CH 44 Assessment and Management of Patients with Biliary Disorders
Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A) Pancreatitis B) Cholecystitis C) Peptic ulcer D) Appendicitis
A
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) Full liquid diet as tolerated. B) Initiate enteral feedings if tolerated. C) Nasogastric tube to intermittent wall suction for relief of nausea. D) Nasogastric tube to intermittent wall suction for removal of gastric secretions. E) No feedings per registered dietitian recommendations.
A, B, and D
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) Maintaining adequate nutritional status D) Preventing fluid volume overload
A
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) Increased serum calcium levels C) Decreased white blood cell count D) Decreased liver enzyme levels
A
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 positions B) Suction the patient every 4 hours C) Perform chest physiotherapy D) Placing the patient in the prone position
A
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) Pain with abdominal distention and hypotension C) Presence of easy bruising and bradycardia D) Presence of blood in the client's stool and recent hypertension
B
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 visualizes the biliary structures and pancreas via endoscopy. B) It visualizes the gallbladder and bile duct. C) It visualizes the liver and pancreas. D) It shows the sizes of the abdominal organs and detects any masses.
B
Clinical manifestations of common bile duct obstruction include all of the following except: A) Pruritus B) Clay-colored feces C) Light-colored urine D) Jaundice
C
The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? A) "I should remain on bed rest for several days." B) "I can take a shower in a week." C) "I should wash the site with mild soap and water." D) "I can drive after 2 weeks."
C
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) Protein digestion C) Carbohydrate digestion D) Fat digestion
C
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? A) Tetany B) Shock C) Pancreatic necrosis D) MODS
C
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) Increases in the rate of pancreatic secretion B) Increases in the bicarbonate output by the kidneys C) Development of local complications D) Decreases in the physiologic function of major organs
D
A client with calculi in the gallbladder is said to have A) Choledocholithiasis B) Choledochotomy C) Cholecystitis D) Cholelithiasis
D
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 is developing a paralytic ileus. C) The patient requires more pain medication. D) The patient has developed peritonitis.
D
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) Placing the client in a semi-Fowler's position C) Providing mouth care D) Maintaining nothing-by-mouth (NPO) status
A
The digestion of carbohydrates is aided by A) amylase. B) secretin. C) lipase. D) trypsin.
A
The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? A) Coffee B) Oatmeal C) Toast D) Orange slices
A
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) Potassium B) Vitamin K C) Vitamin B D) Oral bile acids
B
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)Inability for the liver to reabsorb serum glucose B) Dysfunction of the pancreatic islet cells C) Renal failure D) Ingestion of foods high in sugar
B
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 relieve nausea and vomiting B) To reduce gastric and pancreatic secretions C) To decrease metabolism D) To depress the central nervous system and increase the pain threshold
B
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? A) 1 to 4 months B) 4 to 6 months C) 6 to 12 months D) Over 1 year
C
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A) light amber urine. B) black, tarry stools. C) circumoral pallor. D) yellow sclerae.
D
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 amylase C) Serum potassium D) Serum bilirubin
B
What is a major concern for the nurse when caring for a patient with chronic pancreatitis? A) Pain B) Weight loss C) Nausea D) Mental status changes
B
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A) Appendicitis B) Cholecystitis C) Pancreatitis D) Gastric ulcer
C
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) Red B) Green C) Black D) Gray
D
A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply. A) Administer pain-relieving medication B) Assist the client to a semi-Fowler position C) Administer a low-fat diet D) Administer plasma E) Administer electrolytes
A, B, D, and E
The nurse is caring for a client experiencing pain related to chronic pancreatitis. When developing a care plan for alternative strategies to opoid usage, which approaches will the nurse include? Select all that apply. A) Ibuprofen B) Vitamin E C) Amitriptyline D) Tetracycline E) Methylprednisolone
A, B, and C
What concepts does the nurse understand about gerontologic considerations related to acute pancreatitis? Select all that apply. A) As the client ages, there is an increased mortality rate for acute pancreatitis. B) As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. C) As the client ages, the size of the pancreas decreases, increasing the risk of developing acute pancreatitis. D) As the client ages, the pattern of complications related to acute pancreatitis changes. E) As the client ages, there is an increased risk for the development of acute pancreatitis.
A, B, and D
Which is a clinical manifestation of cholelithiasis? A) Abdominal pain in the upper left quadrant B) Clay-colored stools C) Epigastric distress before a meal D) Nonpalpable abdominal mass
B
Which is a gerontological consideration associated with the pancreas? A) Increased calcium absorption B) Increased amount of fibrous material C) Increased bicarbonate output D) Increased rate of pancreatic secretion
B
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
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
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 muscle spasms B) To diagnose the cause of abdominal pain C) To increase the client's pain threshold D) To control blood pressure
C
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: A) are at risk for gallbladder contraction. B) can digest high-fat foods. C) cannot tolerate high-glucose concentration. D) are at risk for hepatic encephalopathy.
C
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood glucose level does the nurse recognize as inadequate to sustain normal brain function? A) 30 mg/dL B) 50 mg/dL C) 90 mg/dL D) 70 mg/dL
A
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 may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." B) "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." C) "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." D) "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation."
C
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 gastrointestinal tract to rest." D) "The tube helps control fluid and electrolyte imbalance."
C
A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ? A) Controls the flow of trypsin to digest proteins B) Serves as a storage unit for glucagon C) Digests carbohydrates in the jejunum D) Releases bile in response to cholecystokinin
D
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) Carry out wound care as prescribed. C) Administer enteral or parenteral nutrition. D) Maintain the client in a semi-Fowler's position.
D
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 the knees flexed
D
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 hypocalcemia B) Tetany related to hypercalcemia C) Muscle pain related to referred pain manifestations D) Muscle spasm related to hypokalemia
A
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) Deficient knowledge related to prevention of disease recurrence C) Acute pain related to biliary spasms D) Anxiety related to unknown outcome of hospitalization
C
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
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) Teaching the client to choose low-fat foods from the menu B) Performing range-of-motion (ROM) leg exercises hourly while the client is awake C) Assisting the client to ambulate the evening of the operative day D) Assisting the client to turn, cough, and deep breathe every 2 hours
D
A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give? A) 1 to 2 months B) 6 to 8 months C) 3 to 5 months D) 6 to 12 months
D
The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? A) "When was the last time you took acetaminophen?" B) "How many meals do you eat every day?" C) "How often and how long do you exercise each day? D) "How much alcohol do you consume in a day?"
D
