Secretin d. Trypsin
B
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? a. Maintaining adequate nutritional status b. Preventing fluid volume overload c. Relieving abdominal pain d. Teaching about the disease and its treatment
C
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? a. "Take an over the counter analgesic as needed." b. "Come into the emergency room as soon as possible." c. "Apply a heating pad to your shoulder for 15 minutes hourly as needed." d. "Place your shoulder in a sling to avoid moving it."
C
A nurse cares for a client who is post op open cholecystectomy and has a T-tube in place. Which clinical situation will the nurse notify the health care provider about as a possible complication of the surgery? a. Absence of blood or serous fluid in the T-tube. b. Greater than 250 mL bile output from the T-tube in 24 hours. c. Significantly reduced bile output from the T-tube. d. Finding the T-tube placed below the level of the incision.
C
A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? a. Eliminate the need for nasogastric intubation. b. Decrease the amount of postoperative analgesia needed. c. Increase respiratory effectiveness. d. Improve nutritional status during recovery.
C
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? a. To prevent the occurrence of fibrosis b. To drain the pancreatic bed c. To aid opening up of pancreatic duct d. To avoid inflammation of the pancreas
D
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a. MODS b. Tetany c. Shock d. Pancreatic necrosis
D
Which is a gerontological consideration associated with the pancreas? a. Increased amount of fibrous material b. Increased bicarbonate output c. Increased rate of pancreatic secretion d. Increased calcium absorption
A
Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? a. Pancreatitis b. Appendicitis c. Cholecystitis d. Peptic ulcer
A
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? a. Frequent changes of positions b. Placing the patient in the prone position c. Perform chest physiotherapy d. Suction the patient every 4 hours
A
A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ? a. Digests carbohydrates in the jejunum b. Releases bile in response to cholecystokinin c. Serves as a storage unit for glucagon d. Controls the flow of trypsin to digest proteins
B
A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? a. Malnutrition and acute pancreatitis b. Alcohol consumption and smoking c. Caffeine consumption and acute pancreatitis d. Acute hepatitis and alcohol consumption
B
A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? a. Disturbed body image b. Impaired nutrition: less than body requirements c. Nausea d. Anxiety
B
The nurse is assessing a client admitted with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? a. "How many meals do you eat every day?" b. "How much alcohol do you consume in a day?" c. "When was the last time you took acetaminophen?" d. "How often and how long do you exercise each day?
B
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: a. Serum calcium b. Serum lipase c. Serum bilirubin d. Serum amylase
B
Which foods should be avoided following acute gallbladder inflammation? a. Cooked fruits b. Cheese c. Coffee d. Mashed potatoes
B
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? a. CT b. MRI c. ERCP d. Ultrasound
C
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? a. To decrease metabolism b. To depress the central nervous system and increase the pain threshold c. To reduce gastric and pancreatic secretions d. To relieve nausea and vomiting
C
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a. 1 to 4 months b. 4 to 6 months c. 6 to 12 months d. Over 1 year
C
Which is a clinical manifestation of cholelithiasis? a. Nonpalpable abdominal mass b. Epigastric distress before a meal c. Clay-colored stools d. Abdominal pain in the upper left quadrant
C
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? a. Monitor pulse oximetry every hour. b. Withhold analgesics unless necessary. c. Instruct the client to cough only when necessary. d. Use incentive spirometry every hour.
D
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? a. Monitor pulse oximetry every hour. b. Withhold oral feedings for the client. c. Instruct the client to avoid coughing. d. Reposition the client every 2 hours.
D
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? a. Serum bilirubin b. Serum calcium c. Serum potassium d. Serum amylase
D
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? a. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." b. "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." c. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." d. "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."
D
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? a. Auscultate the abdomen for bowel sounds every 4 hours b. Measure abdominal girth every shift c. Monitor for reports of nausea and vomiting d. Measure blood glucose concentration every 4 to 6 hours
D
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? a. Vitamin B b. Oral bile acids c. Potassium d. Vitamin K
D
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? a. Fatigue b. Diarrhea c. Hypertension d. Weight loss
D
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? a. Calcium is unable to form when pancreatic enzymes are elevated. b. Calcium is unable to enter the blood when auto digestion of the pancreas occurs. c. Calcium binds to proteins in the blood when pancreatic enzymes are released. d. Calcium binds to fatty acids when auto digestion of the pancreas occurs.
D
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? a. 1 to 2 months b. 3 to 5 months c. 6 to 8 months d. 6 to 12 months
D
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? a. The patient has developed renal failure. b. The patient requires more pain medication. c. The patient is developing a paralytic ileus. d. The patient has developed peritonitis.
D
