CoursePoint - Chapter 44: Assessment and Management of Patients with Biliary Disorders

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. Seizure activity B. Mental confusion C. Blood pressure reading of 156/92 mm Hg D. Blood glucose level of 46 mg/dl E. Genelalized weakness

A, B, D, E 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 patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.) A. Clay-colored feces B. Amber-colored urine C. Pain in the left upper abdominal quadrant D. Pruritus E. Jaundice

A, D, E Jaundice occurs in a few patients with gallbladder disease, usually with obstruction of the common bile duct. The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin and mucous membranes a yellow color. This is frequently accompanied by marked pruritus (itching) of the skin. 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.

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 pain medication as ordered B. Providing mouth care C. Maintaining nothing-by-mouth (NPO) status D. Placing the client in a semi-Fowler's position

A. Administering pain medication as ordered The nurse should address the client's pain issues first by administering pain medication as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

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. Carbohydrate digestion B. Fat digestion C. Protein synthesis D. Protein digestion

A. 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 recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? A. Coffee B. Toast C. Orange slices D. Oatmeal

A. 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 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. Gray B. Black C. Green D. Red

A. Gray A gray-white stool color is common with a biliary obstruction because the stool is no longer colored with bile pigments.

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. Improve nutritional status during recovery C. Eliminate the need for nasogastric intubation D. Decrease the amount of postoperative analgesia needed

A. 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.

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? A. Measure blood glucose concentration every 4 to 6 hours B. Auscultate the abdomen for bowel sounds every 4 hours C. Measure abdominal girth every shift D. Monitor for reports of nausea and vomiting

A. Measure blood glucose concentration every 4 to 6 hours Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors the serum glucose concentration every 4 to 6 hours.

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A. Pancreatitis B. Peptic ulcer C. Appendicitis D. Cholecystitis

A. Pancreatitis Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.

A client is demonstrating symptoms of pancreatic cancer. Which diagnostic test will the nurse expect to be prescribed to prepare the client for surgery? A. Spiral computed tomography (CT) scan B. Endoscopic retrograde cholangiopancreatogram C. Endoscopic ultrasound D .Percutaneous transhepatic cholangiography

A. Spiral computed tomography (CT) scan Spiral (helical) computed tomography (CT) is more than 85% to 90% accurate in the diagnosis and staging of pancreatic cancer and currently is the most useful preoperative imaging technique. Endoscopic ultrasound is useful to identify small tumors and perform fine-needle biopsy of primary tumors or lymph nodes. Percutaneous transhepatic cholangiography may be used to identify obstructions of the biliary tract by a pancreatic tumor. Endoscopic retrograde cholangiopancreatogram (ERCP) may also be used in the diagnosis of pancreatic carcinoma. Cells obtained during ERCP are sent to the laboratory for analysis.

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. Use incentive spirometry every hour B. Instruct the client to cough only when necessary C. Withhold analgesics unless necessary D. Monitor pulse oximetry every hour

A. Use incentive spirometry every hour The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis.

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. are at risk for gallbladder contraction D. can digest high-fat foods

A. 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 for gallbladder contraction, whereas intake of high protein increases risk for 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 assessing a client admited 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. "How much alcohol do you consume in a day?" C. "How many meals do you eat every day?" D. "When was the last time you took acetaminophen?"

B. "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 prescibed 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 is reviewing the health care provider orders for a client admitted with acute pancreatitis. The health care provider has ordered intravenous calcium chloride infusions for the client. What does the nurse understand is the reason for this order? A. Calcium binds to proteins in the blood when pancreatic enzymes are released B. Calcium binds to fatty acids when auto digestion of the pancreas occurs C. Calcium is unable to enter the blood when auto digestion of the pancreas occurs D. Calcium is unable to form when pancreatic enzymes are elevated

B. Calcium binds to fatty acids when auto digestion of the pancreas occurs Hypocalcemia is a potential problem with acute pancreatitis because calcium binds to fatty acids when auto digestion of the pancreas occurs.

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. Ingestion of foods high in sugar D. Renal failure

B. 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.

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. Hot roast beef sandwich with gravy C. Vanilla pudding D. Mashed potatoes

B. 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 roast beef because fatty foods may bring on an episode of cholecystitis.

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 liver and pancreas B. It visualizes the gallbladder and bile duct C. It visualizes the biliary structures and pancreas via endoscopy D. It shows the sizes of the abdominal organs and detects any masses

B. 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.

Which enzyme aids in the digestion of fats? A. Secretin B. Lipase C. Amylase D. Trypsin

B. Lipase Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Gastric ulcer D. Cholecystitis

B. Pancreatitis 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 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. Serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) A. Administering prophylactic antibiotics B. Assisting the patient into the prone position C. Withholding oral feedings to limit the release of secretin D. Encouraging bed rest to decrease the metabolic rate E. Administering parenteral opioid analgesics as ordered

C, D, E 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.

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 from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." 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 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. "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." 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 nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to A. Presence of diabetes mellitus B. Dietary intake of fat C. Age D. Cigarette smoking

C. Age Incidence of pancreatic cancer increases with age, peaking in the seventh and eighth decades for both men and women. It is very rare before 45 years, and most patients present in or beyond the sixth decade of life. Cigarette smoking, exposure to industrial chemicals or toxins in the environment, and a diet high in fat, meat, or both are associated with pancreatic cancer, although their roles are not completely clear. Diabetes mellitus, chronic pancreatitis, and hereditary pancreatitis are also associated with pancreatic cancer.

Which is a clinical manifestation of cholelithiasis? A. Nonpalpable abdominal mass B. Epigastric distress before a meal C. Clay-colored stools D. Abdominal pain in the upper left quadrant

C. Clay-colored stools The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? A. Sepsis B. Disseminated intravascular coagulopathy C. Edema and inflammation D. Pleural effusion

C. Edema and inflammation Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months.

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. Dry mouth, which makes the client thirsty C. Frequent vomiting, leading to loss of fluid volume D. Acetone in the urine

C. 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.

Clinical manifestations of common bile duct obstruction include all of the following except: A. Clay-colored feces B. Pruritus C. Light-colored urine D. Jaundice

C. 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.

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. Presence of easy bruising and bradycardia B. Adventitious breath sounds and hypertension C. Pain with abdominal distention and hypotension D. Presence of blood in the client's stool and recent hypertension

C. Pain with abdominal distention and hypotension Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with pancreatitis.

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 an analgesic once per shift, as ordered, to prevent drug addiction C. Positioning the client on the side with the knees flexed D. Administering frequent oral feedings

C. 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 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.

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. Teaching about the disease and its treatment B. Preventing fluid volume overload C. Relieving abdominal pain D. Maintaining adequate nutritional status

C. Relieving abdominal pain The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after 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.

The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? A. Mental agitation B. Fever C. Severe abdominal pain D. Jaundice

C. Severe abdominal pain Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A. circumoral pallor B. black, tarry stools C. yellow sclerae D. light amber urine

C. 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.

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 helps control fluid and electrolyte imbalance." D. "The tube allows the gastrointestinal tract to rest."

D. "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 allow the gastrointestinal tract to rest while promoting adequate nutrition.

A client with calculi in the gallbladder is said to have A. Choledocholithiasis B. Choledochotomy C. Cholecystitis D. Cholelithiasis

D. 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 acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.

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 bicarbonate output by the kidneys B. Development of local complications C. Increases in the rate of pancreatic secretion D. Decreases in the physiologic function of major organs

D. 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 physiologic function of major organs with increasing age.

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. Increased serum calcium levels B. Decreased white blood cell count C. Decreased liver enzyme levels D. Elevated urine amylase levels

D. Elevated urine amylase levels Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

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. Perform chest physiotherapy B. Placing the patient in the prone position C. Suction the patient every 4 hours D. Frequent changes of positions

D. Frequent changes of positions Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? A. Tetany B. MODS C. Shock D. Pancreatic necrosis

D. 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 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. Withhold oral feedings for the client C. Monitor pulse oximetry every hour D. Reposition the client every 2 hours

D. 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. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

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 is developing a paralytic ileus. B. The patient has developed renal failure. C. The patient requires more pain medication. D. The patient has developed peritonitis.

D. The patient has developed peritonitis. Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis.

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 aid opening up of pancreatic duct B. To prevent the occurrence of fibrosis C. To drain the pancreatic bed D. To avoid inflammation of the pancreas

D. 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 decrease metabolism B. To depress the central nervous system and increase the pain threshold C. To relieve nausea and vomiting D. To reduce gastric and pancreatic secretions

D. To reduce gastric and pancreatic secretions Anticholinergic medications reduce gastric and pancreatic secretion.

A preoperative 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. gavage B. lavage C. instillation D. decompression

D. decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

A nurse is caring for a client who was admitted with pain, tenderness, and rigidity of the upper right abdomen, suggesting a gall bladder issue. The client has also been experiencing nausea and vomiting for the past 3 days. The admitting service is planning for tests to be conducted in the morning. What is the implication for testing for each diagnostic? Laboratory Assessments: _____ Ultrasonography: _____ Cholescintigraphy: _____

Laboratory Assessments: Cholesterol is elevated in biliary obstruction. Ultrasonography: It is used to visualize calculi in the gallbladder. Cholescintigraphy: The radioactive dye allows for visualization of the biliary tract. Laboratory assessments such as cholesterol levels are used to identify the high levels of cholesterol that contribute to the cholesterol stones. Acidosis (low pH) is not used to diagnosis gall bladder conditions but to identify acid-base imbalances. Potassium is an electrolyte and is not elevated or decreased with the presence of gallstones. An ultrasound or sonography is a high-frequency sound used to produce images of the soft tissue of the gallbladder. Ultrasound can identify a mass, but it does not provide the information needed to determine whether the mass is benign or malignant. The ultrasound does not require sedation; the client is usually awake during the procedure. Cholescintigraphy has been used successfully to diagnosis acute cholecystitis or blockage of a bile duct. In this procedure, a radioactive agent is administered intravenously and then the biliary tract is scanned and images of the gallbladder and biliary tract are obtained. This procedure is more expensive, takes longer to perform and exposes the client to radiation. This procedure does not involve x-rays or high-frequency sound.