8) Chapter 62: Care of Patients with Problems of the Biliary System and Pancreas

Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall B. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase C. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall D. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

A. An increased WBC count is evidence of inflammation. Only calcified gallstones will be visualized on abdominal x-ray.

After receiving change-of-shift report on these clients, which client will the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography (ERCP) D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

A. Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention.

The client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures will the nurse implement to prevent potential complications? Select all that apply. A. Check blood glucose often. B. Check bowel sounds and stools. C. Ensure that drainage color is clear. D. Monitor mental status. E. Place the client in the supine position.

A. Check blood glucose often. B. Check bowel sounds and stools. D. Monitor mental status. Rationale Clear, colorless, bile-tinged drainage or frank blood with increased output may indicate disruption or leakage of a site of anastomosis.

The client has been hospitalized with pancreatitis and is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? A. Limiting the client's activities to one floor of the home B. Instructing the client to take a whenever necessary (PRN) sleeping medication on a nightly basis C. Arranging for the client to have a nutritional consult to assess the client's diet D. Asking the physician for a request for PRN nasal oxygen

A. Limiting the client's activities to one floor of the home will prevent tiring the client with stair climbing.

A client has had an open Whipple procedure for pancreatic cancer. Which nursing interventions are appropriate for this client in the postoperative period? Select all that apply. A. Maintain IV fluids, and monitor for fluid imbalance. B. Assess for signs and symptoms of deep vein thrombosis. C. Connect the nasogastric tube to high intermittent suction. D. Start pancreatic enzyme replacements as soon as possible. E. Check finger-stick blood glucose levels regularly. F. Tell the client to lie flat to protect the incision.

A. Maintain IV fluids, and monitor for fluid imbalance. B. Assess for signs and symptoms of deep vein thrombosis. E. Check finger-stick blood glucose levels regularly. Rationale It is important to maintain available access for TPN and fluids. Care should be taken to prevent any line sepsis. Clients are at risk for DVT after any surgical procedure in which extended immobility is a problem. The nurse should monitor for hypoglycemia or hyperglycemia due to surgical manipulation of the pancreas. An NG tube will be attached to low suction to prevent distention and pressure on the remaining stomach. PERT will be started when the client is able to take solid meals. The client should be placed in a semi-Fowler's position to reduce stress on the anastomosis and suture line. This position will also aid in lung expansion.

The nurse suspects that which client is at highest risk for developing gallstones? A. Obese male with a history of chronic obstructive pulmonary disease B. Obese female on hormone replacement therapy C. Thin male with a history of coronary artery bypass grafting D. Thin female who has recently given birth

B. Both obesity and altered hormone levels increase a woman's risk for developing gallstones.

The client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your physician immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your doctor." D. "You'll need to drastically modify your alcohol intake."

B. In this case, the client's pancreatitis was likely triggered by the development of gallstones.

The client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? A. "Maybe you should find a support group to join." B. "Would you like me to contact the hospital chaplain for you?" C. "Do you want me to try to find a therapist for you?" D. "Do you have any friends that you want me to call?"

B. It is appropriate for the nurse to suggest contact with the hospital chaplain as a counseling option for the client and family.

The physician assistant prescribes pancreatic enzyme replacement capsules for a client with chronic pancreatitis. What health teaching will the nurse provide? A. "Take the enzymes after meals to be most effective." B. "Swallow the capsule whole or with applesauce." C. "Drink a full glass of milk after taking the drug." D. "Crush the capsules and tablets and mix with juice."

B. The client should be instructed to swallow the capsule whole if possible because of its delayed-release action.

The nurse expects that which client will be discharged to the home environment first? A. Older obese adult who has had a laparoscopic cholecystectomy B. Middle-aged thin adult who has had a laparoscopic cholecystectomy C. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy D. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

B. The combination of client age, a thin frame, and the type of procedure performed will cause the client to be discharged first.

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

C. Elevated lipase is more specific to a diagnosis of acute pancreatitis.

The client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Measure intake and output (I&O) every shift. B. Do not administer food or fluids by mouth. C. Administer opioid analgesic medication. D. Assist the client to assume a position of comfort.

C. For the client with acute pancreatitis, pain relief is the highest priority.

The client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? A. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." B. "Keep mentioning the AA meetings to your spouse on a regular basis." C. "I'll get you some information on the support group Al-Anon." D. "Tell me more about your frustration with your spouse's refusal to participate in AA."

C. This response assists with the spouse's frustration by putting her in contact with the Al-Anon support group.

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

C. This response is the only one that will allow the client to provide information on alcohol intake in the client's own words and to the extent that the client wishes to provide it.

The client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? A. "This may be an indication that you are developing sepsis." B. "The gallstones are present but have become fibrotic and contracted." C. "This type of gallbladder inflammation is associated with hypovolemia." D. "This may be an indication of pancreatic disease."

C. This type of gallbladder inflammation is associated with hypovolemia.

The nurse is teaching the client with gallbladder disease about diet modification. Which meal will the nurse suggest to the client? A. Steak and french fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

C. Turkey is an appropriate low-fat selection for this client.

The client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. Carbohydrates B. High fat C. High fiber D. Protein

D. Enzyme preparations should not be mixed with foods containing protein because the enzymes will dissolve the food into a watery substance.

A client with acute cholecystitis is admitted to the medical-surgical unit. Which of the nursing activities associated with the client's care will be best for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assessing dietary risk factors for cholecystitis B. Checking for bowel sounds and distention C. Determining precipitating factors for abdominal pain D. Obtaining the admission weight, height, and vital signs

D. Obtaining height, weight, and vital signs is included in the education for unlicensed assistive personnel (UAP) and usually is included in the job description for these staff members.

Which set of assessment findings indicates to the nurse that the client may have acute pancreatitis? A. Absence of jaundice, pain of gradual onset B. Absence of jaundice, pain in right abdominal quadrant C. Presence of jaundice, pain worsening when sitting up D. Presence of jaundice, pain worsening when lying supine

D. Pain that worsens when lying supine and the presence of jaundice are the only assessment findings indicative of acute pancreatitis.

The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction will the nurse include when teaching the client about this medication? A. Administer pancrelipase before taking an antacid. B. Chew tablets before swallowing. C. Take pancrelipase before meals. D. Wipe your lips after taking pancrelipase.

D. Pancrelipase (Cotazym) is a pancreatic enzyme used for enzyme replacement for clients with chronic pancreatitis. To avoid skin irritation and breakdown from residual enzymes, the lips should be wiped.

A client is admitted to the same-day surgery unit after recovery from a laparoscopic cholecystectomy. Which action is the nurse's priority in caring for the client? A. Turn the client on the right side to help the flow of bile into the drainage bag. B. Check that the nasogastric tube is connected to low intermittent suction. C. Document the client's use of the patient-controlled analgesia (PCA) pump. D. Monitor the client's oxygen saturation level via pulse oximetry.

D. The client's oxygen saturation level should be assessed frequently until the effects of the anesthesia have passed.

The nurse is attempting to position the client having an acute attack of pancreatitis in the most comfortable position possible. In which position will the nurse place this client? A. Supine, with a pillow supporting the abdomen B. Up in a chair between frequent periods of ambulation C. High Fowler's position, with pillows used as needed D. Side-lying position, with knees drawn up to the chest

D. The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis.

The nurse is caring for a client, recently diagnosed with type 1 diabetes mellitus, who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? A. "The diabetes could be related to your obesity." B. "What has your doctor told you about your disease?" C. "Do you use alcohol on a frequent basis?" D. "Type 1 diabetes can occur when the pancreas is destroyed by disease."

D. This is the only response that accurately describes the relationship of the client's diabetes to pancreatic destruction.