PrepU Chapter 50: Biliary Disorders

Which enzyme aids in the digestion of fats? a. Lipase b. Secretin c. Amylase d. Trypsin

a. Lipase Rationale: Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

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

A client with calculi in the gallbladder is said to have a. Choledochotomy b. Cholecystitis c. Cholelithiasis d. Choledocholithiasis

c. Cholelithiasis Rationale: Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.

Which is a clinical manifestation of cholelithiasis? a. Clay-colored stools b. Nonpalpable abdominal mass c. Abdominal pain in the upper left quadrant d. Epigastric distress before a meal

a. Clay-colored stools Rationale: 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 is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? a. Malnutrition and acute pancreatitis b. Caffeine consumption and acute pancreatitis c. Acute hepatitis and alcohol consumption d. Alcohol consumption and smoking

d. Alcohol consumption and smoking Rationale: 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. Caffeine consumption is not related to acute pancreatitis. Acute hepatitis does not usually lead to chronic pancreatitis unless complications develop.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a. MODS b. Pancreatic necrosis c. Tetany d. Shock

b. Pancreatic necrosis Rationale: 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.

Which foods should be avoided following acute gallbladder inflammation? a. Mashed potatoes b. Coffee c. Cheese d. Cooked fruits

c. Cheese Rationale: 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.

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a. Mashed potatoes b. White rice c. Vanilla pudding d. Hot roast beef sandwich with gravy

d. Hot roast beef sandwich with gravy Rationale: The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as roast beef because fatty foods may bring on an episode of cholecystitis.

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. Placing the patient in the prone position b. Suction the patient every 4 hours c. Frequent changes of positions d. Perform chest physiotherapy

c. Frequent changes of positions Rationale: Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

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. Diarrhea b. Fatigue c. Weight loss d. Hypertension

c. Weight loss Rationale: 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 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. Monitor pulse oximetry every hour. b. Withhold analgesics unless necessary. c. Instruct the client to cough only when necessary. d. Use incentive spirometry every hour.

d. Use incentive spirometry every hour. Rationale: 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. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis.

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 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." b. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." c. "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." d. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."

a. "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." Rationale: 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 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 liver enzyme levels c. Increased serum calcium levels d. Decreased white blood cell count

a. Elevated urine amylase levels Rationale: Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

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. Frequent vomiting, leading to loss of fluid volume b. Dry mouth, which makes the client thirsty c. Acetone in the urine d. High glucose concentration in the blood

a. Frequent vomiting, leading to loss of fluid volume Rationale: 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.

A nurse cares for a client with a disorder of the endocrine function of the pancreas. Which hormones or enzymes may be impacted by this disorder? Select all that apply. a. Glucagon b. Insulin c. Amylase d. Lipase e. Somatostatin

a. Glucagon b. Insulin e. Somatostatin Rationale: Insulin, glucagon, and somatostatin are hormones released by the endocrine function of the pancreas. An impairment impacting endocrine function will impact all of these hormones. Lipase and amylase are enzymes released by the exocrine function of the pancreas and are not directly impacted by endocrine function.

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. Impaired nutrition: less than body requirements b. Nausea c. Disturbed body image d. Anxiety

a. Impaired nutrition: less than body requirements Rationale: 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.

Which is a gerontological consideration associated with the pancreas? a. Increased amount of fibrous material b. Increased calcium absorption c. Increased rate of pancreatic secretion d. Increased bicarbonate output

a. Increased amount of fibrous material Rationale: An increase in fibrous material and some fatty deposition occurs in the normal pancreas of people older than 70 years of age. There is a decreased rate of pancreatic secretion and decreased bicarbonate output in older adults. Decreased calcium absorption may also occur.

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. Preventing fluid volume overload c. Maintaining adequate nutritional status d. Teaching about the disease and its treatment

a. Relieving abdominal pain Rationale: 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.

A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply. a. "It can assess for ecchymosis in the body." b. "It can evaluate the presence and location of ductal stones and aid in stone removal." c. "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." d. "It is used in the diagnostic evaluation of acute pancreatitis." e. "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."

b. "It can evaluate the presence and location of ductal stones and aid in stone removal." c. "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." e. "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts." Rationale: ERCP can determine the difference between pancreatitis and other biliary disorders and is generally used in chronic pancreatitis. It is particularly useful in diagnosis and treatment of clients who have symptoms after biliary tract surgery, clients with intact gallbladders, and clients for whom surgery is particularly hazardous. It can be used to assist with the removal of stones. ERCP is a useful tool in providing anatomic details about the pancreas and biliary ducts. It can evaluate the presence and location of ductal stones and detect changes in the anatomy of the client with pancreatitis, such as obstruction in the pancreatic duct and tissue necrosis due to premature release of pancreatic enzymes, and assess for abscesses and pseudocysts and atrophy of the glands in the body. ERCP is rarely used in the diagnostic evaluation of acute pancreatitis because the clients is acutely ill; however, it may be valuable in treating gallstone pancreatitis.

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply. a. Persistent hiccups b. Clay-colored stools c. Dark urine d. Weight gain e. Jaundice

b. Clay-colored stools c. Dark urine e. Jaundice Rationale: 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. Persistent hiccups are seen with stomach and bowel diseases.

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? a. Withhold oral feedings. b. Maintain the client in a semi-Fowler's position. c. Carry out wound care as prescribed. d. Administer enteral or parenteral nutrition.

b. Maintain the client in a semi-Fowler's position. Rationale: The nurse maintains the client in the semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. Respiratory distress and hypoxia are common, and the client may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values. The client who has undergone surgery may have multiple drains or an open surgical incision and is at risk for skin breakdown and infection. Oral food or fluid intake is not permitted; therefore, enteral or parenteral feedings may be prescribed.

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? a. Calcification of the pancreatic duct, leading to its blockage b. Self-digestion of the pancreas by its own proteolytic enzymes c. Use of loop diuretics to increase the incidence of pancreatitis d. Fibrosis and atrophy of the pancreatic gland

b. Self-digestion of the pancreas by its own proteolytic enzymes Rationale: Self-digestion of the pancreas by its own proteolytic enzymes, principally trypsin, causes acute pancreatitis. Of clients with acute pancreatitis, 80% had undiagnosed chronic pancreatitis. Gallstones enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of pancreatic juice or causing a reflux of bile from the common bile duct into the pancreatic duct, thus activating the powerful enzymes within the pancreas. Normally, these remain in an inactive form until the pancreatic secretions reach the lumen of the duodenum. Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage.

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. Rationale: 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.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a. are at risk for gallbladder contraction. b. cannot tolerate high-glucose concentration. c. can digest high-fat foods. d. are at risk for hepatic encephalopathy.

b. cannot tolerate high-glucose concentration. Rationale: Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

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 to 18 b. 1 to 2 c. 6 to 12 d. 3 to 5

c. 6 to 12 Rationale: 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.

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, there is an increased risk for the development of acute pancreatitis. 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 the development of multiple organ dysfunction syndrome. e. 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 the development of multiple organ dysfunction syndrome. e. As the client ages, the pattern of complications related to acute pancreatitis changes. Rationale: Gerontologic considerations must be remembered when caring for older adult clients with acute pancreatitis. Clients of all ages may develop acute pancreatitis; however, mortality rate for acute pancreatitis increases as the client ages. Additionally, as the client ages, the pattern of complications related to acute pancreatitis changes and the risk of developing multiple organ dysfunction syndrome (MODS) increases with age. The size of the pancreas does not decrease as the client ages.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a. Duodenum b. Common bile duct c. Gallbladder d. Cystic duct

c. Gallbladder Rationale: The gallbladder functions as a storage depot for bile.

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. Low-carbohydrate, high-potassium diet b. High-carbohydrate, high-protein, low-fat diet c. High-carbohydrate, low-protein, low-fat diet d. Low-sodium, high-potassium, low-fat diet

c. High-carbohydrate, low-protein, low-fat diet Rationale: 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 of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Peptic ulcer c. Pancreatitis d. Cholecystitis

c. Pancreatitis Rationale: 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.

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 can atrophy the diaphragm and alter the breathing pattern. b. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. c. Pancreatitis can elevate the diaphragm and alter the breathing pattern. d. Pancreatitis causes alterations to hemoglobin, impairing oxygenation.

c. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Rationale: 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.

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a. To depress the central nervous system and increase the pain threshold b. To relieve nausea and vomiting c. To reduce gastric and pancreatic secretions d. To decrease metabolism

c. To reduce gastric and pancreatic secretions Rationale: Anticholinergic medications reduce gastric and pancreatic secretion.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Oral bile acids b. Vitamin B c. Vitamin K d. Potassium

c. Vitamin K Rationale: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

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 helps control fluid and electrolyte imbalance." c. "The tube provides relief from nausea and vomiting." d. "The tube allows the gastrointestinal tract to rest."

d. "The tube allows the gastrointestinal tract to rest." Rationale: 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.

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 Rationale: Serum amylase usually returns to normal within 48 to 72 hours.

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. Fat digestion b. Protein synthesis c. Protein digestion d. Carbohydrate digestion

d. Carbohydrate digestion Rationale: 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.

Clinical manifestations of common bile duct obstruction include all of the following except: a. Clay-colored feces b. Jaundice c. Pruritus d. Light-colored urine

d. Light-colored urine Rationale: The excretion of the bile pigments by the kidneys gives the urine a very dark color. The feces, no longer colored with bile pigments, are grayish, like putty, or clay-colored. The symptoms may be acute or chronic. Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen, may occur. If it goes untreated jaundice and pruritus can occur.

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 blood in the client's stool and recent hypertension c. Presence of easy bruising and bradycardia d. Pain with abdominal distention and hypotension

d. Pain with abdominal distention and hypotension Rationale: Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with pancreatitis.

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. Monitor pulse oximetry every hour. b. Withhold oral feedings for the client. c. Instruct the client to avoid coughing. d. Reposition the client every 2 hours.

d. Reposition the client every 2 hours. Rationale: 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. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

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 calcium b. Serum bilirubin c. Serum potassium d. Serum amylase

d. Serum amylase Rationale: 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 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 to only the pancreas." b. "Tissue necrosis occurs within the pancreas." c. "Normal function returns after about 2 weeks." d. "Inflammation spreads to the surrounding glands."

a. "Inflammation is confined to only the pancreas." Rationale: 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.

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. Multiparous b. Older than 40 years old c. Obese d. History of diabetes mellitus e. Smoking

a. Multiparous b. Older than 40 years old c. Obese d. History of diabetes mellitus Rationale: Two to three times more women than men develop cholesterol stones and gallbladder disease; affected women are usually older than 40 years, multiparous, and obese. Diabetes mellitus, cystic fibrosis and frequent weight changes predispose a client to gallbladder disease. Smoking is not a related factor.

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 avoid inflammation of the pancreas c. To drain the pancreatic bed d. To aid opening up of pancreatic duct

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

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? a. One-time exposure to petrochemicals b. Ingestion of caffeinated coffee c. Ingestion of a low-fat diet d. History of pancreatitis

d. History of pancreatitis Rationale: Pancreatitis is associated with the development of pancreatic cancer. Other factors that correlate with pancreatic cancer include diabetes mellitus, a high-fat diet, and chronic exposure to carcinogenic substances (i.e., petrochemicals). Although data are inconclusive, a relationship may exist between cigarette smoking and high coffee consumption (especially decaffeinated coffee) and the development of pancreatic carcinoma.

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 has developed renal failure. b. The patient has developed peritonitis. c. The patient requires more pain medication. d. The patient is developing a paralytic ileus.

b. The patient has developed peritonitis. Rationale: Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis (Privette et al., 2011).

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. Auscultate the abdomen for bowel sounds every 4 hours b. Measure abdominal girth every shift c. Measure blood glucose concentration every 4 to 6 hours d. Monitor for reports of nausea and vomiting

c. Measure blood glucose concentration every 4 to 6 hours Rationale: 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 client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a. Administering morphine I.V. as ordered b. Providing mouth care c. Placing the client in a semi-Fowler's position d. Maintaining nothing-by-mouth (NPO) status

a. Administering morphine I.V. as ordered Rationale: The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? a. Assisting the client to turn, cough, and deep breathe every 2 hours b. Assisting the client to ambulate the evening of the operative day c. Performing range-of-motion (ROM) leg exercises hourly while the client is awake d. Teaching the client to choose low-fat foods from the menu

a. Assisting the client to turn, cough, and deep breathe every 2 hours Rationale: Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a. Providing the client with plenty of P.O. fluids b. Limiting I.V. fluid intake according to the physician's order c. Providing generous servings at mealtime d. Reserving a site for a peripherally inserted central catheter (PICC)

d. Reserving a site for a peripherally inserted central catheter (PICC) Rationale: Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve a site for placement of a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.