ATI Chapter 44 Biliary Disorder
A nurse is caring for a client who has a history of alcohol use disorder and reports bruising and frequent nosebleeds. The nurse should recognize that this client in manifesting which of the following conditions?
Cirrhosis The nurse should recognizes this client is displaying manifestations of cirrhosis. A history of alcohol use disorder increases the client's risk of developing cirrhosis and coagulation defects are a common complication of cirrhosis.
A nurse is planning care for a client who has diverticulitis. Which of the following menu selections should the nurse include in the plan?
Grilled chicken breast with white rice Both of these items are low in fiber which is advised during the inflammation of diverticulitis. In the presence of diverticulosis, a high-fiber diet is indicated.
A nurse on the day shift is preparing to change a client's TPN solution, but the new TPB solution has not arrived from the pharmacy. The client receives additional IV fat emulsion during the night sift. Which of the following actions should the nurse take?
Hang dextrose 10% in water until the TPN solution is delivered The nurse should hang D10W if the TPN runs out or is not available to hang. D10W is a hypertonic solution that will maintain glucose level and prevent rebound hypoglycemia.
A nurse admits a client to the ER who reports nausea and vomiting that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following lab. test results should the nurse expect to see?
Increase Serum Amylase With acute pancreatitis, serum amylase rises within 24 hr of the start of the client's symptoms.
A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching?
Obstruction of the bile duct Prolonged obstruction of the common bile duct is the most common cause of biliary cirrhosis.
A nurse is teaching a client about strategies to manage GERD. Which of the following statements should the nurse include?
"Avoid eating 2-3 hrs before bedtime" The nurse should instruct the client to avoid eating or drinking 2 to 3 hr prior to lying down.
A nurse is caring for an older adult client who reports taking bisacodyl tablets daily. Which of the following responses should the nurse make?
"Excessive laxative use may cause an electrolyte imbalance" Bisacodyl is a stimulant laxative that acts by stimulating intestinal motility and increasing the amount of water and electrolytes within the intestines; therefore, chronic use of laxatives can lead to fluid and electrolyte imbalance.
A nurse is providing discharge teaching to a client who will be receiving TPN at home. Which of the following instructions should the nurse include? (Select all that apply.)
"Keep the TPN refrigerated when not in use." is correct. TPN should be stored in the refrigerator to maintain the integrity of the substances. These ingredients provide nutritional support and daily requirements to clients who cannot eat food by mouth or achieve nutrition from a diet for more than a week. TPN is required by clients who have pancreatitis, ulcerative colitis, Crohn's disease, burn injury, cancer, AIDS, and starvation. "Infuse 10 percent dextrose and water if the solution runs out." is correct. The nurse should infuse 10% dextrose and water at the same rate if the next TPN is not available to maintain blood glucose levels and prevent hypoglycemia. "Maintain TPN infusion rate when behind schedule." is correct. The rate of TPN infusion should not be changed without the guidance of the provider. TPN is a hypertonic solution and should be slowly decreased in rate with a strategic plan to discontinue therapy over time. An increase or decrease in TPN infusion rate can impact the client's glucose level and cause the complication of hyperglycemia or hypoglycemia.
A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan?
Avoid foods high in fat The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods.
A nurse is for a client who has an active upper gastrointestinal bleed. After inserting a NG tube into the client, which of the following findings should the nurse anticipate?
Coffee-ground drainage "Coffee-ground" drainage or emesis indicates the presence of blood. The coffee ground appearance is the result of the effects of methemoglobin on the hemoglobin.
A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse recognize as a risk factor for this condition?
History of NSAID use The nurse should recognize that long-term use of NSAIDs is a risk factor for peptic ulcer disease. NSAIDs break down the mucosal barrier and cause production of prostaglandins to decrease, which results in local gastric mucosal injury.
A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestations should the nurse expect?
Petechiae A manifestation of advanced cirrhosis is petechiae due to impaired coagulation from a dysfunctional liver.
A nurse is caring for a client who has just returned for the PACU after a traditional cholecystectomy. In which of the following positions should the nurse place the client?
Semi-Fowler's The nurse should expect a prescription to place the client in semi-Fowler's position following a traditional cholecystectomy to facilitate lung expansion as well as coughing and deep breathing. This position will place minimal stress on the abdomen and increase comfort.
