PREP U CH. 50

Clinical manifestations of common bile duct obstruction include all of the following except: A. Light colored urine B. Pruritus C. Clay-colored feces D. Jaundice

A. Light colored urine Urine would dark and amber in color.

The nurse knows that the serum amylase concentration returns to normal within which time frame? A. 12 hours B. 24 hours C. 36 hours D. 48 hours

D. 48 hours Serum amylase usually returns to normal within 48 to 72 hours.

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A. Pancreatitis B. Cholecystitis C. Appendicitis D. Peptic ulcer

A. Pancreatitis Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.

Which dietary modification is used for a client diagnosed with acute pancreatitis? A. Low carbohydrate diet B. High fat diet C. High protein diet D. Elimination of coffee

D. Elimination of coffee A high-carbohydrate, low-fat, and low-protein diet should be implemented. Alcohol, caffeine, and spicy foods should be avoided.

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply. A. Dark urine B. Weight gain C. Clay colored stools D. Hiccups E. Jaundice

A. Dark urine C. Clay colored stools E. Jaundice Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected.

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? A. Deficient fluid volume B. Excess fluid volume C. Ineffective gastrointestinal perfusion D. Decreased cardiac output

A. Deficient fluid volume Clients with acute pancreatitis often experience deficient fluid volume, which can lead to hypovolemic shock. Vomiting, hemorrhage (in hemorrhagic pancreatitis), and plasma leaking into the peritoneal cavity may cause the volume deficit. Hypovolemic shock will cause a decrease in cardiac output.

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? A. Tetany related to hypercalcemia B. Tetany related to hypocalcemia C. Muscle spasm related to hypokalemia D. Muscle pain related to referred pain manifestations

B. Tetany related to hypocalcemia A client with acute pancreatitis who reports muscle cramping or pain should be suspected of having hypocalcemia and tetany of the muscles. Hypocalcemia may occur in acute pancreatitis because, when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.

A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply. A. Allow the client to have sips of clear liquids B. Withhold oral feedings to limit the release of secretin C. Encourage bed rest to decrease the client's metabolic rate D. Teach the client about the correlation between alcohol intake and pain

B. Withhold oral feedings to limit the release of secretin C. Encourage bed rest to decrease the client's metabolic rate D. Teach the client about the correlation between alcohol intake and pain The acutely ill client is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. The nurse also assesses the home situation and reinforces instructions about fluid and nutrition intake and avoidance of alcohol. Oral feedings are withheld to decrease the secretion of secretin; therefore, having sips of clear liquids is not an appropriate intervention.

Which is a clinical manifestation of cholelithiasis? A. Epigastric distress before a meal B. Nonpalpable abdominal mass C. Clay-colored stools D. Abdominal pain in upper left quadrant

C. Clay-colored stools The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas? Select all that apply. A. "Internal secretion of hormones is the function of the endocrine pancreas." B. "The exocrine pancreas secretes pancreatic enzymes into the GI tract." C. "The endocrine pancreas secretes hormones through a ductless gland." D. "The exocrine pancreas secretes hormones from excretory ducts." E. "Internal secretion of hormones is the function of the exocrine pancreas."

A. "Internal secretion of hormones is the function of the endocrine pancreas." B. "The exocrine pancreas secretes pancreatic enzymes into the GI tract." C. "The endocrine pancreas secretes hormones through a ductless gland." D. "The exocrine pancreas secretes hormones from excretory ducts." The pancreas has both endocrine and exocrine functions. The endocrine pancreas secretes hormones internally through a ductless gland. The exocrine pancreas secretes external hormones from excretory ducts. Also, the exocrine pancreas secretes pancreatic enzymes into the GI tract.

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? A. High carbohydrate, high protein, low fat diet B. Low sodium, high potassium, low fat diet C. High carbohydrate, low protein, low fat diet D. Low carbohydrate, high potassium diet

C. High carbohydrate, low protein, low fat diet The nurse should provide a high-carbohydrate, low-protein, low-fat diet when tolerated. These foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? A. MODS B. Shock C. Pancreatic necrosis D. Tetany

C. Pancreatic necrosis Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Shock and multiple organ failure may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in clients with acute pancreatitis.

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? A. To prevent the occurrence of fibrosis B. To drain the pancreatic bed C. To avoid inflammation of the pancreas D. To aid in opening up pancreatic duct

C. To avoid inflammation of the pancreas Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? A. It shows the sizes of abdominal organs and detects any masses B. It visualized the liver and pancreas C. It visualized the gallbladder and bile duct D. It visualizes biliary structures and pancreas via endoscopy

C. It visualized the gallbladder and bile duct The cholecystogram is a diagnostic imaging test used to visualize the gallbladder and bile duct.

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? A. Decrease in the physiologic function of major organs B. Increases in the rate of pancreatic secretion C. Increases in the bicarbonate output by the kidneys D. Development of local complications

A. Decrease in the physiologic function of major organs Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in physiologic function of major organs with increasing age.

What concepts does the nurse understand about gerontologic considerations related to acute pancreatitis? Select all that apply. A. As the client ages, the size of the pancreas decreases, increasing the risk of developing acute pancreatitis B. As the client ages, the pattern of complications related to acute pancreatitis changes C. As the client ages, there is an increased mortality rate for acute pancreatitis D. As the client ages, there is an increased risk for development of acute pancreatitis E. As the client ages, there is an increased risk for development of MODS

C. As the client ages, there is an increased mortality rate for acute pancreatitis

A client who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25-pound weight loss in the past year. The nurse attributes which factor as the most likely cause of this weight loss? A. Malabsorption B. Vomiting after heavy meals C. Skipping meals out of fear of painful attacks D. Ingesting a low fat diet to prevent abdominal pain

C. Skipping meals out of fear of painful attacks Weight loss is a major problem in chronic pancreatitis. More than 80% of clients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack.

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? A. Pancreatitis causes alterations to hemoglobin, impairing oxygenation B. Pancreatitis can atrophy the diaphragm and alter the breathing pattern C. Pancreatitis can elevate the diaphragm and alter the breathing pattern D. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation

C. Pancreatitis can elevate the diaphragm and alter the breathing pattern Aggressive pulmonary care is required for clients with acute pancreatitis. Pancreatitis can elevate the diaphragm and alter the breathing pattern of clients. Pancreatitis can cause retention of pulmonary secretions but does not thicken the secretions. Acute pancreatitis does not alter the hemoglobin.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? A. Relieving abdominal pain B. Teaching about the disease and its treatment C. Preventing fluid volume overload D. Maintaining adequate nutritional status

A. Relieving abdominal pain The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? A. Renal failure B. Inability for the liver to reabsorb serum glucose C. Ingestion of foods high in sugar D. Dysfunction of the pancreatic islet cells

D. Dysfunction of the pancreatic islet cells Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? A. Dry mouth, which makes the client thirsty B. High glucose concentration in the blood C. Acetone in the urine D. Frequent vomiting, leading to loss of fluid volume

D. Frequent vomiting, leading to loss of fluid volume Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the client's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the client daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea.

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? A. Maintaining a high Fowler's position B. Administering oral analgesics around the clock C. Allowing a clear liquid diet D. Providing intensive insulin therapy

D. Providing intensive insulin therapy ntensive insulin therapy (continuous infusion) in the critically ill client has undergone much study and has shown promise in terms of positive client outcomes when compared with intermittent insulin dosing. Glycemic control with normal or near normal blood glucose levels improves client outcomes. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration, even with insulin coverage.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? A. Imbalanced nutrition: less than body requirements related to biliary inflammation B. Acute pain related to biliary spasms C. Deficient knowledge related to prevention of disease recurrence D. Anxiety related to unknown outcome of hospitalization

B. Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? A. Reposition the client every 2 hours B. Instruct the client to avoid coughing C. Withhold oral feedings for the client D. Monitor pulse oximetry every hour

A. Reposition the client every 2 hours Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis.

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: A. Sepsis B. Disseminated intravascular coagulotherapy C. Pleural effusion D. Edema and inflammation

D. Edema and inflammation Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas.

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right? A. Pigment B. Patterned C. Pearl D. Pixelated

A. Pigment

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? A. Frequent changes of position B. Suction the patient every 4 hours C. Perform chest physiotherapy D. Placing the patient in the prone position

A. Frequent changes of position Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client? A. "Inflammation is confined only to the pancreas." B. "Tissue necrosis occurs within the pancreas." C. "Inflammation spreads to the surrounding glands." D. "Normal function returns after about 2 weeks."

A. "Inflammation is confined only to the pancreas." There are two forms of pancreatitis-inflammatory and necrotizing. Interstitial pancreatitis is characterized by diffuse enlargement of the pancreas due to inflammatory edema confined only to the pancreas itself; normal function returns after about 6 months. Necrotizing pancreatitis is life-threatening and tissue necrosis occurs within the pancreas as well as the surrounding glands.

Management of a patient with ascites includes nutritional modifications and diuretic therapy. Which of the following interventions would a nurse expect to be part of patient care? Select all that apply. A. Aldactone, an aldosterone-blocking agent would be used B. A daily weight change of 0.5 pounds would require HCP notification C. Zaroxolyn would be the thiazide diuretic of choice D. Daily salt intake would be restricted to 2g or less E. The diuretic will be held if the serum sodium level decreases to <134 mEq/L

A. Aldactone, an aldosterone-blocking agent would be used D. Daily salt intake would be restricted to 2g or less

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Choose all that apply. A. Pruritus B. Dark urine C. Clay colored stool D. Jaundice E. Weight gain

A. Pruritus B. Dark urine C. Clay colored stool D. Jaundice The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected.

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? A. To avoid inflammation of the pancreas B. To drain the pancreatic bed C. To aid opening up the pancreatic duct D. To prevent the occurrence of fibrosis

A. To avoid inflammation of the pancreas Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.

The nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelithiasis can interfere with the absorption of A. Vitamin A B. Vitamin B6 C. Vitamin C D. Vitamin B12

A. Vitamin A Obstruction of bile flow interferes with absorption of the fat-soluble vitamins A, D, E, and K. Clients may exhibit deficiencies of these vitamins if biliary obstruction has been prolonged. Vitamins B6, B12, and C are not fat soluble.

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? A. "This may be the initial symptom of an infection. You need to come see the surgeon for an evaluation." B. "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." C. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." D. "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use."

B. "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.

A nurse is caring for a client in the emergency department who is reporting severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value indicates further investigation? A. Elevated WBC count B. Elevated troponin C. Decreased calcium D. Elevated blood glucose level

B. Elevated troponin level The nurse closely monitors the patient diagnosed with acute pancreatitis for early signs of neurologic, cardiovascular, renal, and respiratory dysfunction. An elevated troponin level indicates myocardial damage and requires immediate further investigation. Hyperglycemia (evidenced by a serum glucose level of 240 mg/dL), an elevated white blood cell count, and hypocalcemia, although commonly seen in pancreatitis, don't require immediate action.

Which dietary modification is used for a client diagnosed with acute pancreatitis? A. Low carbohydrate diet B. Elimination of coffee C. High fat diet D. High protein diet

B. Elimination of coffee A high-carbohydrate, low-fat, and low-protein diet should be implemented. Alcohol, caffeine, and spicy foods should be avoided.

A nurse admits a woman reporting severe right upper quadrant pain after eating dinner. What client risk factors lead the nurse to suspect gallbladder disease? Select all that apply. A. Smoking B. Hx of diabetes mellitus C. Obese D. Older than 40 years old E. Multiparous

B. Hx of diabetes mellitus C. Obese D. Older than 40 years old E. Multiparous

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? A. Elevated blood glucose concentration B. Muscle twitching and finger numbness C. Hypotension D. Paralytic ileus and abdominal distention

B. Muscle twitching and finger numbness Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should the nurse administer to the client before surgery? A. Vitamin C B. Packed RBCs C. Oral bile acids D. Potassium

B. Packed RBCs Preoperative preparation includes adequate hydration, correction of prothrombin deficiency with vitamin K, and treatment of anemia to minimize postoperative complications. Parenteral nutrition and blood component therapy are frequently required.

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? A. Instruct the client the proper use of an incentive spirometer B. Place the client in semi Fowler's position C. Encourage the client to ambulate frequently D. Encourage the client to cough and deep breathe

B. Place the client in semi Fowler position

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? A. "The tube allows toxins to be removed." B. "The tube provides relief from nausea and vomiting." C. "The tube allows the GI tract to rest." D. "The tube helps control fluid and electrolyte imbalance."

C. "The tube allows the GI tract to rest." Postoperative management of clients who have undergone a pancreatectomy or a pancreaticoduodenectomy is similar to the management of clients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allow the gastrointestinal tract to rest while promoting adequate nutrition.

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? A. 1-4 months B. 4-6 months C. 6-12 months D. Over 1 year

C. 6-12 months Six to 12 months of therapy with UDCA is recommended in clients to dissolve the stones.

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? A. 1 month B. 4 months C. 7 months D. Over 1 year

C. 7 months Six to 12 months of therapy with UDCA is recommended in clients to dissolve the stones.

A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to A. Presence of diabetes mellitus B. Dietary intake of fat C. Age D. Cigarette smoking

C. Age Incidence of pancreatic cancer increases with age, peaking in the seventh and eighth decades for both men and women. It is very rare before 45 years, and most patients present in or beyond the sixth decade of life.

Which foods should be avoided following acute gallbladder inflammation? A. Coffee B. Cooked fruits C. Cheese D. Mashed potatoes

C. Cheese The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? A. Monitor for reports of nausea and vomiting B. Measure abdominal girth every shift C. Measure blood glucose concentration every 4-6 hours D. Auscultate the abdomen for bowel sounds every 4 hours

C. Measure blood glucose concentration every 4-6 hours Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors the serum glucose concentration every 4 to 6 hours.

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? A. Administering meperidine , as ordered, to relieve severe pain B. Keep the client supine to increase comfort C. Withholding all oral intake as ordered, to decrease pancreatic secretions D. Limiting IV fluids, as ordered, to decrease cardiac workload

C. Withholding all oral intake as ordered, to decrease pancreatic secretions The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Pain relief may require parenteral opioids such as morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid).

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms? A. "Place your shoulder in a sling to avoid moving it." B. "Take an over the counter analgesic as needed." C. "Come into the emergency room as soon as possible." D. "Apply a heating pad to your shoulder 15 minutes hourly as needed."

D. "Apply a heating pad to your shoulder 15 minutes hourly as needed." Pain in the right shoulder may occur after laparoscopic cholecystectomy due to migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure. The nurse should instruct the client to apply a heating pad to the shoulder for 15 to 20 minutes every hour as needed for pain relief.

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? A. "Maintain a high fat, high carbohydrate diet." B. "Maintain a high sodium, high calorie diet." C. "Maintain a high fat diet and drink at least 3L of fluid a day." D. "Maintain a high carbohydrate, low fat diet."

D. "Maintain a high carbohydrate, low fat diet." A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet.

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? A. 3-5 B. 1-2 C. 13-18 D. 6-12

D. 6-12 Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time.

This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States? A. 60% B. 25% C. 15% D. 75%

D. 75% Cholesterol stones account for approximately 75% of cases of gallbladder disease in the United States.

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? A. Protein synthesis B. Fat digestion C. Protein digestion D. Carbohydrate digestion

D. Carbohydrate digestion Amylase is a pancreatic enzyme involved in the breakdown and digestion of carbohydrates. Trypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.

A very ill client with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which term? A. Choledoduodenostomy B. Cholecystectomy C. Cholecystostomy D. Choledochsostomy

D. Choledochostomy This procedure is reserved for the client with acute cholecystitis who may be too ill to undergo a surgical procedure. It involves making an incision in the common duct, usually to remove stones (choledochostomy).

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? A. Adventitious breath sounds and hypertension B. Presence of easy bruising and bradycardia C. Presence of blood in the client's stool and recent hypertension D. Pain with abdominal distention and hypotension

D. Pain with abdominal distention and hypotension Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? A. Administering an analgesic once per shift, as ordered, to prevent drug addiction B. Administering frequent oral feedings C. Encouraging frequent visits from family and friends D. Positioning the client on the side with knees flexed

D. Positioning the client on the side with knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles.

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? A. Fatigue B. Hypertension C. Diarrhea D. Weight loss

D. Weight loss Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.

A nurse is reviewing the health care provider orders for a client admitted with acute pancreatitis. The health care provider has ordered intravenous calcium chloride infusions for the client. What does the nurse understand is the reason for this order? A. Calcium binds to fatty acids when auto digestion of the pancreas occurs. B. Calcium is unable to enter the blood when auto digestion of the pancreas occurs. C. Calcium binds to proteins in the blood when pancreatic enzymes are released. D. Calcium is unable to form when pancreatic enzymes are elevated

A. Calcium binds to fatty acids when auto digestion of the pancreas occurs. Hypocalcemia is a potential problem with acute pancreatitis because calcium binds to fatty acids when auto digestion of the pancreas occurs.

Which term most precisely refers to the incision of the common bile duct for removal of stones? A. Choledocholithotomy B. Choledochotomy C. Cholecystostomy D. Choledochoduodenostomy

A. Choledocholithotomy Choledocholithotomy refers to incision of the common bile duct for the removal of stones.

A client with calculi in the gallbladder is said to have A. Cholelithiasis B. Choledochotomy C. Cholecystitis D. Choledocholithiasis

A. Cholelithiasis Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? A. Elevated urine amylase levels B. Decreased WBC count C. Increased serum calcium levels D. Decreased liver enzyme levels

A. Elevated urine amylase levels Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis.

A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? A. Gray B. Black C. Red D. Green

A. Gray A gray-white stool color is common with a biliary obstruction because the stool is no longer colored with bile pigments.

A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply. A. K B. Essential fatty acids C. D D. Folic acid E. A

A. K B. Essential fatty acids C. D E. A A low-fat diet should be supplemented with vitamins A, D, K, and essential fatty acids. These vitamins are fat-soluble and will need to be administered if the client does not have adequate fat intake. Folic acid is not a fat-soluble vitamin.

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? A. Maintaining normal respiratory function B. Developing no acute complications from the pancreatitis C. Maintaining satisfactory pain control D. Achieving adequate fluid and electrolyte imbalance

A. Maintaining normal respiratory function Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal.

A client is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and reports of vague upper and midabdominal pain that increases in intensity at night. The client' health history indicates alcoholism, smoking of a pack of cigarettes daily, and diabetes for the past 20 years. Upon examination the nurse finds swelling in the feet and abdominal ascites. Based on the clinical manifestations, which condition is the most likely diagnosis? A. Pancreatic carcinoma B. Cholecystitis C. Acute pancreatitis with edema D. Pancreatic pseudocysts

A. Pancreatic carcinoma Pain, jaundice, and weight loss are considered classic signs of pancreatic carcinoma. Other signs include rapid, profound, and progressive weight loss as well as vague upper or midabdominal pain or discomfort unrelated to any gastrointestinal function that is often difficult to describe. It is often more severe at night and is accentuated when lying supine. The formation of ascites is common.

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? A. 13-18 B. 6-12 C. 1-2 D. 3-5

B. 6-12 Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time.

A nurse is caring for a client with mild acute pancreatitis. Which health care provider prescriptions will the nurse question as it relates to evidence based practices in the treatment of acute pancreatitis? Select all that apply. A. NG tube to intermittent wall suction for removal of gastric secretions B. Full liquid diet as tolerated C. NG tube to intermittent wall suction for relief of nausea D. Initiate parenteral feedings first and advance to enteral feedings as tolerated E. Enteral feedings per registered dietitian recommendations

B. Full liquid diet as tolerated A. NG tube to intermittent wall suction for removal of gastric secretions D. Initiate parenteral feedings first and advance to enteral feedings as tolerated

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? A. Placing the client on NPO status for 2 days after surgery B. Clamping the T-tube immediately after surgery C. Assessing the color of sclera every shift D. Placing the client in semi Fowler's position immediately after surgery

C. Assessing the color of sclera every shift If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the sclerae.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? A. Serum amylase B. Serum potassium C. Serum calcium D. Serum bilirubin

A. Serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? A. Use incentive spirometry every hour. B. Withhold analgesics until necessary C. Instruct the client to cough only when necessary D. Monitor pulse oximetry every hour

A. Use incentive spirometry every hour The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A. Yellow sclerae B. Circumoral pallor C. Light amber urine D. Black, tarry stools

A. Yellow sclerae Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: A. Serum amylase B. Serum lipase

B. Serum lipase The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:

Which is the most common report by clients with pancreatitis? A. Increased and painful urination B. Tarry, black stools and dark urine C. Severe, radiating abdominal pain D. Increased appetite and weight gain

C. Severe radiating abdominal pain Clients with pancreatitis most commonly report severe mid- to upper-abdominal pain, radiating to both sides and straight to the back.

A client is admitted to the health care center with severe abdominal pain rated 10 on a 1-to-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP), as ordered. The nurse plans for which goal after administration of this mediation? A. To control blood pressure B. To increase the client's pain threshold C. To control muscle spasms D. To diagnose the cause of abdominal pain

B. To increase the client's pain threshold Morphine, fentanyl, and hydromorphone act by depressing the central nervous system, thereby increasing the client's pain threshold.

A client with calculi in the gallbladder is said to have: A. Choledochotomy B. Choledocholithiasis C. Cholelithiasis D. Cholecystitis

C. Cholelithiasis Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition.

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? A. US B. CT C. MRI D. ERCP

D. ERCP The ERCP is the most useful study in the diagnosis of chronic pancreatitis. The other answer choices may be used; however, these are not the most useful in the diagnosis of chronic pancreatitis.

A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action? A. Contact the HCP B. Auscultate the bowel sounds C. Ask the client the last bowel date D. Prepare to insert an NG tube to intermittent suction

A. Contact the HCP A client who is post op from open abdominal surgery is at risk for internal bleeding, which may manifest as rigidity of the abdomen. The nurse's priority is to contact the health care provider. Additional interventions will be necessary but contacting the health care provider is priority.

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? A. Caffeine consumption and acute pancreatitis B. Alcohol consumption and smoking C. Acute hepatitis and alcohol consumption D. Malnutrition and acute pancreatitis

B. Alcohol consumption and smoking Alcohol consumption in Western societies is a major factor in the development of chronic pancreatitis, as is smoking. Because heavy drinkers usually smoke, it is difficult to separate the effects of the alcohol abuse and smoking. Malnutrition is a major cause of chronic pancreatitis worldwide, but alcohol consumption is more commonly the cause in Western societies.

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? A. Anxiety B. Impaired nutrition: less than body requirements C. Nausea D. Disturbed body image

B. Impaired nutrition: less than body requirements While each diagnosis may be applicable to this client, the priority nursing diagnosis is impaired nutrition: less than body requirements. The physician, nurse, and dietitian emphasize to the client and family the importance of avoiding alcohol and foods that have produced abdominal pain and discomfort in the past. Oral food or fluid intake is not permitted during the acute phase.

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient? A. The patient is developing a paralytic ileus B. The patient has developed peritonitis C. The patient has developed renal failure D. The patient requires more pain medication

B. The patient has developed peritonitis Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? A. Hypertension B. Warm, dry skin C. Weight loss D. Bile-stained vomiting

D. Bile-stained vomit Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? A. Sepsis B. Pleural effusion C. Disseminated intravascular coagulopathy D. Edema and inflammation

D. Edema and inflammation Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months.