Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas

A nurse cares for a client with acute pancreatitis. The client states, I am hungry. How should the nurse reply?

Have you passed any flatus or moved your bowels?

A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond?

Bile salts accumulate in the skin and cause the itching.

A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this clients condition?

Body mass index of 46 Pregnant with twins Glycosylated hemoglobin level of 15%

A nurse cares for a client with acute pancreatitis who is prescribed gentamicin (Garamycin) 3 mg/kg/day in 3 divided doses. The client weighs 264 lb. How many milligrams should the nurse administer for each dose?

264lb = 120kg 3mg/kg/day * 120kg = 360mg/day 360mg/day / 3 divided doses = 120mg/dose

A nurse cares for a client who is prescribed 4 mg of calcium gluconate to infuse over 5 hours. The pharmacy provides 2 premixed infusion bags with 2 mg of calcium gluconate in 100 mL of D5W. At what rate should the nurse administer this medication?

40mL/hr

A nurse assesses clients at a community health center. Which client is at highest risk for pancreatic cancer?

A 50-year-old who has the BRCA2 gene mutation.

A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer?

A 66-year-old who smokes cigarettes

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond?

Ambulating in the hallway twice a day will help.

A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first?

Assess the clients endotracheal tube with 40% FiO2.

A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this clients teaching?

Attend local Alcoholics Anonymous (AA) meetings weekly. Use cooking spray when you cook rather than margarine or butter. We can talk to your doctor about a prescription for nicotine patches.

A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take?

Contact the provider immediately Lower the head of the bed

A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first?

Determine whether the client feels like talking about his or her feelings.

A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge?

Do you have a one- or two-story home?

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider?

Drainage from a fistula

A nurse cares for a client who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The client states, When I wake up I am in pain. Which action should the nurse take?

Encourage the client to use the PCA pump upon awakening.

A nurse cares for a client with end-stage pancreatic cancer. The client asks, Why is this happening to me? How should the nurse respond?

I don't know. I wish I had an answer for you, but I don't.

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?

I will decrease the amount of fatty foods in my diet.

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute?

Light-colored stools

A nurse cares for a client with pancreatic cancer who is prescribed implanted radioactive iodine seeds. Which actions should the nurse take when caring for this client?

Place the client in a private room Wear a lead apron when providing client care Bundle care to minimize exposure to the client

A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take?

Place the client in semi-Fowlers position.

A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client?

Registered dietitian Clinical pharmacist Health care provider

After teaching a client who has a history of cholelithiasis, the nurse assesses the clients understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching?

Roasted chicken breast, baked potato with chives, and orange juice

A nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure?

Substernal chest pain Shortness of breath Lack of bowel sounds or flatus Urine output of 20mL/6hr

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort?

Maintain nothing by mouth (NPO) and administer intravenous fluids.

A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is in the healing phase of acute pancreatitis. Which statements focused on nutritional requirements should the nurse include when delegating care for this client?

Make sure the client receives a protein shake. Do not allow caffeine-containing beverages. Make sure the foods are bland with little spice.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?

The best time to take the enzymes is immediately after I have a meal or a snack.