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

SG#33 The patient is to continue pancreatic enzyme replacement therapy (PERT) after discharge. Which statement indicates that the patient understands teaching about this therapy? a. "I will take the enzymes before meals with a full glass of water." b. "I will take the enzymes after I take my ranitidine (Zantac)." c. "I will mix the enzymes with chopped meat." d. "I will chew the capsules before swallowing the enzymes."

b. "I will take the enzymes after I take my ranitidine (Zantac)."

SG#14 Which statement about the care of a patient with a Jackson-Pratt (JP) drain after a traditional cholecystectomy is true? a. The patient is maintained in the prone position. b. When the patient is allowed to eat, the JP drain is clamped continuously. c. The JP drain is irrigated every hour for the first 24 hours. d. Serosanguineous drainage stained with bile is expected for 24 hours.

d. Serosanguineous drainage stained with bile is expected for 24 hours.

SG#2 The daughter of a patient with cholelithiasis has heard that there is a genetic disposition for cholelithiasis. The daughter asks the nurse about the risk factors. How does the nurse respond? a. "There is no evidence that first- degree relatives have an increased risk for this disease." b. "Cholecystitis is seen more frequently in patients who are underweight." c. "Hormone replacement therapy has been associated with increased risk for cholecystitis." d. "Patients with diabetes mellitus are at increased risk for cholecystitis."

c. "Hormone replacement therapy has been associated with increased risk for cholecystitis."

SG#9 Which type of drug is used to treat acute severe biliary pain? a. Acetaminophen (Tylenol) b. Nonsteroidal antiinflammatory drugs (NSAIDs)(Ibuprofen) c. Antiemetics (Compazine) d. Opioids (Morphine)

d. Opioids (Morphine)

1. 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? (Record your answer using a whole number.) ____ mg/dose

ANS: 120 mg/dose 264 lb (2.2 lb/kg) = 120 kg. 3 mg/kg/day 120 kg = 360 mg/day. 360 mg/day 3 divided doses = 120 mg/dose.

2. 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? (Record your answer using a whole number.) ____ mL/hr

ANS: 40 mL/hr

SG#22 Which diagnostic test is the most accurate in verifying a diagnosis of acute pancreatitis? a. Trypsin b. Lipase c. Alkaline phosphatase d. Alanine aminotransferase

b. Lipase

SG#11 The nurse is caring for an older adult patient with acute biliary pain. Which drug order does the nurse question? a. Ketorolac (Toradol) b. Meperidine (Demerol) c. Morphine d. Hydromorphone

b. Meperidine (Demerol)

SG#30 What is the most common and serious complication after a Whipple procedure? a. Diabetes mellitus b. Wound infection c. Fistula development d. Bowel obstruction

c. Fistula development

SG#12 Which factor renders a patient the least likely to benefit from ESWL for the treatment of gallstones? a. Height 5 feet 10 inches, 325 lbs. b. Cholesterol-based stones c. Height 5 feet 7 inches, 138 lbs. d. Small gallstones

a. Height 5 feet 10 inches, 325 lbs.

SG#28 The nurse detects an epigastric mass while assessing a patient with acute pancreatitis. The patient describes epigastric pain that radiates to his back. What does the nurse suspect? a. Liver cirrhosis b. Pancreatic pseudocyst c. Gallstones d. Chronic pancreatitis

b. Pancreatic pseudocyst

7. 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? Select all that apply a. Dispose of dirty linen in a red biohazard bag. b. Place the client in a private room. c. Wear a lead apron when providing client care. d. Bundle care to minimize exposure to the client. e. Initiate Transmission-Based Precautions.

b. Place the client in a private room. c. Wear a lead apron when providing client care. d. Bundle care to minimize exposure to the client. The client should be placed in a private room and dirty linens kept in the clients room until the radiation source is removed. The nurse should wear a lead apron while providing care, ensuring that the apron always faces the client. The nurse should also bundle care to minimize exposure to the client. Transmission-Based Precautions will not protect the nurse from the implanted radioactive iodine seeds.

6. 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? a. The capsules can be opened and the powder sprinkled on applesauce if needed. b. I will wipe my lips carefully after I drink the enzyme preparation. c. The best time to take the enzymes is immediately after I have a meal or a snack. d. I will not mix the enzyme powder with food or liquids that contain protein.

c. The best time to take the enzymes is immediately after I have a meal or a snack. The enzymes should be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.

SG#21 The patient comes to the emergency department (ED) with severe abdominal pain in the midepigastric area. The patient states that the pain began suddenly, is continuous, radiates to his back, and is worst when he lies flat on his back. What condition does the nurse suspect? a. Acute cholecystitis b. Pancreatic cancer c. Acute pancreatitis d. Pancreatic pseudocyst

c. Acute pancreatitis

4. 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? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

d. Roasted chicken breast, baked potato with chives, and orange juice Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

SG#34 Which are potential cardiovascular complications for a patient after surgery for a Whipple procedure? Select all that apply. a. Thrombophlebitis b. Pulmonary embolism c. Myocardial infarction d. Heart failure e. Renal failure f. Hemorrhage at anastomosis sites with hypovolemia

a. Thrombophlebitis c. Myocardial infarction d. Heart failure f. Hemorrhage at anastomosis sites with hypovolemia

SG#38 Which is a key feature of pancreatic cancer? a. Anorexia b. Weight gain c. Pale urine d. Dark-colored stools

a. Anorexia

SG#31 Which are manifestations of pancreatic cancer? Select all that apply. a. Light-colored urine and dark-colored stools b. Anorexia and weight loss c. Splenomegaly d. Ascites e. Leg or calf pain f. Weakness and fatigue

b. Anorexia and weight loss c. Splenomegaly d. Ascites e. Leg or calf pain f. Weakness and fatigue

SG#5 Which are common manifestations of acute cholecystitis? (Select all that apply.) a. Anorexia b. Ascites c. Eructation d. Steatorrhea e. Jaundice f. Rebound tenderness

a. Anorexia c. Eructation e. Jaundice f. Rebound tenderness

SG#1 A patient is admitted to the patient care unit with obstructive jaundice. Which sign/symptom does the nurse expect to find upon assessment of the patient? a. Pruritus b. Pale urine in increased amounts c. Pink discoloration of sclera d. Dark, tarry stools

a. Pruritus

SG#7 The health care provider has assessed a patient's abdomen and found rebound tenderness on deep palpation. What does the nurse recognize? a. Steatorrhea b. Eructation c. Biliary colic d. Blumberg's sign

d. Blumberg's sign

SG#36 What are the advantages of minimally invasive surgery(MIS) laparoscopic cholecystectomy? Select all that apply a. Complications are uncommon b. The mortality is similar to traditional cholecystectomy c. Patients recovery more rapidly d. Postoperative pain is less severe e. Bile duct injuries are rare f. IV abx are never needed because of decreased infection rates

a. Complications are uncommon c. Patients recovery more rapidly d. Postoperative pain is less severe e. Bile duct injuries are rare

SG#32 The nurse is teaching a patient and family how to prevent exacerbations of chronic pancreatitis. Which testing point does the nurse include? a. Moderation in the use of caffeinated beverages b. Avoidance of alcohol and nicotine c. Consume a bland, high-fat, low-protein diet d. Regular exercise, stressing aerobic activities

b. Avoidance of alcohol and nicotine

SG#17 The patient with acute cholecystitis had a pacemaker. Which diagnostic test is contraindicated? a. ERCP b. Magnetic resonance cholangiopancreatography (MRCP) c. Ultrasonography of the right upper quadrant d. Hepatobiliary (HIDA) scan

b. Magnetic resonance cholangiopancreatography (MRCP)

SG#39 The patient with acute necrotizing pancreatitis experiences a temperature spike of 104F. What does the nurse suspect? a. Pancreatic pseudocyst b. Pancreatic abscess c. Chronic pancreatitis d. Pancreatic cancer

b. Pancreatic abscess

SG#10 The nurse is administering ketorolac (Toradol) to a 78-year-old patient for mild to moderate pain management. Which assessment finding indicates the patient is experiencing a side effect of this drug? a. Gastrointestinal upset b. Ventricular cardiac dysrhythmias c. Decreased urinary output d. Jaundice

a. Gastrointestinal upset

9. A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first? a. Bring the client to a quiet room for privacy. b. Pull up a chair and sit next to the clients bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care providers notes about the prognosis for the client.

c. Determine whether the client feels like talking about his or her feelings. Before conducting an assessment about the clients feelings, the nurse should determine whether he or she is willing and able to talk about them. If the client is open to the conversation and his or her room is not appropriate, an alternative meeting space may be located. The nurse should be present for the client during this time, and pulling up a chair and sitting with the client indicates that presence. Because the nurse is assessing the clients response to a terminal diagnosis, it is not necessary to have detailed information about the projected prognosis; the nurse knows that the client is facing an end-of-life illness.

SG#24 Which condition is most likely to be treated with antibiotics? a. Cancer of the gallbladder b. Acute cholelithiasis c. Chronic pancreatitis d. Acute necrotizing pancreatitis

d. Acute necrotizing pancreatitis

SG#37 What is one of the main advantages of cholecystectomy by the natural orifice transluminal endoscopic surgery (NOTES) procedure? a. Very small visible incisions b. Jackson-Pratt drain removes excess fluid c. No visible incision lines d. Resumption of normal activities the day of surgery

c. No visible incision lines

3. 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? a. Ambulating in the hallway twice a day will help. b. I will apply a cold compress to the painful area on your back. c. Drinking a warm beverage can relieve this referred pain. d. You should cough and deep breathe every hour.

a. Ambulating in the hallway twice a day will help. The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Cold compresses and drinking a warm beverage would not be helpful. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide.

7. A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first? a. Assess the clients endotracheal tube with 40% FiO2. b. Insert an indwelling Foley catheter to gravity drainage. c. Place the clients nasogastric tube to low intermittent suction. d. Start lactated Ringers solution through an intravenous catheter.

a. Assess the clients endotracheal tube with 40% FiO2. Using the ABCs, airway and oxygenation status should always be assessed first, so checking the endotracheal tube is the first action. Next, the nurse should start the IV line (circulation). After that, the Foley catheter can be inserted and the nasogastric tube can be set.

SG#20 The patient with acute pancreatitis experiences abdominal pain. What is the best intervention to begin management of this pain? a. IV opioids by means of patient-controlled analgesia(PCA) b. Oral opioids such as morphine sulfate given as needed c. Intramuscular opioids given every 6 hours d. Oral hydromorphone (Dilaudid) given twice a day

a. IV opioids by means of patient-controlled analgesia(PCA)

11. A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1 F (37.8 C) b. Positive Murphys sign c. Light-colored stools d. Upper abdominal pain after eating

c. Light-colored stools Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen equally with both chronic and acute cholecystitis.

1. A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond? a. Bile salts accumulate in the skin and cause the itching. b. Toxins released from an inflamed gallbladder lead to itching. c. Itching is caused by the release of calcium into the skin. d. Itching is caused by a hypersensitivity reaction.

a. Bile salts accumulate in the skin and cause the itching. In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.

2. A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this clients condition? Select all that apply a. Body mass index of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

a. Body mass index of 46 d. Pregnant with twins f. Glycosylated hemoglobin level of 15% Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasis. A diet low in saturated fats and moderate alcohol intake may decrease the risk. Although metabolic syndrome is a precursor to diabetes, it is not a risk factor for cholelithiasis. The client should be informed of the connection.

4. A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? Select all that apply a. Contact the provider immediately. b. Lower the head of the bed. c. Decrease intravenous fluids. d. Ask the client to bear down. e. Administer prescribed opioids.

a. Contact the provider immediately. b. Lower the head of the bed. Clients who are experiencing biliary colic may present with tachycardia, pallor, diaphoresis, prostration, or other signs of shock. The nurse should stay with the client, lower the clients head, and contact the provider or Rapid Response Team for immediate assistance. Treatment for shock usually includes intravenous fluids; therefore, decreasing fluids would be an incorrect intervention. The clients tachycardia is a result of shock, not pain. Performing the vagal maneuver or administering opioids could knock out the clients compensation mechanism.

14. A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge? a. Do you have a one- or two-story home? b. Can you check your own pulse rate? c. Do you have any alcohol in your home? d. Can you prepare your own meals?

a. Do you have a one- or two-story home? A client recovering from chronic pancreatitis should be limited to one floor until strength and activity increase. The client will need a bathroom on the same floor for frequent defecation. Assessing pulse rate and preparation of meals is not specific to chronic pancreatitis. Although the client should be encouraged to stop drinking alcoholic beverages, asking about alcohol availability is not adequate to assess this clients safety.

16. 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? a. Drainage from a fistula b. Absent bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

a. Drainage from a fistula Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis. Absent bowel sounds, pain at the incision site, and NG tube drainage are normal postoperative findings.

SG#35 Which abnormal laboratory findings are cardinal findings in acute pancreatitis? Select all that apply. a. Elevated serum lipase b. Increased serum amylase c. Decreased serum trypsin d. Elevated serum elastase e. Elevated serum glucose f. Elevated bilirubin

a. Elevated serum lipase b. Increased serum amylase d. Elevated serum elastase f. Elevated bilirubin

8. 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? a. I dont know. I wish I had an answer for you, but I dont. b. Its important to keep a positive attitude for your family right now. c. Scientists have not determined why cancer develops in certain people. d. I think that this is a trial so you can become a better person because of it.

a. I dont know. I wish I had an answer for you, but I dont. The client is not asking the nurse to actually explain why the cancer has occurred. The client may be expressing his or her feelings of confusion, frustration, distress, and grief related to this diagnosis. Reminding the client to keep a positive attitude for his or her family does not address the clients emotions or current concerns. The nurse should validate that there is no easy or straightforward answer as to why the client has cancer. Telling a client that cancer is a trial is untrue and may diminish the client-nurse relationship.

SG#13 Which statements are true regarding laparoscopic cholecystectomy? (Select all that apply.) a. Laparoscopic cholecystectomy is considered the "gold standard" and is performed far more often than the traditional open approach. b. Patients with chronic lung disease or heart failure who are unable to tolerate the oxygen used in the laparoscopic procedure are examples of patients who have the open surgical approach (abdominal laparotomy). c. Removing the gallbladder with the laparoscopic technique reduces the risk of wound complications. d. Patients who have their gallbladders removed by the laparoscopic technique should be taught the importance of early ambulation to promote absorption of carbon dioxide. e. Use of laparoscopic cholecystectomy puts the patient at increased risk for bile duct injuries. f. After a laparoscopic cholecystectomy, assess the patient's oxygen saturation level frequently until the effects of the anesthesia has passed.

a. Laparoscopic cholecystectomy is considered the "gold standard" and is performed far more often than the traditional open approach. c. Removing the gallbladder with the laparoscopic technique reduces the risk of wound complications. d. Patients who have their gallbladders removed by the laparoscopic technique should be taught the importance of early ambulation to promote absorption of carbon dioxide.

SG#4 The nurse on a medical-surgical unit is caring for several patients with acute cholecystitis. Which task is best to delegate to the unlicensed assistive personnel (UAP)? a. Obtain the patients' vital signs. b. Determine if any foods are not tolerated. c. Assess what measures relieve the abdominal pain. d. Ask the patients to describe their daily activity or exercise routines.

a. Obtain the patients' vital signs.

SG#29 The nurse is caring for a patient with pancreatic cancer who had a whipple procedure. Which interventions and assessments does the nurse implement? Select all that apply a. Place the patient in semi-fowler's position b. Place the NG tube on intermittent suction c. Monitor NG drainage, which should be bile-tinged and contain blood d. Keep patient NPO e. Check blood glucose often f. Monitor for signs of hypovolemia to prevent shock

a. Place the patient in semi-fowler's position b. Place the NG tube on intermittent suction d. Keep patient NPO e. Check blood glucose often f. Monitor for signs of hypovolemia to prevent shock

5. 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? Select all that apply. a. Registered dietitian b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Health care provider

a. Registered dietitian c. Clinical pharmacist e. Health care provider Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse should collaborate with the registered dietitian, clinical pharmacist, and health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision.

SG#40 The nurse is collaborating with the dietitian to provide diet teaching for a patient with chronic pancreatitis and his family. Which are important teaching points for this teaching plan? Select all that apply a. The patient will need to increase calorie intake (4000-6000) per day to maintain weight b. Be sure to include foods that are high in fat because they are essential for healing c. Alcohol intake should be avoided d. Provide a bland diet with frequent meals e. Avoid irritating substances such as caffeinated beverages which stimulate the GI system f. Add rich foods to the diet to help meet the caloric requirements

a. The patient will need to increase calorie intake (4000-6000) per day to maintain weight c. Alcohol intake should be avoided d. Provide a bland diet with frequent meals e. Avoid irritating substances such as caffeinated beverages which stimulate the GI system

SG#27 Which statements about pancreatic cancer are accurate? Select all that apply. a. Venous thromboembolism (VTE) is a common complication of pancreatic cancer. b. Pancreatic cancer often presents in a slow and vague manner. c. Severe pain is an early feature of this disease d. There are no specific blood tests to diagnose pancreatic cancer. e. Chemotherapy is the treatment of choice for pancreatic cancer. f. Chronic pancreatitis predisposes a patient to pancreatic cancer.

a. Venous thromboembolism (VTE) is a common complication of pancreatic cancer. b. Pancreatic cancer often presents in a slow and vague manner. d. There are no specific blood tests to diagnose pancreatic cancer. f. Chronic pancreatitis predisposes a patient to pancreatic cancer.

SG#18 The nurse is evaluating electrolyte values for a patient with acute pancreatitis and notes that the serum calcium is 6.8 mEq/L. How does the nurse interpret this finding? a. Within normal limits considering the diagnosis of acutepancreatitis b. A result of the body not being able to use bound calcium c. A protective measure that will reduce the risk ofcomplications d. Full compensation of the parathyroid gland

b. A result of the body not being able to use bound calcium

3. A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this clients teaching? Select all that apply. a. Take a 20-minute walk at least 5 days each week. b. Attend local Alcoholics Anonymous (AA) meetings weekly. c. Choose whole grains rather than foods with simple sugars. d. Use cooking spray when you cook rather than margarine or butter. e. Stay away from milk and dairy products that contain lactose. f. We can talk to your doctor about a prescription for nicotine patches.

b. Attend local Alcoholics Anonymous (AA) meetings weekly. d. Use cooking spray when you cook rather than margarine or butter. f. We can talk to your doctor about a prescription for nicotine patches. The client should be advised to stay sober, and AA is a great resource. The client requires a low-fat diet, and cooking spray is low in fat compared with butter or margarine. If the client smokes, he or she must stop because nicotine can precipitate an exacerbation. A nicotine patch may help the client quit smoking. The client must rest until his or her strength returns. The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones. Dairy products do not cause a problem.

12. 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? a. Administer intravenous morphine while the client sleeps. b. Encourage the client to use the PCA pump upon awakening. c. Contact the provider and request a different analgesic. d. Ask a family member to initiate the PCA pump for the client.

b. Encourage the client to use the PCA pump upon awakening. The nurse should encourage the client to use the PCA pump prior to napping and upon awakening. Administering additional intravenous morphine while the client sleeps places the client at risk for respiratory depression. The nurse should also evaluate dosages received compared with dosages requested and contact the provider if the dose or frequency is not adequate. Only the client should push the pain button on a PCA pump.

2. 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? a. Drinking at least 2 liters of water each day is suggested. b. I will decrease the amount of fatty foods in my diet. c. Drinking fluids with my meals will increase bloating. d. I will avoid concentrated sweets and simple carbohydrates.

b. I will decrease the amount of fatty foods in my diet. After cholecystectomy, clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients. Good fluid intake is healthy for all people but is not related to the surgery. Drinking fluids between meals helps with dumping syndrome, which is not seen with this procedure. Restriction of sweets is not required.

5. 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? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowlers position with the head of bed elevated.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids. The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort.

6. 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? Select all that apply a. Do not allow the client to eat between meals. b. Make sure the client receives a protein shake. c. Do not allow caffeine-containing beverages. d. Make sure the foods are bland with little spice. e. Do not allow high-carbohydrate food items.

b. Make sure the client receives a protein shake. c. Do not allow caffeine-containing beverages. d. Make sure the foods are bland with little spice. During the healing phase of pancreatitis, the client should be provided small, frequent, moderate- to high carbohydrate, high-protein, low-fat meals. Protein shakes can be provided to supplement the diet. Foods and beverages should not contain caffeine and should be bland.

17. A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take? a. Clamp the nasogastric tube. b. Place the client in semi-Fowlers position. c. Assess vital signs once every shift. d. Provide oral rehydration.

b. Place the client in semi-Fowlers position. Postoperative care for a client recovering from an open Whipple procedure should include placing the client in a semi-Fowlers position to reduce tension on the suture line and anastomosis sites, setting the nasogastric tube to low suction to remove free air buildup and pressure, assessing vital signs frequently to assess fluid and electrolyte complications, and providing intravenous fluids.

1. A nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure? Select all that apply a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and renal failure (urine output of 20 mL/6 hr) are just some of the complications for which the nurse must assess the client after the Whipple procedure. Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure.

SG#8 A patient is scheduled for tests to verify the medical diagnosis of cholecystitis. For which diagnostic test does the nurse provide patient teaching? a. Extracorporeal shock wave lithotripsy (ESWL) b. Ultrasonography of the right upper quadrant c. Endoscopic retrograde cholangiopancreatography(ERCP) d. Serum level of aspartate aminotransferase (AST)

b. Ultrasonography of the right upper quadrant

SG#25 The nurse has instructed a patient in the recovery phase of acute pancreatitis about diet therapy. Which statement by the patient indicates that teaching has been successful? a. "I will eat the usual three meals a day that I am used to." b. "I am eating tacos for my first meal back home." c. "I will avoid eating chocolate and drinking coffee." d. "I will limit the amount of protein in my diet."

c. "I will avoid eating chocolate and drinking coffee."

SG#26 The nursing student is caring for a patient with chronic pancreatitis who is receiving pancreatic enzyme replacement therapy. Which statement by the student indicates the need for further study concerning this therapy? a. "The enzymes will be administered with meals." b. "The patient will take the drugs with a glass of water." c. "If the patient has difficulty swallowing the enzyme preparation, I will crush it and mix it with foods." d. "The effectiveness of pancreatic enzyme treatment is monitored by the frequency and fat content of stools.

c. "If the patient has difficulty swallowing the enzyme preparation, I will crush it and mix it with foods."

10. A nurse assesses clients at a community health center. Which client is at highest risk for pancreatic cancer? a. A 32-year-old with hypothyroidism b. A 44-year-old with cholelithiasis c. A 50-year-old who has the BRCA2 gene mutation d. A 68-year-old who is of African-American ethnicity

c. A 50-year-old who has the BRCA2 gene mutation Mutations in both the BRCA2 and p16 genes increase the risk for developing pancreatic cancer in a small number of cases. The other factors do not appear to be linked to increased risk.

SG#23 A patient with acute pancreatitis is at risk for the development of paralytic (adynamic) ileus. Which action provides the nurse with the best indication of bowel function? a. Observing contents of the nasogastric drainage b. Weighing the patient every day at the same time c. Asking the patient if he or she has passed flatus or had a stool d. Obtaining a computed tomography (CT) scan of the abdomen with contrast medium

c. Asking the patient if he or she has passed flatus or had a stool

13. A nurse cares for a client with acute pancreatitis. The client states, I am hungry. How should the nurse reply? a. Is your stomach rumbling or do you have bowel sounds? b. I need to check your gag reflex before you can eat. c. Have you passed any flatus or moved your bowels? d. You will not be able to eat until the pain subsides.

c. Have you passed any flatus or moved your bowels? Paralytic ileus is a common complication of acute pancreatitis. The client should not eat until this has resolved. Bowel sounds and decreased pain are not reliable indicators of peristalsis. Instead, the nurse should assess for passage of flatus or bowel movement.

SG#6 The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient is pale, is diaphoretic, and describes extreme fatigue. Vital signs are: heart rate of 118/minute, BP 95/70, respirations 32/min, Temp 101ºF. What is the nurse's priority action at this time? a. Instruct the UAP to check a complete set of vital signs. b. Auscultate the patient's abdomen in all four quadrants. c. Notify the patient's health care provider. d. Administer the ordered opioid analgesic

c. Notify the patient's health care provider.

SG#3 Which patient would the nurse assess as low risk for the development of gallbladder disorders? a. Patient with sickle cell anemia b. Patient who is Mexican American c. Patient who is 20 years old and male d. Patient with a history of prolonged parenteral nutrition

c. Patient who is 20 years old and male

SG#15 The female patient is to have her gallbladder removed by natural orifice transluminal endoscopic surgery. What does the nurse teach about this surgery? a. The surgeon will use powerful shock waves to break up the gallstones. b. The surgeon will insert a transhepatic biliary catheter to open blocked bile ducts. c. The surgeon will use a vaginal approach to remove your gallbladder. d. The surgeon will inject ursodeoxycholic acid to dissolve any remaining gallstone fragments

c. The surgeon will use a vaginal approach to remove your gallbladder

15. A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer? a. A 26-year-old with a body mass index of 21 b. A 33-year-old who frequently eats sushi c. A 48-year-old who often drinks wine d. A 66-year-old who smokes cigarettes

d. A 66-year-old who smokes cigarettes Risk factors for pancreatic cancer include obesity, older age, high intake of red meat, and cigarette smoking. Sushi and wine intake are not risk factors for pancreatic cancer.

SG#19 Disseminated intravascular coagulation (DIC) is a complication of pancreatitis. What pathophysiology leads to this complication? a. Hypovolemia b. Peritoneal irritation and seepage of pancreatic enzymes c. Disruption of alveolar-capillary membrane d. Consumption of clotting factors and formation of microthrombi

d. Consumption of clotting factors and formation of microthrombi

SG#16 After removal of the gallbladder, a patient experiences abdominal pain with vomiting for several weeks. What does the nurse recognize? a. Chronic cholecystitis b. Recurrence of acute cholecystitis c. Unremoved gallstones d. Postcholecystectomy syndrome

d. Postcholecystectomy syndrome