Chapter 44

A nurse is caring for a client in the emergency department who is reporting severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value indicates further investigation? a. Decreased calcium b. Elevated serum glucose level c. Elevated troponin d. Elevated white blood cell count

Elevated troponin

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

Light-colored urine

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. Withhold oral feedings. b. Administer enteral or parenteral nutrition. c. Maintain the client in a semi-Fowler's position. d. Carry out wound care as prescribed.

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

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 is developing a paralytic ileus. c. The patient has developed peritonitis. d. The patient requires more pain medication.

The patient has developed peritonitis.

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

a. Jaundice b. Clay-colored stools e. Dark urine

The digestion of carbohydrates is aided by a. lipase. b. amylase. c. secretin. d. trypsin.

amylase.

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

"Inflammation is confined to only the pancreas."

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. Anxiety related to unknown outcome of hospitalization c. Imbalanced nutrition: Less than body requirements related to biliary inflammation d. Deficient knowledge related to prevention of disease recurrence

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? a. Increases in the rate of pancreatic secretion b. Decreases in the physiologic function of major organs c. Development of local complications d. Increases in the bicarbonate output by the kidneys

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? a. Increased serum calcium levels b. Elevated urine amylase levels c. Decreased white blood cell count d. Decreased liver enzyme levels

Elevated urine amylase levels

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? a. Maintaining a high-Fowler's position b. Administering oral analgesics around the clock c. Allowing a clear liquid diet during the acute phase d. Providing intensive insulin therapy

Providing intensive insulin therapy

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. Reposition the client every 2 hours. b. Withhold oral feedings for the client. c. Monitor pulse oximetry every hour. d. Instruct the client to avoid coughing.

Reposition the client every 2 hours.

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. ERCP b. MRI c. CT d. Ultrasound

ERCP

A client telephones the medical clinic to ask for help with pruritus and a change in stool color. Which additional symptom(s) indicates to the nurse that the client is experiencing gallbladder stones? Select all that apply. a. Yellow sclera b. Epigastric pain c. Diarrhea d. Right shoulder pain e. Dark-colored urine

a. Yellow sclera d. Right shoulder pain e. Dark-colored urine

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. Finding the T-tube placed below the level of the incision. b. Absence of blood or serous fluid in the T-tube. c. Significantly reduced bile output from the T-tube. d. Greater than 250 mL bile output from the T-tube in 24 hours.

Significantly reduced bile output from the T-tube.

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 may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." c. "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. "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."

"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."

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

Assessing the color of the sclera every shift

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. Performing range-of-motion (ROM) leg exercises hourly while the client is awake b. Assisting the client to ambulate the evening of the operative day c. Assisting the client to turn, cough, and deep breathe every 2 hours d. Teaching the client to choose low-fat foods from the menu

Assisting the client to turn, cough, and deep breathe every 2 hours

The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator? a. Serum lipase b. Serum bilirubin c. Serum amylase d. Serum calcium

Serum lipase

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. Potassium b. Vitamin K c. Vitamin B d. Oral bile acids

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? a. Diarrhea b. Weight loss c. Hypertension d. Fatigue

Weight loss

The nurse reviews data collected during a health history with a client. Which finding(s) does the nurse identify that increases the client's risk of developing cholesterol gallbladder stones? Select all that apply. a. Female b. History of appendicitis c. Body mass index 23 d. Age 45 e. Vegan eating plan

a. Female d. Age 45

A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins or other acids will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply. a. D b. Folic acid c. A d. K e. Essential fatty acids

D A K Essential fatty acids

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 is used in the diagnostic evaluation of acute pancreatitis." b. "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts." c. "It can evaluate the presence and location of ducta

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

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. Fat digestion c. Carbohydrate digestion d. Protein synthesis

Carbohydrate digestion

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? a. Endoscopy b. Abdominal x-ray c. Ultrasound d. Computed tomography (CT) scan

Computed tomography (CT) scan

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. Fat digestion d. Carbohydrate digestion

Carbohydrate digestion

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

Light-colored urine

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. a. "The pancreas decreases bicarbonate secretion with age." b. "The pancreas develops fatty deposits with age." c. "The pancreas develops fibrous material with age." d. "The pancreas enlarges and atrophies with age." e. "The pancreas decreases

a. "The pancreas decreases bicarbonate secretion with age." b. "The pancreas develops fatty deposits with age." c. "The pancreas develops fibrous material with age." e. "The pancreas decreases secretion of enzymes with age."

A client with calculi in the gallbladder is said to have a. Choledochotomy b. Cholelithiasis c. Choledocholithiasis d. Cholecystitis

Cholelithiasis

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

Clay-colored stools

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

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

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

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

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 allows the gastrointestinal tract to rest." b. "The tube helps control fluid and electrolyte imbalance." c. "The tube allows toxins to be removed." d. "The tube provides relief from nausea and vomiting."

"The tube allows the gastrointestinal tract to rest."

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. 70 mg/dL b. 90 mg/dL c. 30 mg/dL d. 50 mg/dL

30 mg/dL

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

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? a. Providing mouth care b. Maintaining nothing-by-mouth (NPO) status c. Placing the client in a semi-Fowler's position d. Administering morphine I.V. as ordered

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? a. Malnutrition and acute pancreatitis b. Acute hepatitis and alcohol consumption c. Caffeine consumption and acute pancreatitis d. Alcohol consumption and smoking

Alcohol consumption and smoking

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. Acute hepatitis and alcohol consumption d. Caffeine consumption and acute pancreatitis

Alcohol consumption and smoking

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

Coffee

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. Dysfunction of the pancreatic islet cells b. Inability for the liver to reabsorb serum glucose c. Ingestion of foods high in sugar d. Renal failure

Dysfunction of the pancreatic islet cells

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. Suction the patient every 4 hours b. Frequent changes of positions c. Placing the patient in the prone position d. Perform chest physiotherapy

Frequent changes of positions

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. Green c. Black d. Red

Gray

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a. Vanilla pudding b. White rice c. Hot roast beef sandwich with gravy d. Mashed potatoes

Hot roast beef sandwich with gravy

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. Anxiety c. Impaired nutrition: less than body requirements d. Nausea

Impaired nutrition: less than body requirements

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

Increased amount of fibrous material

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? a. Developing no acute complications from the pancreatitis b. Maintaining satisfactory pain control c. Achieving adequate fluid and electrolyte balance d. Maintaining normal respiratory function

Maintaining normal respiratory function

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. Measure abdominal girth every shift b. Measure blood glucose concentration every 4 to 6 hours c. Auscultate the abdomen for bowel sounds every 4 hours d. Monitor for reports of nausea and vomiting

Measure blood glucose concentration every 4 to 6 hours

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. a. Older than 40 years old b. History of diabetes mellitus c. Multiparous d. Smoking e. Obese

Older than 40 years old History of diabetes mellitus Multiparous Obese

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. Adventitious breath sounds and hypertension b. Presence of blood in the client's stool and recent hypertension c. Pain with abdominal distention and hypotension d. Presence of easy bruising and bradycardia

Pain with abdominal distention and hypotension

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

Pancreatic necrosis

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? a. Peptic ulcer b. Appendicitis c. Pancreatitis d. Cholecystitis

Pancreatitis

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. Pigment c. Pearl d. Pixelated

Pigment

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. Instruct the client on the proper use of an incentive spirometer. b. Place the client in semi-Fowler's position. c. Encourage the client to deep breathe and cough. d. Encourage the client to ambulate frequently.

Place the client in semi-Fowler's position.

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. Administering frequent oral feedings c. Encouraging frequent visits from family and friends d. Administering an analgesic once per shift, as ordered, to prevent drug addiction

Positioning the client on the side with the knees flexed

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. Serves as a storage unit for glucagon b. Releases bile in response to cholecystokinin c. Digests carbohydrates in the jejunum d. Controls the flow of trypsin to digest proteins

Releases bile in response to cholecystokinin

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. Relieving abdominal pain c. Teaching about the disease and its treatment d. Preventing fluid volume overload

Relieving abdominal pain

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

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? a. Fibrosis and atrophy of the pancreatic gland b. Use of loop diuretics to increase the incidence of pancreatitis c. Calcification of the pancreatic duct, leading to its blockage d. Self-digestion of the pancreas by its own proteolytic enzymes

Self-digestion of the pancreas by its own proteolytic enzymes

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 amylase b. Serum potassium c. Serum bilirubin d. Serum calcium

Serum amylase

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

Tetany related to hypocalcemia

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 reduce gastric and pancreatic secretions b. To decrease metabolism c. To depress the central nervous system and increase the pain threshold d. To relieve nausea and vomiting

To reduce gastric and pancreatic secretions

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? a. Ultrasound b. Abdominal x-ray c. Oral cholecystography d. Cholescintigraphy

Ultrasound

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

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

A client recovering from a cholecystectomy has decreased breath sounds bilaterally in the lower lobes. Which action(s) will the nurse take to improve the client's respiratory function? Select all that apply. a. Deep breathe and cough every hour. b. Raise the head of the bed. c. Splint the affected area. d. Assist to ambulate as prescribed. e. Use the incentive spirometer as instructed.

a. Deep breathe and cough every hour. b. Raise the head of the bed. c. Splint the affected area. d. Assist to ambulate as prescribed. e. Use the incentive spirometer as instructed.

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

cannot tolerate high-glucose concentration.

---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. lavage b. decompression c. instillation d. gavage

decompression

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

yellow sclerae.