Chapter 50: Assessment and Management of Patients With Biliary Disorders

A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply). - An abnormal glucose tolerance - Glucosuria - Hyperglycemia - Elevated lipase level - Hypoglycemia

Answer: - An abnormal glucose tolerance - Glucosuria - Hyperglycemia

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.) Hot roast beef sandwich with gravy B.) Mashed potatoes C.) White rice D.) Vanilla pudding

Answer: A.) Hot roast beef sandwich with gravy

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

Answer: A.) decompression

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.

Answer: A.) yellow sclerae.

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

Answer: B.) Elevated urine amylase levels

The digestion of carbohydrates is aided by A.) lipase. B.) amylase. C.) trypsin. D.) secretin.

Answer: B.) amylase.

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

Answer: C.) Administering morphine I.V. as ordered

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. - Teach the client about the correlation between alcohol intake and pain. - Allow the client to have sips of clear liquids. - Withhold oral feedings to limit the release of secretin.

Answer: - 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.

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

Answer: A.) Assisting the client to turn, cough, and deep breathe every 2 hours

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: A.) Edema and inflammation B.) Pleural effusion C.) Sepsis D.) Disseminated intravascular coagulopathy

Answer: A.) Edema and inflammation

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.

Answer: D.) Use incentive spirometry every hour.

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

Answer: A.) Acute pain related to biliary spasms

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.

Answer: A.) It visualizes the gallbladder and bile duct.

A client with calculi in the gallbladder is said to have A.) Cholecystitis B.) Cholelithiasis C.) Choledocholithiasis D.) Choledochotomy

Answer: B.) Cholelithiasis

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

Answer: B.) Serum lipase

Which enzyme aids in the digestion of fats? A.) Lipase B.) Amylase C.) Secretin D. ) Trypsin

Answer; A.) Lipase

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.) Weight loss B.) Diarrhea C.) Fatigue D.) Hypertension

Answer; A.) Weight loss

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

Answer: B.) Impaired nutrition: less than body requirements

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

Answer: B.) Positioning the client on the side with the knees flexed

From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography? A.) Steven, suspected of having a tumor in the colon B.) Andrew, suspected of having esophageal abnormalities C.) Mark, suspected of having stones in the gallbladder D.) Sandra, suspected of having lesions in the liver

Answer: C.) Mark, suspected of having stones in the gallbladder

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

Answer: D.) Measure blood glucose concentration every 4 to 6 hours

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

Answer: D.) cannot tolerate high-glucose concentration.

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? A.) Muscle twitching and finger numbness B.) Paralytic ileus and abdominal distention C.) Hypotension D.) Elevated blood glucose concentration

Answer: A.) Muscle twitching and finger numbness

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A.) Appendicitis B.) Pancreatitis C.) Cholecystitis D.) Peptic ulcer

Answer: B.) Pancreatitis

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.) Cystic duct B.) Duodenum C.) Gallbladder D.) Common bile duct

Answer: C.) Gallbladder

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.) Relieving abdominal pain B.) Preventing fluid volume overload C.) Maintaining adequate nutritional status D.) Teaching about the disease and its treatment

Answer: A.) Relieving abdominal pain

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

Answer: D.) Ultrasonography Rationale: Ultrasonography has replaced cholecystography (discussed later) as the diagnostic procedure of choice because it is rapid and accurate and can be used in patients with liver dysfunction and jaundice. It does not expose patients to ionizing radiation.

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

Answer; A.) Frequent changes of positions Rationale: Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

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

Answer; A.) Gray

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.) Ingestion of foods high in sugar C.) Inability for the liver to reabsorb serum glucose D.) Renal failure

Answer: A.) Dysfunction of the pancreatic islet cells

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? A.) Frequent vomiting, leading to loss of fluid volume B.) Dry mouth, which makes the client thirsty C.) Acetone in the urine D.) High glucose concentration in the blood

Answer; A.) Frequent vomiting, leading to loss of fluid volume

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

Answer; C.) To reduce gastric and pancreatic secretions

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

Answer: A.) 30 mg/dL

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.) Decreases in the physiologic function of major organs B.) Increases in the bicarbonate output by the kidneys C.) Increases in the rate of pancreatic secretion D.) Development of local complications

Answer: A.) Decreases in the physiologic function of major organs

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.

Answer: A.) Maintain the client in a semi-Fowler's position.

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.) Muscle spasm related to hypokalemia C.) Muscle pain related to referred pain manifestations D.) Tetany related to hypercalcemia

Answer: A.) Tetany related to hypocalcemia Rationale: A client with acute pancreatitis who reports muscle cramping or pain should be suspected of having hypocalcemia and tetany of the muscles. Hypocalcemia may occur in acute pancreatitis because, when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.