GI
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
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
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 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
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, BP 95/70, respirations 32/min, temp 101. What is priority 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
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
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
Which patient is at 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
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
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 microthrombi formation
d
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
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
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
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
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
the patient will need increased calorie intake (4000-6000) per day to maintain weight alcohol intake should be avoided provide a bland diet with frequent meals avoid irritating substances such as caffeinated beverages which stimulate the GI system
which are potential cardiovascular complications for a patient after surgery for a Whipple procedure
thrombophlebitis myocardial infarction heart failure hemorrhage at anastomosis sites with hypovolemia
Which statements about pancreatic cancer are accurate
venous throm is a common complication of pancreatic cancer pancreatic cancer often presents in a slow and vague manner there are no specific blood tests to diagnose pancreatic cancer chronic pancreatitis predisposes a patient to pancreatic cancer
The nurse is caring for an obese post-op patient who underwent surgery for bowel resection. As the client is moving in the bed, he comments 'Somethings popped open." Upon examination, the nurse notes wound evisceration. Place the steps in order for this situation
1. Stay calm and stay with the client. 2. Put the client into semi-fowler position with knees slightly flexed. 3. Check the vital signs, especially blood presure and pulse 4. Have a colleague gather sterile supplies and contact the HCP 5. Cover the intestine with sterile moistened gauze 6. Prepare the client for surgery as ordered.
A client underwent an exploratory laparotomy 2 days ago. THe HCP should be called immediately for which physical assessment finding?
Abdominal distention and rigidity
Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopancreatography (ERCP)?
Bilirubin level
For which clinical indicator should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice ?
Dark urine, yellow skin, clay colored stool
A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks what a pseudocyst is, what information should the nurse include in a response to this question?
Dilated space of necrotic tissue and blood
Before a cholecystectomy, vitamin K is prescribed, which element, should the nurse determine is the purpose of administering this medication?
Prothrombin
The nurse is providing post-op care for a client who underwent laparoscopic cholecystectomy. What should be reported immediately to the health care provider?
The client reports right upper quadrant pain
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
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. Abdominal bloating and cramping b. Ventricular cardiac dysrhythmias c. Decreased urinary output d. Jaundice
a
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
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
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
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
a, b, d
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.
a, c, d
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, c, e, f
Which are manifestations of pancreatic cancer
all answers right but light colored urine and dark colored stools
The nurse is caring for a patient with pancreatic cancer who had a whipple procedure. which interventions and assessments does the nurse implement
all but answers right but monitor NG drainage, which should be nile tinged and contain blood
Which is a key feature of pancreatic cancer
anorexia
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
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
The nurse is caring for an older adult patient with acute biliary pain. Which drug order does the nurse question? a. Ketorolac (Toradol, Acular) b. Meperidine (Demerol) c. Morphine d. Hydromorphone (Dilaudid)
b
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 acute pancreatitis b. A result of the body not being able to use bound calcium c. A protective measure that will reduce the risk of complications d. Full compensation of the parathyroid gland
b
The nurse is teaching a patient and family how to prevent exacerbations of chronic pancreatitis. Which teaching 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
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
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
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
The nurse is caring for a client with a nasogastric (NG) tube. Which task can be delegated to experienced unlicensed assistive personnel (UAP)?
Disconnecting the suction to allow ambulation to the toilet
A client is admitted with tentative diagnosis of pancreatitis, the medical and nursing measures for this client are aimed towards maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance and decreasing anxiety. Which intervention should the nurse implement? select all
Administer analgesics, teach relaxation exercises, monitor cardiac rate and rhythm
A nurse is preparing a teaching plan for a client with a history of cholelithiasis, which information about why the ingestion of fatty foods will cause discomfort should the nurse include in the teaching plan?
Bile flow into the intestine is obstructed
A nurse is caring for a client with cholelithiasis and obstructive jaundice, when assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions?
Ecchymosis, yellow sclera, pain in right upper quadrant
what is the most common and serious complication after a whipple procedure
Fistula development
The home health nurse sees that the client is taking cimetidine. What question is the nurse most likely to ask to evaluate the efficacy of this therapy?
Has the medication helped to relive the acid indigestion?
A client is returned to the surgical unit after an abdominal cholecystectomy, what is the main reason why the nurse should assess for clinical indicators of respiratory complications?
Incision is in close proximity to the clients diaphragm
A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism, the client asks what does my drinking have to do with my diagnosis, what effect of alcohol should the nurse include when responding?
Increases in enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas
What is one of the main advantages of cholecystectomy by the natural orifice transluminal endoscopic surgery (NOTES) procedure?
No visible incision lines
Which are advantages of minimally invasive surgery laparoscopic cholecystectomy? select all
complications are uncommon patients recover more rapidly postoperative pain is less severe bile duct injuries are rare
a client is discharged the same day after ambulatory surgery for a laparoscopic cholecystectomy. the nurse is providing discharge teaching about how many days the client should way to engage in activities
getting out of bed performing light exercise showering driving lifting
The patient with acute necrotizing pancreatitis experiences a temperature spike to 104 F what does the nurse suspect
pancreatic abscess