321 Exam 3 - Ch 50: Assessment/Management of Pts with Biliary Disorders
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?
administering morphine IV as ordered
A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?
maintain a high carb, low fat diet
Which enzyme aids in the digestion of fats?
lipase
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function?
30 mg/dL
A client with calculi in the gallbladder is said to have
cholelithiasis
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?
frequent changes in positions
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?
frequent vomiting, leading to loss of fluid volume
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:
gallbladder
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?
hot roast beef sandwich with gravy
Which is a gerontological consideration associated with the pancreas?
increased amount of fibrous material
The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client?
assisting client to turn, cough, and deep breathe every 2 hours
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
yellow sclera
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?
edema and inflammation
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?
measure blood glucose concentration every 4-6 hours
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?
muscle twitching and finger numbness
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 boardlike and no bowel sounds are detected. What is the major concern for this patient?
patient has developed peritonitis
When caring for a client with acute pancreatitis, the nurse should use which comfort measure?
positioning client on the side with knees flexed
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?
reposition client every 2 hours
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?
serum amylase
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?
to reduce gastric and pancreatic secretions
