med/surg chapter 62

The nurse is providing discharge teaching for a client who will be going home with a T-tube following cholecystectomy surgery. Which statement by the client indicates the need for additional teaching?

"I will slowly pull about an inch of the tube out each day until it's out."

The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery. Which statement by the client indicates understanding of the instructions?

"I need a diet without a lot of fatty foods."

The nurse is caring for a postoperative client who reports pain in the shoulder blades following laparoscopic cholecystectomy surgery. Which direction does the nurse give to the nursing assistant to help relieve the client's pain?

"Ambulate the client in the hallway."

The nurse is caring for a client who is being discharged from the hospital after an attack of acute pancreatitis. Which discharge instructions does the nurse provide for the client to help prevent a recurrence? (Select all that apply.)

"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."

The client with obstructive jaundice asks the nurse why his skin is so itchy. Which is the nurse's best response?

"Bile salts accumulate in the skin and cause the itching."

The nurse is caring for a client with end-stage pancreatic cancer. The client asks the nurse, "Why is this happening to me?" Which is the nurse's best response?

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

The nurse is caring for a client with acute pancreatitis. The client's health care provider has ordered gentamicin (Garamycin) 3 mg/kg/day in three divided doses. The client weighs 264 lb. The client will receive _______ milligrams/dose of Garamycin.

120 264 lb/(2.2 lb/kg) = 120 kg (3 mg/kg/day) 120 kg = 360 mg/day (360 mg/day)/3 = 120 mg/dose

The nurse is teaching a community group about pancreatic cancer. Which risk factor does the nurse instruct is known for development of this type of cancer?

BRCA2 gene mutation

The nurse is caring for a client who has just been diagnosed with end-stage pancreatic cancer. The nurse assesses the client's emotional response to the diagnosis. Which is the nurse's initial action for the assessment?

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

The nurse is caring for a client who has just undergone traditional cholecystectomy surgery and has a Jackson-Pratt (JP) drain in place. The nurse notes serosanguineous drainage present in the drain. Which is the nurse's priority action?

Document the finding in the client's chart

The postanesthesia care unit nurse is caring for a client who has just undergone an open Whipple procedure. The client has multiple tubes and drains in place after the surgery. Which does the nurse assess first?

Endotracheal tube with 40% fraction of inspired oxygen (FiO2)

The nurse is caring for a client with acute pancreatitis. During the physical assessment, the nurse notes a grayish-blue discoloration of the client's flanks. Which is the nurse's priority action?

Ensure that the client has a patent large-bore IV site.

A client is hospitalized with acute pancreatitis. The nursing assistant reports to the nurse that when a blood pressure cuff was applied, the client's hand had a spasm. Which additional finding does the nurse correlate with this condition?

Serum calcium, 5.8 mg/dL

The nurse is caring for a client who had a T-tube placed 3 days ago. Which assessment finding indicates to the nurse that the procedure was successful?

Soft, brown, formed stool this morning

The nurse is caring for a client after a Whipple procedure. Which manifestations might indicate that a complication from the operation has occurred? (Select all that apply.)

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

The nurse is providing discharge teaching for a client who will be receiving pancreatic enzyme replacement at home. Which statement by the client indicates that additional teaching is needed?

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

The nurse is caring for a client with chronic pancreatitis. Which instruction by the nurse is most appropriate?

"We need to call the dietitian to get help in planning your diet."

A client is admitted for suspected cholecystitis. On reviewing laboratory results, the nurse notes that the client's amylase is elevated. Which action by the nurse is best?

Ask the client about drinking habits.

The nurse is caring for a client who had undergone a Whipple procedure 2 days previously. The nurse notes that the client's hands and feet are edematous, and urine output has decreased from the previous day. Which intervention does the nurse expect to provide for the client?

Add colloids to the client's IV solutions.

The nurse is caring for a client who has undergone surgery to drain a pancreatic pseudocyst with placement of a pancreatic drainage tube. Which nursing intervention prevents complications from this procedure?

Applying a skin barrier around the drainage tube site

The nurse is caring for a female client with cholelithiasis. Which assessment findings from the client's history and physical examination may have contributed to development of the condition? (Select all that apply.)

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

The nurse is caring for a client with cholecystitis. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

Clay-colored stools and dark amber urine

The nurse is caring for a client with cholecystitis. The client is a poor historian and is unable to tell the nurse when the symptoms started. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

Light-colored stools

The nurse is caring for a client with acute pancreatitis. Which nursing intervention best reduces discomfort for the client?

Maintaining NPO status for the client with IV fluids

The nurse is teaching a client with a history of cholelithiasis to select menu items for dinner. Which selections made by the client indicate that the nurse's teaching was effective?

Roasted chicken breast, baked potato with chives, hot tea with sugar