Med Surg - Chapter 59 - Care of Patients with Problems of the Biliary System and Pancreas

When caring for a patient with pancreatic cancer who is having severe pain, which intervention is the priority? 1 Supplementation with nonnarcotic medications to minimize opioid use 2 Reassurance that pain medication doses will be increased when needed 3 Use of adjunctive pain management strategies to prevent drug dependency 4 Administration of high-dose opioid analgesics when the patient reports pain

4 Administration of high-dose opioid analgesics when the patient reports pain High doses of opioid analgesics are given for pancreatic cancer pain without regard for drug dependency because of the poor prognosis. Reassurance, supplementation, and adjunctive pain management should all be used, but are not the top priority.

The nurse is providing discharge teaching to a patient who is being discharged home after hospitalization for acute pancreatitis. Which statement by the patient indicates a need for further teaching? 1 "I may have caffeine and chocolate in moderation." 2 "I should avoid alcohol even after symptoms resolve." 3 "I may need to take fat-soluble vitamins and other supplements." 4 "I will consume a diet high in carbohydrates and protein and low in fats."

1 "I may have caffeine and chocolate in moderation." Patients recovering from pancreatitis should avoid caffeine, chocolate, and other gastrointestinal stimulants. Fat-soluble vitamins may be prescribed. Patients should avoid alcohol, which could trigger a return of symptoms. The diet should be high in carbohydrates and protein and low in fats.

A patient receiving chenodiol acid for cholelithiasis has just received teaching about the medication. What statement by the patient indicates that the teaching was effective? 1 "If I have diarrhea, I will call my doctor." 2 "I can take this medication for up to 5 years." 3 "I should take the medication on an empty stomach." 4 "I will need to have gallbladder ultrasound every 2 months for a year."

1 "If I have diarrhea, I will call my doctor." The patient should contact the health care provider if diarrhea occurs. The medication can only be taken for 2 years. The patient should take chenodiol acid with milk or food, not on an empty stomach. The patient will need to have a gallbladder ultrasound every 6 months for the first year of therapy, not 2 months.

The nurse is providing postoperative teaching to a patient scheduled for a laparoscopic cholecystectomy. What instructions should be included? 1 "Introduce high-fat foods one at a time." 2 "The sutures will be removed in 14 days." 3 "You will be back to normal activities within 4 weeks." 4 "You will not be able to eat regular food for 24 to 48 hours."

1 "Introduce high-fat foods one at a time." High-fat foods, if resumed, will need to be introduced one at a time to determine how the patient will tolerate the foods. Sutures are not used; glue and Steri-Strips are used for this procedure. The patient should be able to resume normal activities within 1 week, not 4 weeks. The patient will be able to eat regular food not long after surgery.

A patient with an internal/external biliary drainage tube contacts the health care provider's office to report jaundice and leakage around the catheter site. What instructions should the nurse provide? 1 "Reconnect the drainage bag." 2 "Take your ursodeoxycholic acid." 3 "Go to the emergency department." 4 "Go to the lab to have your bilirubin level checked."

1 "Reconnect the drainage bag." A patient with jaundice or leakage around the tube insertion should reconnect the tube to drainage. Ursodeoxycholic acid is not indicated. The patient does not need to go to the emergency department. The patient will not need to have the bilirubin level checked.

Which patient characteristics are risk factors for cholelithiasis? Select all that apply. 1 Aging 2 Obesity 3 Depression 4 Diabetes mellitus 5 Vitamin deficiency

1 Aging 2 Obesity 4 Diabetes mellitus The risk for developing gallstones increases with age. Obesity increases the risk for cholelithias is due to impaired fat metabolism or increased cholesterol. Diabetes mellitus increases the chances of cholelithiasis due to higher levels of fatty acids. Neither depression nor vitamin deficiency cause cholelithiasis; they do not interfere with bile production and storage.

Which is the primary risk factor for chronic calcifying pancreatitis? 1 Alcoholism 2 Cholecystitis 3 Viral infection 4 Metabolic disturbances

1 Alcoholism Alcoholism is the primary risk factor for chronic calcifying pancreatitis. Cholecystitis is a risk factor for chronic obstructive pancreatitis. Metabolic disturbances and viral infection are risk factors for acute pancreatitis, not chronic calcifying pancreatitis.

What dietary suggestions are indicated for a patient who is in the healing phase after acute pancreatitis? Select all that apply. 1 Bland foods 2 Low-fat foods 3 Low-protein foods 4 Small, frequent meals 5 Low-carbohydrate foods

1 Bland foods 2 Low-fat foods 4 Small, frequent meals Patients in the healing phase after acute pancreatitis should have bland, low-fat foods and small, frequent meals. Patients should have a high, not low, carbohydrate diet and a high, not low, protein diet.

A patient who has just undergone a Whipple procedure for pancreatic cancer has frank blood and an increased output from the biliary drainage tubes. What action by the nurse is priority? 1 Contact the surgeon 2 Document the output 3 Assess the patient's vital signs 4 Clamp the nasogastric (NG) tube

1 Contact the surgeon The surgeon should be contacted because frank blood with increasing output may indicate a disruption or leakage of the anastomosis site. Documenting the output should not be done until after the surgeon is contacted. Clamping the NG tube is not indicated. Assessing the vital signs should be done after the surgeon is contacted.

A patient scheduled for a cholecystectomy because of gallstones causing cholecystitis reports a pain level of 4 on a 0-to-10 pain scale. Which analgesic medication does the nurse anticipate will be prescribed for the patient? 1 Ketorolac 2 Morphine 3 Meperidine 4 Hydromorphone

1 Ketorolac Ketorolac may be used for mild to moderate pain. Acute biliary pain requires opioid analgesia, such as morphine or hydromorphone. In the past, meperidine was the drug of choice for acute biliary pain because it was thought to cause fewer spasms of the sphincter of Oddi, which blocks bile flow. However, this drug breaks down into a toxic metabolite and can cause seizures, especially in older adults. All opioids may cause some degree of sphincter spasm.

A patient hospitalized with pancreatitis is being discharged with home health services. The patient is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the patient's strength? 1 Limiting the patient's activities to one floor of the home 2 Asking the health care provider for a request for PRN nasal oxygen 3 Instructing the patient to take an as-needed (PRN) sleeping medication at night 4 Arranging for the patient to have a nutritional consult to assess the patient's diet

1 Limiting the patient's activities to one floor of the home Limiting the patient's activities to one floor of the home will prevent tiring the patient with stair-climbing. Taking a PRN sleeping medication may not necessarily increase the patient's strength level or conserve strength; also, the patient may not be experiencing difficulty sleeping. Arranging for a nutritional consult or placing the patient on PRN nasal oxygen will not necessarily result in an increase in the patient's strength level or conserve strength; no information suggests that the patient has any history of breathing difficulties.

A patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach? 1 Normal weight 2 Absence of infection 3 Low serum cholesterol 4 Ability to tolerate iodine

1 Normal weight Patients who undergo extracorporeal shock wave lithotripsy must be of normal weight and have cholesterol-based, smaller gallstones and good gallbladder function. Iodine is not used in this procedure. The presence of infection and serum cholesterol levels are not factors to consider in candidates for this procedure.

A patient reports severe mid-epigastric pain radiating to the left flank and back. The nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen and periumbilical area. The nurse suspects which cause of acute pain in this patient? 1 Pancreatitis 2 Biliary colic 3 Cholecystitis 4 Gastroenteritis

1 Pancreatitis Patients with acute pancreatitis will have severe mid-epigastric pain that radiates to the left side and back and may have generalized jaundice and a gray-blue discoloration caused by pancreatic enzyme leakage into the cutaneous tissue. Biliary colic and cholecystitis will present with right-sided abdominal pain. Patients with gastroenteritis will have generalized discomfort.

Which patients are suitable candidates for extracorporeal shock wave lithotripsy (ESWL) to treat gallstones? Select all that apply. 1 Patient with normal body weight 2 Patient with cancer of the gallbladder 3 Patient with cholesterol-based stones 4 Patient with good gallbladder function 5 Patient with severe biliary obstruction

1 Patient with normal body weight 3 Patient with cholesterol-based stones 4 Patient with good gallbladder function ESWL is used for patients who have small stones and for those who are not good surgical candidates. Patients who are within normal weight range, have cholesterol-based stones, and good gallbladder function are suitable candidates for this procedure. ESWL is not used for patients with severe biliary obstruction or cancer of the gallbladder.

What are risk factors for cholecystitis? Select all that apply. 1 Pregnancy 2 Male gender 3 Prolonged fasting 4 African American ethnicity 5 Family history of gallstones

1 Pregnancy 3 Prolonged fasting 5 Family history of gallstones Pregnancy, prolonged fasting, and family history of gallstones are all risk factors for cholecystitis. Men and African Americans are not at increased risk for cholecystitis.

A patient with an external transhepatic biliary catheter has had a reduction in drainage. What does this finding indicate? 1 The catheter is not working. 2 The patient needs to change positions. 3 There is a decrease in biliary secretions. 4 The patient will need to increase the medication.

1 The catheter is not working. A reduction in drainage of an external transhepatic biliary catheter indicates that the catheter is not working. A reduction in drainage would not be related to the decrease in biliary secretions. It would not indicate that the patient needs to change positions. The patient does not need to take medication.

The patient has severe biliary obstruction. What type of surgery does the nurse anticipate this patient requiring in order to explore the ducts for patency? 1 Traditional cholecystectomy 2 Transhepatic biliary catheter 3 Laparoscopic cholecystectomy 4 Natural orifice transluminal endoscopic surgery

1 Traditional cholecystectomy Patients with severe biliary obstruction whose ducts will need to be explored will need a traditional cholecystectomy. A transhepatic biliary catheter placement is not a surgical procedure to treat cholecystectomy. A laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery will not provide visualization of the ducts.

What elevated blood level indicates inflammation in a patient diagnosed with cholecystitis? 1 White blood cell count 2 Lactate dehydrogenase 3 Serum alkaline phosphate 4 Aspartate aminotransferase

1 White blood cell count The white blood cell count is indicative of inflammation. The lactate dehydrogenase, serum alkaline phosphate, and aspartate aminotransferase are significant for abnormalities in the liver.

After receiving a change-of-shift report, which patient does the nurse plan to assess first? 1 Young adult patient with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min 2 Adult patient admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain 3 Middle-aged patient who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography 4 Older adult patient who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

1 Young adult patient with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic patient is at greatest risk for rapid deterioration and requires immediate assessment and intervention. The patient with cholecystitis and the patient with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult patient's glucose level will require intervention but, again, is not a medical emergency.

The nurse is assessing a patient's alcohol intake to determine whether it is the underlying cause of the patient's attacks of pancreatitis. Which question does the nurse ask to elicit this information? 1 "Do you usually binge drink?" 2 "Tell me more about your alcohol intake." 3 "Do you tend to drink more on holidays or weekends?" 4 "Estimate how many episodes of binge drinking you do in a week."

2 "Tell me more about your alcohol intake." Asking the patient about his or her alcohol intake is the only way that will allow the patient to provide information in the patient's own words and to the extent that the patient wishes to provide it. Asking the patient if he or she binge drinks may tend to put the patient on the defensive rather than provide the desired information. It has not yet been determined whether the patient engages in binge drinking.

Which symptom of chronic pancreatitis also occurs with acute pancreatitis? 1 Ascites 2 Abdominal pain 3 Protein malabsorption 4 Loss of exocrine function

2 Abdominal pain Abdominal pain occurs with both types of pancreatitis, although pain intensity does vary between the two. Ascites, loss of exocrine function, and protein malabsorption occur only with chronic pancreatitis.

A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis? 1 Acute 2 Chronic 3 Calculous 4 Acalculous

2 Chronic Patients with chronic cholecystitis are more likely to have jaundice and icterus caused by obstruction of bile flow, causing increased circulating levels of bilirubin. Patients with acute cholecystitis present with abdominal pain. Acalculous cholecystitis and calculous cholecystitis are both types of acute cholecystitis.

Which factors increase the risk of developing pancreatic cancer? Select all that apply. 1 Aging 2 Cirrhosis 3 Smoking 4 Vitamin deficiency 5 Chronic pancreatitis

2 Cirrhosis 3 Smoking 5 Chronic pancreatitis Pancreatic cancer is an abnormal growth in the pancreas. Cirrhosis, cigarette smoking, and chronic pancreatitis cause chronic irritation of the pancreatic tissue, increasing the risk for pancreatic cancer. Aging and vitamin deficiencies are not risk factors associated with pancreatic cancer.

The patient presents to the emergency department with severe abdominal pain. The nurse is reviewing the patient's lab results. What laboratory findings would prompt the nurse to suspect a diagnosis of acute pancreatitis? Select all that apply. 1 Decreased bilirubin 2 Increased serum amylase 3 Decreased serum glucose 4 Decreased serum calcium 5 Increased alanine aminotransferase

2 Increased serum amylase 4 Decreased serum calcium 5 Increased alanine aminotransferase A patient with acute pancreatitis will have an increased serum amylase, decreased serum calcium, and increased alanine aminotransferase. Patients will have an increased, not decreased, bilirubin. Patients will have an increased, not decreased, serum glucose level.

The nurse is caring for a patient with chronic pancreatitis. What assessment findings are related to this disease process? Select all that apply. 1 Diarrhea 2 Jaundice 3 Polydipsia 4 Polyphagia 5 Weight gain

2 Jaundice 3 Polydipsia 4 Polyphagia Jaundice, polydipsia, and polyphagia are manifestations observed in chronic pancreatitis. Jaundice occurs because of chronic inflammation in the biliary tract; bile cannot drain into the small intestines. Excessive thirst (polydipsia) and an increased appetite (polyphagia) occur because the patient has chronic organ dysfunction and develops diabetes mellitus (of which both symptoms are common). Diarrhea is not a symptom of chronic pancreatitis. Weight loss occurs in chronic pancreatitis.

The nurse understands that which patient is at highest risk for developing gallstones? 1 Thin female who has recently given birth 2 Obese female on hormone replacement therapy 3 Thin male with a history of coronary artery bypass grafting 4 Obese male with a history of chronic obstructive pulmonary disease

2 Obese female on hormone replacement therapy Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk.

Which is a priority nursing assessment for the patient with severe acute pancreatitis? 1 Fever and other signs of infection 2 Perfusion and other signs of shock 3 Pain level and other signs of discomfort 4 Breath sounds and other signs of pneumonia

2 Perfusion and other signs of shock The majority of deaths in patients with acute pancreatitis result from irreversible shock, so the nurse should observe the patient closely for signs of shock. Pneumonia, fever, and pain may also occur, but are not immediately life threatening.

Which factor is considered a risk factor in the development of cholelithiasis? 1 Anemia 2 Pregnancy 3 Less than age 40 years 4 Low body mass index (BMI)

2 Pregnancy In pregnancy, hormone levels (progesterone and estrogen) are altered, which delays muscular contraction of the gallbladder and decreases the rate of bile emptying, thus increasing the risk for cholelithiasis. Similarly, hormonal changes and hormonal replacement therapy make women over 40 years, not under, more susceptible to the development of cholelithiasis. Obese women, not those with a low BMI, are at a high risk of developing cholelithiasis because of impaired fat metabolism and increased cholesterol. Anemia is not associated with the development of gallstones.

A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this procedure? 1 Mouth 2 Vagina 3 Rectum 4 Umbilicus

2 Vagina Surgical removal of the gallbladder in women is most often accomplished via the vagina because it is easily decontaminated with betadine or other antiseptic, and it allows easy access into the peritoneal cavity. The surgeon makes a small internal incision through the cul-de-sac of Douglas, between the rectum and uterine wall, to access the gallbladder. The mouth and rectum do not provide easy access into a woman's peritoneal cavity. The umbilicus is used for removing the gallbladder in laparoscopic cholecystectomy.

A patient is undergoing extracorporeal shockwave lithotripsy. The patient complains of pain in the abdomen. What action by the nurse is appropriate? 1 Reposition the patient. 2 Prepare for conscious sedation. 3 Ask the interventionist to stop the procedure. 4 Let the patient know this is normal when the stones are breaking up and moving.

4 Let the patient know this is normal when the stones are breaking up and moving. The patient may experience pain during extracorporeal shockwave lithotripsy when the stones are breaking up and moving. This is not an indication to reposition the patient. The patient will not be placed under conscious sedation. The interventionist would not stop the procedure.

The nurse suspects that a patient may have acute pancreatitis as evidenced by which group of laboratory results? 1 Elevated bilirubin, elevated alkaline phosphatase 2 Deceased calcium, elevated amylase, decreased magnesium 3 Elevated lipase, elevated white blood cell count, elevated glucose 4 Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

3 Elevated lipase, elevated white blood cell count, elevated glucose Elevated lipase is more specific to a diagnosis of acute pancreatitis. Many pancreatic and nonpancreatic disorders can cause increased serum amylase levels. Bilirubin and alkaline phosphatase levels will be increased only if pancreatitis is accompanied by biliary dysfunction. Usually, calcium and magnesium will be increased and BUN increased, not decreased, in acute pancreatitis.

A patient who has had acute mid-epigastric pain for 3 days has elevated glucose, bilirubin, serum lipase, and a threefold increase in alanine aminotransferase. The serum amylase is normal. What does the nurse suspect about the possible cause of this patient's pain? 1 It is not caused by pancreatitis. 2 It may be caused by pancreatitis. 3 It is caused by acute biliary pancreatitis. 4 It is caused by hepatobiliary inflammation only.

3 It is caused by acute biliary pancreatitis. The patient has elevated glucose, bilirubin, lipase, and alanine aminotransferase, which indicate pancreatitis with hepatobiliary involvement. Serum amylase levels may have been elevated and returned to normal, since they increase in 12 to 24 hours of onset and remain elevated only 2 to 3 days. A threefold or greater rise in alanine aminotransferase indicates acute biliary pancreatitis.

What labs should the nurse review for a patient suspected of having cholecystitis? Select all that apply. 1 Platelets 2 Hematocrit 3 Liver function 4 White blood cells 5 Alkaline phosphate

3 Liver function 4 White blood cells 5 Alkaline phosphate Liver function, white blood cells, and alkaline phosphate are often elevated in patients with cholecystitis. Hematocrit and platelets are not often abnormal, and therefore are not diagnostic.

Which of the following factors may be associated with the development of cholelithiasis? Select all that apply. 1 Smoking 2 Weight loss 3 Nutrition habits 4 Sedentary lifestyle 5 Mexican-American populations

3 Nutrition habits 4 Sedentary lifestyle 5 Mexican-American populations A familial or genetic tendency appears to play a role in the cholelithiasis, but this may be partially related to familial nutrition habits (excessive dietary cholesterol intake) and sedentary lifestyles. The highest frequency of gallstone production lies among the American-Indian and Mexican-American populations. Development of gallstones is not related to smoking or normal weight loss.

The nurse is caring for a patient with acute pancreatitis. The patient is complaining of shortness of breath and orthopnea. The patient's vital signs are: blood pressure 140/80, pulse 110, oxygen saturation 90% on room air, and temperature 99.8° F. What complication does the nurse suspect? 1 Hemorrhage 2 Paralytic ileus 3 Pleural effusion 4 Pancreatic infection

3 Pleural effusion Patients should be assessed frequently for pleural effusions and other respiratory complications. The patient has multiple symptoms of pleural effusion. The patient does not exhibit symptoms of hemorrhage, paralytic ileus, or pancreatic infection.

The patient recently diagnosed with acute pancreatitis complains of severe pain despite intravenous narcotic pain medication. Into which position should the nurse assist the patient in order to help decrease pain? 1 Prone 2 Supine 3 Side lying 4 High Fowler's

3 Side lying The side-lying position may decrease the abdominal pain of pancreatitis. Prone, supine, and high Fowler's positions are not indicated to decrease pain in pancreatitis.

The nurse is attempting to position a patient having an acute attack of pancreatitis in the most comfortable position possible. Which position is appropriate for this patient? 1 Supine, with a pillow supporting the abdomen 2 High Fowler's position, with pillows used as needed 3 Side-lying position, with knees drawn up to the chest 4 Up in a chair between frequent periods of ambulation

3 Side-lying position, with knees drawn up to the chest The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis. No evidence suggests that supine position, sitting up in a chair, or high Fowler's position have any effect on abdominal discomfort related to acute pancreatitis.

The nurse is teaching a patient with gallbladder disease about diet modification. Which meal does the nurse suggest to the patient? 1 Steak and french fries 2 Sausage and scrambled eggs 3 Turkey sandwich on wheat bread 4 Fried chicken and mashed potatoes

3 Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this patient. Steak, french fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a patient with gallbladder disease.

The patient is evaluated for use of extracorporeal shockwave lithotripsy for treatment of cholelithiasis. What findings should the nurse notify the health care provider about? 1 Body mass index (BMI) of 27 2 Upper abdominal pain 3 Cholesterol-based stones 4 Poor gallbladder function

4 Poor gallbladder function A patient scheduled for extracorporeal shockwave lithotripsy should have normal gallbladder function, so poor gallbladder function should be reported. A BMI of 27 indicates normal weight, which is necessary for this procedure. Upper abdominal pain is expected in a patient who has gallstones. A patient with cholesterol-based stones is an appropriate candidate for this procedure.

The nurse is teaching a patient with chronic pancreatitis about pancreatic-enzyme replacement therapy. Which statement by the patient indicates a correct understanding of the teaching? 1 "I should mix the capsule contents with high-protein foods." 2 "I should drink a minimum amount of water after taking the medication." 3 "If I can't swallow the capsule, I may break it open and chew the contents." 4 "I may spread the capsule contents over applesauce, mashed fruit, or rice cereal."

4 "I may spread the capsule contents over applesauce, mashed fruit, or rice cereal." Patients who cannot swallow pancreatic enzyme capsules may break them open and spread the contents over applesauce, mashed fruit, or rice cereal. They should be taught to drink a large amount of water to make sure the enzymes do not remain in the mouth. Mixing the enzymes with high-protein foods results in the enzymes breaking the protein down into a watery substance. Contents should not be chewed or crushed because this will destroy the delayed-release coating.

A patient diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? 1 "This may be an indication of pancreatic disease." 2 "This may be an indication that you are developing sepsis." 3 "The gallstones are present, but have become fibrotic and contracted." 4 "This type of gallbladder inflammation is associated with severe dehydration."

4 "This type of gallbladder inflammation is associated with severe dehydration." This type of gallbladder inflammation is associated with hypovolemia. Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed.

Which possible complication of chronic pancreatitis presents as a painful, palpable mass in the left upper quadrant? 1 Ascites 2 Steatorrhea 3 Cholecystitis 4 Abscess or pseudocyst

4 Abscess or pseudocyst Patients with chronic pancreatitis may develop an abscess or pseudocyst, which causes a painful, palpable mass in the left upper quadrant. Ascites produce dullness on abdominal percussion. Cholecystitis causes jaundice and biliary colic. Steatorrhea is a fatty, foul-smelling stool.

What interventions are necessary in a patient with acute pancreatitis who is at risk for paralytic ileus? Select all that apply. 1 Provide enteral feedings 2 Decrease pain medication 3 Administer a saline enema 4 Ask if patient has passed flatus 5 Maintain a patent nasogastric (NG) tube

4 Ask if patient has passed flatus 5 Maintain a patent nasogastric (NG) tube It is important to determine if the patient has passed gas or stool. It is also important to make sure the NG tube is functioning. Enteral feedings are not indicated in patients at risk for paralytic ileus. A saline enema would not be administered. Pain medication cannot be decreased by the nurse.

A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition? 1 Peritonitis 2 Malnutrition 3 Vitamin deficiency 4 Chronic cholecystitis

4 Chronic cholecystitis Fever, yellowing of the skin and eyes, clay-colored stools, and dark urine are symptoms of chronic cholecystitis. These symptoms occur when repeated episodes of cystic duct obstruction cause chronic inflammation. Peritonitis is an infection of the peritoneal cavity in which the patient presents with a hard, distended abdomen. Patients with malnutrition are underweight for their height and have low albumin. Patients with a vitamin deficiency do not display these symptoms; symptoms are always dependent upon the vitamin in which the patient is deficient.

The nurse is preparing a patient for a magnetic resonance cholangiopancreatography (MRCP) scan. Which contrast medium does the nurse tell the patient will be administered prior to the procedure? 1 Ketorolac 2 Morphine 3 Meperidine 4 Gadolinium

4 Gadolinium The oral or IV contrast material gadolinium is given before an MRCP scan. Gadolinium does not contain iodine; therefore, it does not carry the risk for an allergic reaction. Ketorolac, morphine, and meperidine are not helpful in MRI; these drugs are analgesics.

Which finding is expected in a patient who has a liver function abnormality? 1 Increased white blood cell (WBC) count 2 Decreased level of lactate dehydrogenase 3 Decreased level of aspartate aminotransferase 4 Increase in serum levels of alkaline phosphatase

4 Increase in serum levels of alkaline phosphatase Alkaline phosphatase is an enzyme found in the liver, kidneys, and bones. An increase in serum levels of alkaline phosphatase indicates a liver function abnormality. An increased level of WBCs indicates inflammation or infection. When the liver is not functioning normally, the level of lactate dehydrogenase and aspartate aminotransferase are increased, not decreased.

Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin? 1 Lipase 2 Trypsin 3 Elastase 4 Kallikrein

4 Kallikrein Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. These substances cause vasodilation and increased vascular permeability, compounding the hemorrhagic process. Lipase enzyme is involved in enzymatic fat necrosis. Trypsin activates elastase, which dissolves elastic fibers of the blood vessels and ducts.

The nurse is caring for a patient diagnosed with acute pancreatitis who has had increased pain and guarding along with the following vital signs: blood pressure 108/60, pulse 125, temperature of 103.8°F, and an O 2 saturation of 95% on 2 L via nasal cannula. The nurse suspects the patient has a pancreatic abscess. After contacting the health care provider, what should the nurse do first? 1 Reassess the vital signs 2 Place the patient supine 3 Administer rectal acetaminophen 4 Prepare the patient for pancreatic drainage

4 Prepare the patient for pancreatic drainage Pancreatic drainage needs to be performed as soon as possible to prevent sepsis. Reassessing vital signs should be done after the patient is prepared for drainage. Placing the patient in a supine position is not indicated. After ensuring everything is in order for the health care provider, acetaminophen may be administered, but it is not priority.

Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis, in order to dissolve remaining stone fragments? 1 Ketorolac 2 Morphine sulfate 3 Bethanechol 4 Ursodeoxycholic acid

4 Ursodeoxycholic acid Ursodeoxycholic acid is administered to dissolve remaining fragments of stones after ESWL. Ketorolac, morphine, and bethanechol are not indicated for dissolution of stones.

A patient is diagnosed with pancreatic cancer. Which is a common complication that the patient can develop? 1 Infection 2 Dyspepsia 3 Eructation 4 Venous emboli

4 Venous emboli The patient with pancreatic cancer is at a higher risk for developing venous emboli. This occurs because necrotic products of the pancreatic tumor have thromboplastic properties which, in turn, cause a hypercoagulable state. Decreased mobility and extensive surgical manipulation are also responsible for this infection. Dyspepsia (indigestion) and eructation (belching) are not common complications associated with pancreatic cancer.