Chapter 44 Prepu: Assessment and Management of Patients with Biliary Disorders
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. circumoral pallor. c. yellow sclerae. d. black, tarry stools.
yellow sclerae.
A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a. Limiting I.V. fluid intake according to the physician's order b. Reserving a site for a peripherally inserted central catheter (PICC) c. Providing the client with plenty of P.O. fluids d. Providing generous servings at mealtime
Reserving a site for a peripherally inserted central catheter (PICC) (Pancreatitis treatment typically involves resting the GI tract by maintaining a 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.)
A client is diagnosed with a disorder that affects pancreatic digestive enzymes, and their trypsin levels are elevated. The client has jaundice and verbalizes severe abdominal pain. The nurse most likely anticipates which condition. a. Choledochostomy b. Acute pancreatitis c. Cholecysitis d. Steatorrhea
Acute pancreatitis (Self-digestion of the pancreas by its own proeolytic enzymes, principally trypsin, causes acute pancreatitis. These clients usually have undiagnosed chronic pancreatitis before their first episode of acute pancreatitis. Severe abdominal pain is a major symptom of pancreatitis. The client may also have jaundice. Choledochostomy Is an opening into the common bile duct. Steatorrhea is frothy, foul-smelling stools with a high fat content, resulting from impaired digestion of proteins and fats due to a lack of pancreatic juice in the intestinal tract. Cholecystitis is inflammation of the gallbladder, which can be acute or chronic. While all of these conditions may result in some level of abdominal pain, only acute pancreatitis has all the factors mentioned.)
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 liver enzyme levels D. Decreased white blood cell count
Elevated urine amylase levels
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 is developing a paralytic ileus. d. The patient requires more pain medication.
Peritonitis (Abdominal guarding is present. A rigid or boardlike abdomen may develop and is generally an ominous sign, usually indicating peritonitis)
The nurse is assessing a client admitted with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? a. "How often and how long do you exercise each day? b. "When was the last time you took acetaminophen?" c. "How much alcohol do you consume in a day?" d. "How many meals do you eat every day?"
"How much alcohol do you consume in a day?" Chronic pancreatitis is an inflammatory disorder characterized by progressive destruction of the pancreas. Alcohol consumption in Western societies is the major cause of chronic pancreatitis. Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of chronic pancreatitis. The incidence of pancreatitis is 50 times greater in people with alcoholism than in those who do not abuse alcohol. The type of food (like fried or heavily processed foods) rather than the number of meals eaten each day may contribute to pancreatitis and subsequent flare-ups of the condition. The prescribed use of acetaminophen is not a typical risk factor in pancreatitis and is rare with cases of overdose. The amount and/or lack of exercise is not directly linked to pancreatitis. Risk factors do include obesity.
A nurse cares for a client who is post-op cholecystectomy due to the development of cholesterol stones. The client asks the nurse, "Why did I develop these stones?" What is the nurse's best response? a. "The stones formed from pigments in the bile and are cause by fatty molecules that deposit in the gallbladder." b. "The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream." c. "The stones formed from a component in the bile and are caused by excessive fat in the bloodstream." d. "The stones formed from pigments in the bile and are caused by an infection of the biliary tract."
"The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream." There are two types of gallstones: cholesterol and pigment. 1. Cholesterol gallstones: formed from cholesterol (a component in the bile) and caused by a decrease in bile acid synthesis & and increased cholesterol synthesis. 2. Pigment gallstones: formed by unconjugated pigment in the bile.
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."
"The tube allows the gastrointestinal tract to rest." 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 allows the gastrointestinal tract to rest while promoting adequate nutrition.
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 by 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 pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." c. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." d. "This pain is caused by your incision. Take analgesics as needed and as prescribed and report to the surgeon if the pain is unrelieved even with analgesic use."
"This pain is caused by 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." (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 diagnosed with a disorder that affects pancreatic digestive enzymes, and their trypsin levels are elevated. The client has jaundice and verbalizes severe abdominal pain. The nurse most likely anticipates which condition? a. Steatorrhea b. Cholecystitis c. Choledochostomy d. Acute pancreatitis
Acute pancreatitis (Self-digestion of the pancreas by its own proeolytic enzymes, principally trypsin, causes acute pancreatitis. These clients usually have undiagnosed chronic pancreatitis before their first episode of acute pancreatitis. Severe abdominal pain is a major symptom of pancreatitis. The client may also have jaundice. Choledochostomy Is an opening into the common bile duct. Steatorrhea is frothy, foul-smelling stools with a high fat content, resulting from impaired digestion of proteins and fats due to a lack of pancreatic juice in the intestinal tract. Cholecystitis is inflammation of the gallbladder, which can be acute or chronic. While all of these conditions may result in some level of abdominal pain, only acute pancreatitis has all the factors mentioned.)
A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? a. Caffeine consumption and acute pancreatitis b. Alcohol consumption and smoking c. Malnutrition and acute pancreatitis d. Acute hepatitis and alcohol consumption
Alcohol consumption and smoking (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 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.)
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. Performing range-of-motion (ROM) leg exercises hourly while the client is awake b. Assisting the client to ambulate the evening of the operative day c. Teaching the client to choose low-fat foods from the menu d. Assisting the client to turn, cough, and deep breathe every 2 hours
Assisting the client to turn, cough, and deep breathe every 2 hours (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.)
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a. cannot tolerate high-glucose concentration. b. are at risk for hepatic encephalopathy. c. can digest high-fat foods. d. are at risk for gallbladder contraction.
Cannot tolerate high-glucose concentration. (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 of gallbladder contraction, whereas intake of high protein increases the risk of hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.)
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 digestion b. Carbohydrate digestion c. Protein synthesis d. Fat digestion
Carbohydrate digestion (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)
The nurse is caring for a client with a history of recurrent episodes of acute pancreatitis. The nurse will anticipate preparing the client for which diagnostic test? a. Endoscopy b. Computed tomography (CT) scan c. Abdominal x-ray d. Ultrasound
Computed tomography (CT) scan (A computed tomography (CT) scan is the initial diagnostic test that should be performed for clients in whom there is a suspicion of chronic pancreatitis. Endoscopy is not used to diagnose chronic pancreatitis. Transabdominal ultrasonography is used as a screening method for clients with abdominal symptoms. Abdominal x-rays are not used to diagnose chronic pancreatitis)
A 70-year-old client was 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. Development of local complications c. Increases in the bicarbonate output by the kidneys d. Decreases in the physiologic function of major organs
Decreases in the physiologic function of major organs (Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in the physiologic function of major organs with increasing age.)
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. Dysfunction of the pancreatic islet cells b. The inability for the liver to reabsorb serum glucose c. Ingestion of foods high in sugar d. Renal failure
Dysfunction of the pancreatic islet cells (Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.)
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a. Sepsis b. Edema and inflammation c. Pleural effusion d. Disseminated intravascular coagulopathy
Edema and inflammation (Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and a return to normal function usually occurs within 6 months.)
A nurse is caring for a client in the emergency department who is reporting severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value indicates further investigation? a. Decreased calcium b. Elevated white blood cell count c. Elevated serum glucose level d. Elevated troponin
Elevated Troponin (An elevated troponin level indicates myocardial damage and needs immediate further investigation). (The nurse closely monitors the patient diagnosed with acute pancreatitis for early signs of neurologic, cardiovascular, renal, and respiratory dysfunction. An elevated troponin level indicates myocardial damage and requires immediate further investigation. Hyperglycemia (evidenced by a serum glucose level of 240 mg/dL), an elevated white blood cell count, and hypocalcemia, although commonly seen in pancreatitis, don't require immediate action.)
When caring for a patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) a. Withholding oral feedings to limit the release of secretin b. Encouraging bed rest to decrease the metabolic rate c. Administering prophylactic antibiotics d. Administering parenteral opioid analgesics as ordered e. Assisting the patient into the prone position
Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered (The current recommendation for pain management is the use of opioids, with assessment for their effectiveness and altering therapy if pain is not controlled or increased (Marx, 2009). Nonpharmacologic interventions such as proper positioning (not prone), music, distraction, and imagery may be effective in reducing pain when used along with medications. In addition, oral feedings are withheld to decrease the secretion of secretin.)
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
Frequent changes of 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? a. High glucose concentration in the blood b. Frequent vomiting, leading to loss of fluid volume c. Acetone in the urine d. Dry mouth, which makes the client thirsty
Frequent vomiting, leading to loss of fluid volume (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.)
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 causes thickening of pulmonary secretions, impairing oxygenation. b. Pancreatitis can elevate the diaphragm and alter the breathing pattern. c. Pancreatitis can atrophy the diaphragm and alter the breathing pattern. d. Pancreatitis causes alterations to hemoglobin, impairing oxygenation.
Pancreatitis can elevate the diaphragm and alter the breathing pattern. (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).
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a. Encouraging frequent visits from family and friends b. Administering frequent oral feedings c. Positioning the client on the side with the knees flexed d. Administering an analgesic once per shift, as ordered, to prevent drug addiction
Positioning the client on the side with the knees flexed (The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before the pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.)
Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? a. Allowing a clear liquid diet during the acute phase b. Maintaining a high Fowler's position c. Providing intensive insulin therapy d. Administering oral analgesics around the clock
Providing intensive insulin therapy (Intensive insulin therapy (continuous infusion) in the critically ill clients has undergone much study and has shown promise in terms of positive client outcomes when compared with intermittent insulin dosing. Glycemic control with normal or near-normal blood glucose levels improves client outcomes. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high glucose concentration, even with insulin coverage. Clients with pancreatitis should not be given high-fat foods because they are difficult to digest. The current recommendation for pain management in this population is parenteral opioids. The nurse should maintain the client in a semi-Fowler's position to reduce pressure on the diaphragm.)
A client with a new diagnosis of gallstones declines surgical intervention and requests information on mitigating strategies. The nurse anticipates teaching to focus on which client behaviors and monitoring strategies? a. Recommend a low-fiber diet, and monitor for fevers and increased abdominal girth. b. Report episodes of vomiting and severe abdominal pain, and limit alcohol consumption. c. Monitor for increased pruritus and jaundice; consider the use of analgesic medications prophylactically. d. Increase fiber intake, report any episodes of vomiting, and consider lithotripsy.
Recommend a low fiber diet, monitor for fevers and increased abdominal girth. (The patient with gallbladder disease resulting from gallstones may develop two types of symptoms: those with disease to the gallbladder itself and those due to obstruction of the bile passages. 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. Those at high risk may be encouraged to maintain an optimal body weight and consider reducing modifiable risk factors by avoiding consumption of sugar and sweet foods and maitaining a low fiber diet. If the gallstone obstructs the cystic duct the gallbladder becomes distended inflamed and eventually infected which results in acute cholecystitis. The patient develops a fever and may have a palpable abdominal mass. The pain of an acute cystitis may be so severe that analgesic medications are required but should not be given prophylactically which could mask a worsening condition. Jaundice occurs in a few patients with gallbladder disease usually with obstruction of the common bile duct which is frequently accompanied by pruritus (itching) of the skin. Lithotripsy is the use of shock waves to disintegrate gallstones and is a surgical procedure).
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. Maintaining adequate nutritional status c. Teaching about the disease and its treatment d. Preventing fluid volume overload
Relieving abdominal pain (The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after the 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 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. Self-digestion of the pancreas by its own proteolytic enzymes b. Fibrosis and atrophy of the pancreatic gland c. Calcification of the pancreatic duct, leading to its blockage d. Use of loop diuretics to increase the incidence of pancreatitis
Self-digestion of the pancreas by its own proteolytic enzymes (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 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 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. Oral bile acids c. Vitamin B d. Vitamin K
Vitamin K (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 with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? a. Fatigue b. Weight loss c. Hypertension d. Diarrhea
Weight loss (Weight loss is most common in clients 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.)
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 can drive after 2 weeks." d. "I should wash the site with mild soap and water."
"I should wash the site with mild soap and water." After a laparoscopic cholecystectomy, the client should be instructed about pain management, activity and exercise, wound care, nutrition, and follow-up care. The client should be directed to wash the puncture site with mild soap and water when caring for the wound. When resuming activity, the client should be instructed to drive after 3 or 4 days, take a shower or bath after 1 or 2 days, and begin light exercise such as walking immediately.
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
6 to 12 months of therapy with UDCA is recommended in patients to dissolve the stones
A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins or other acids will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply. a. A b. D c. K d. Essential fatty acids d. Folic acid
A, D, K, Essential Fatty Acids.
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. Deficient knowledge related to the prevention of disease recurrence b. Acute pain related to biliary spasms c. Anxiety related to the unknown outcome of hospitalization d. Imbalanced nutrition: Less than body requirements related to biliary inflammation
Acute pain related to biliary spasms (The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes the highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.)
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. Maintaining nothing-by-mouth (NPO) status b. Placing the client in a semi-Fowler's position c. Administering morphine I.V. as ordered d. Providing mouth care
Administering morphine I.V. as ordered
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Cholecystitis b. Appendicitis c. Pancreatitis d. Gastric ulcer
Appendicitis (Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. Appendicitis, cholecystitis, and gastric ulcer are less likely to exhibit fluid volume deficit.)
A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiates over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? a. Warm, dry skin b. Weight loss c. Bile-stained vomiting d. Hypertension
Bile-stained vomiting Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.
A client is being tested to determine the presence of an insulinoma. Which symptoms will the nurse expect to assess in this client? Select all that apply. a. Blood glucose level of 46 mg/dl b. Blood pressure reading of 156/92 mm Hg c. Seizure activity d. Mental confusion e. Generalized weakness
Blood glucose level of 46 mg/dl Seizure activity Mental confusion Generalized weakness (Insulinomas produce hypersecretion of insulin and cause an excessive rate of glucose metabolism. Seizures, weakness, and mental confusion can occur as symptoms of low blood glucose or hypoglycemia. Insulinomas do not affect blood pressure regulation.)
A client with calculi in the gallbladder is said to have a. Choledochotomy b. Choledocholithiasis d. Cholecystitis e. Cholelithiasis
Cholelithiasis (Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is an 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. Abdominal pain in the upper left quadrant b. Epigastric distress before a meal c. Nonpalpable abdominal mass d. Clay-colored stools
Clay-colored stools
A client has a tumor on 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
Clay-colored stools Dark urine Jaundice (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.)
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. Orange slices d. Toast
Coffee (Post-acute management of the client with acute pancreatitis includes the introduction of solid food. Oral feedings that are low in fat and protein are gradually initiated. Caffeine is eliminated from the diet and therefore coffee, which contains caffeine, should be removed from the client's breakfast tray. Even decaffeinated coffee has a small amount of caffeine but could serve as a compromise for chronic coffee drinkers. The other food items are appropriate for the client.)
A pre-operative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? a. decompression b. gavage c. instillation d. lavage
Decompression
The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? a. ERCP b. Ultrasound c. CT d. MRI
ERCP (The ERCP is the most useful study in the diagnosis of chronic pancreatitis. The other answer choices may be used; however, these are not the most useful in the diagnosis of chronic pancreatitis.)
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. White rice b. Mashed potatoes c. Hot roast beef sandwich with gravy d. Vanilla pudding
Hot roast beef sandwich with gravy (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 fried chicken, because fatty foods may bring on an episode of cholecystitis.)
A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? a. Increase respiratory effectiveness. b. Eliminate the need for nasogastric intubation. c. Improve nutritional status during recovery. d. Decrease the amount of postoperative analgesia needed.
Increase respiratory effectiveness. (The nurse must teach the client about using an incentive spirometer to promote lung expansion. The high abdominal incision used in a cholecystectomy interferes with respirations postoperatively, increasing the risk of atelectasis. The client will need to use incentive spirometry to promote lung expansion, increase alveolar inflation, and strengthen respiratory muscles. Most clients don't have a nasogastric tube in place after a cholecystectomy. It isn't appropriate to teach improved nutritional status before surgery. It isn't important for the client to be aware of how to decrease the amount of postoperative analgesia, because this is the responsibility of the health care team.)
Which is a gerontological consideration associated with the pancreas? a. Increased bicarbonate output b. Increased amount of fibrous material c. Increased calcium absorption d. Increased rate of pancreatic secretion
Increased amount of fibrous material (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 scheduled for a cholecystogram for later in the day. What is the nurse's understanding of 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 shows the sizes of the abdominal organs and detects any masses. d. It visualizes the liver and pancreas.
It visualizes the gallbladder and bile duct. (The cholecystogram is a diagnostic imaging test used to visualize the gallbladder and bile duct. The celiac axis arteriography visualizes the liver and pancreas. Ultrasonography shows the sizes of the abdominal organs and detects any masses. The endoscopic retrograde cholangiopancreatography (ERCP) visualizes the biliary structures and pancreas via endoscopy.)
Clinical manifestations of common bile duct obstruction include all of the following except: a. Clay-colored feces b. Pruritus c. Jaundice d. Light-colored urine
Light-colored urine (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.)
Which enzyme aids in the digestion of fats? a. Amylase b. Lipase c. Secretin d. Trypsin
Lipase
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. Maintain the client in a semi-Fowler's position. d. Administer enteral or parenteral nutrition.
Maintain the client in a semi-Fowler's position. 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 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. The presence of blood in the client's stool and recent hypertension b. Adventitious breath sounds and hypertension c. Pain with abdominal distention and hypotension d. Presence of easy bruising and bradycardia
Pain with abdominal distention and hypotension
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a. Tetany b. Shock c. MODS d. Pancreatic necrosis
Pancreatic necrosis (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.)
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. Digests carbohydrates in the jejunum b. Serves as a storage unit for glucagon c. Controls the flow of trypsin to digest proteins d. Releases bile in response to cholecystokinin
Releases bile in response to cholecystokinin (a hormone secreted by cells in the duodenum and stimulates the release of bile into the intestine and the secretion of enzymes by the pancreas.) (The gallbladder is a pear-shaped, hollow, saclike organ that lies in a shallow depression on the inferior surface of the liver. When food enters the duodenum, the gallbladder contracts, and the sphincter of Oddi relaxes. Relaxation of this sphincter allows the bile to enter the intestine. This response is mediated by the secretion of the hormone cholecystokinin (CCK) from the intestinal wall. Gallstones can block the bile duct and digestive juices to the pancreas causing acute pancreatitis. The gallbladder functions as a storage depot for bile. Bile does not digest carbohydrates in the jejunum. The liver controls the flow of trypsin to digest proteins.)
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. Instruct the client to avoid coughing. b. Monitor pulse oximetry every hour. c. Reposition the client every 2 hours. d. Withhold oral feedings for the client.
Reposition the client every 2 hours (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.)
A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? a. Muscle spasm related to hypokalemia b. Tetany related to hypocalcemia c. Muscle pain related to referred pain manifestations d. Tetany related to hypercalcemia
Tetany related to hypocalcemia (A client with acute pancreatitis who reports muscle cramping or pain should be suspected of having hypocalcemia and tetany of the muscles. Hypocalcemia may occur in acute pancreatitis because, when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.)
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 by your incision. Take analgesics as needed and as prescribed and report to the surgeon if the pain is unrelieved even with analgesic use." b. "This pain is caused by 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." c. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." d. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."
This pain is caused by 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. (If pain occurs in the right shoulder or scapular area (from the 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.)
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 avoid inflammation of the pancreas b. To drain the pancreatic bed c. To prevent the occurrence of fibrosis d. To aid in opening up of pancreatic duct
To avoid inflammation of the pancreas (Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.)
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 depress the central nervous system and increase the pain threshold c. To decrease metabolism d. To reduce gastric and pancreatic secretions
To reduce gastric and pancreatic secretions Anticholinergic medications reduce gastric and pancreatic secretion.
The nurse is caring for a client with symptoms of gallbladder disease. Which diagnostic test will the nurse anticipate preparing the client for to confirm the diagnosis? a. Cholescintigraphy b. Abdominal x-ray c. Oral cholecystography d. Ultrasound
Ultrasound (Ultrasonography is the diagnostic procedure of choice because it is rapid and accurate and can be used for clients with liver dysfunction and jaundice. Ultrasonography can detect calculi in the gallbladder or a dilated common bile duct with 90% accuracy. An abdominal X-ray may be obtained to exclude other causes of symptoms; however, only 10% to 15% of gallstones are calcified sufficiently to be visible in such x-ray studies. Cholescintigraphy is used successfully in the diagnosis of acute cholecystitis or blockage of a bile duct. Cholescintigraphy, however, is more expensive than ultrasonography, takes longer to perform, and exposes the client to radiation. It is often used when ultrasonography is not conclusive, such as in acalculous cholecystitis. Oral cholecystography is used if ultrasound equipment is not available or if the ultrasound results are inconclusive.)
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. Withhold analgesics unless necessary. b. Monitor pulse oximetry every hour. c. Use incentive spirometry every hour. d. Instruct the client to cough only when necessary.
Use incentive spirometry every hour.
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. black, tarry stools. b. yellow sclerae. c. circumoral pallor. d. light amber urine.
Yellow sclerae. Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.
The digestion of carbohydrates is aided by a. lipase. b. secretin. c. trypsin. d. amylase.
amylase. (Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.)
