EAQ 4510 PAncreatitis/Cholecystitis Summer 2020
A primary healthcare provider diagnoses a client with acute cholecystitis with biliary colic. Which clinical findings should the nurse expect when performing a health history and physical assessment? Select all that apply. A. Diarrhea with black feces B. Intolerance to foods high in fat C. Vomiting of coffee-ground emesis D. Gnawing pain when stomach is empty E. Pain that radiates to the right shoulder
B & E Rationale: Interference with bile flow into the intestine will lead to an increasing inability to tolerate fatty foods. Although the gallbladder is in the upper right quadrant of the abdomen, when inflamed it can radiate to the right shoulder or scapula. Diarrhea with melena (black feces) is not associated with cholecystitis. Melena is tarry stools associated with upper gastrointestinal bleeding; diarrhea is associated with increased intestinal motility. Coffee-ground emesis is indicative of gastric bleeding; it is not associated with cholecystitis. Gnawing pain when the stomach is empty is associated with duodenal ulcers, not with cholecystitis.
A client is admitted to the hospital with Laënnec cirrhosis and chronic pancreatitis. Bile salts (bile acid factor) are prescribed, and the client asks why they are needed. What is the nurse's best response? A. "They stimulate prothrombin production." B. "They aid absorption of fat-soluble vitamins." C. "They promote bilirubin secretion in the urine." D. "They help the common bile duct contract stronger."
B. "They aid absorption of fat-soluble vitamins." Rationale: Bile salts are used to aid digestion of fats and absorption of the fat-soluble vitamins A, D, E, and K. Bile salts are not involved in stimulating prothrombin production, in promoting bilirubin secretion in the urine, or in stimulating contraction of the common bile duct.
A client has cholelithiasis with possible obstruction of the common bile duct. The nurse performs a nutritional assessment. What is the primary goal for this assessment? A. To determine if follows a high fatty diet B. To determine if deficient in vitamins A, D, and K C. To determine if eats adequate amounts of dietary fiber D. To determine if consumes excessive amounts of protein
B. To determine if deficient in vitamins A, D, and K Rationale: Bile promotes the absorption of the fat-soluble vitamins. An obstruction of the common bile duct limits the flow of bile to the duodenum and thus the absorption of these fat-soluble vitamins. Most clients have pain after eating a fatty meal and do not follow this diet, but this is expected in cholelithiasis and is not the primary goal. Dietary fiber is not relevant to the situation. Although adequate dietary protein is desirable for wound healing, it is unrelated to cholelithiasis.
Discharge planning for a client with chronic pancreatitis includes dietary teaching. Which statement indicates to the nurse that the client needs more teaching? A. "I must eat foods high in calories." B. "I should avoid alcoholic beverages." C. "I will eat more often but in smaller amounts." D. "I can eat foods high in fat now that the acute stage is over."
D. "I can eat foods high in fat now that the acute stage is over." Rationale: The nurse needs to follow up on the client statement that indicates eating foods high in fat can be allowed. A low-fat diet should be followed to avoid diarrhea. All the rest of the client responses are correct and do not require additional teaching. The response to eating foods high in calories is appropriate because additional calories are needed to maintain weight. The response to avoiding alcoholic beverages is appropriate to prevent overstimulation of the pancreas. Small, frequent meals limit stimulation of the pancreas and is appropriate.
A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis? A. Encouraging clear liquids B. Obtaining a prescription for morphine C. Assisting the client into a semi-Fowler position D. Administering prescribed anticholinergic medication
D. Administering prescribed anticholinergic medication Rationale: Anticholinergic drugs block the neural impulses that stimulate pancreatic and gastric secretions; they inhibit the action of acetylcholine at postganglionic cholinergic nerve fibers. Oral fluids stimulate pancreatic secretion and are contraindicated. Morphine sulfate is an analgesic and therefore does not decrease gastric secretions; in the past morphine sulfate was contraindicated for pain control with pancreatitis because it can precipitate spasms of the smooth musculature of the pancreatic ducts and the sphincter of Oddi. However, recent research indicates that it is the drug of choice over meperidine hydrochloride because the metabolites of meperidine hydrochloride can cause central nervous system irritation and seizures. The semi-Fowler position decreases pressure against the diaphragm; it will not decrease pancreatic secretions.
A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? A. Promotes the formation of calculi in the cystic duct B. Stimulates the pancreas to secrete more insulin than it can immediately produce C. Alters the composition of enzymes so they are capable of damaging the pancreas D. Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas
D. Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas Rationale: Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct. The backflow of enzymes into the pancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Although blockage of the bile duct with calculi may precipitate pancreatitis, this is not associated with alcohol. Alcohol does not deplete insulin stores; the demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged.
A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit? A. Is the easiest method for administering needed nutrition B. Is the safest method for meeting the client's nutritional requirements C. Will satisfy the client's hunger without the discomfort associated with eating D. Will meet the client's nutritional needs without causing the discomfort precipitated by eating
D. Will meet the client's nutritional needs without causing the discomfort precipitated by eating Rationale: Providing nutrients by the intravenous route eliminates pancreatic stimulation, therefore reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.
A client is admitted with the diagnosis of acute pancreatitis. Which clinical manifestations should a nurse assess in the client? Select all that apply. A. Jaundice B. Acute pain C. Hypertension D. Hypoglycemia E. Increased amylase
A, B, E Rationale: Obstruction of the common bile duct by inflammation leads to jaundice. Autodigestion of the pancreas causes severe abdominal pain. Obstruction of the pancreatic duct leads to elevated levels of amylase and lipase. Hypotension, not hypertension, is caused by fluid shifting out of the intravascular space. Decreased pancreatic function causes hyperglycemia, not hypoglycemia.
A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment? A. Platelet count B. Amylase level C. Red blood cell count D. Erythrocyte sedimentation rate
B. Amylase level Rationale: In 90% of clients with acute pancreatitis, the amylase level is elevated up to three times over baseline; serum amylase usually returns to expected adult levels within three days after treatment begins. The platelet count is not an indicator of the response to treatment for pancreatitis; platelets are important in the control of bleeding. The red blood cell count is unchanged in acute pancreatitis, unless hemorrhage is present. The erythrocyte sedimentation rate is not an indicator of a response to treatment for pancreatitis.
Which clinical indicator should the nurse identify before scheduling a client for an endoscopic retrograde cholangiopancreatography (ERCP)? A. Urine output B. Bilirubin level C. Blood pressure D. Serum glucose
B. Bilirubin level Rationale: ERCP involves the insertion of a cannula into the pancreatic and common bile ducts during an endoscopy. The test is not performed if the client's bilirubin level is more than 3 to 5 mg/dL (51 to 85 mcmol/L) because cannulation may cause edema, which will increase obstruction of bile flow. Urine output, blood pressure, and serum glucose are not related directly to this test.
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? A. Crackles B. Hypovolemia C. Gastric reflux D. Jugular vein distention
B. Hypovolemia Rationale: Hypovolemia that results from a fluid shift from the intravascular compartment to the peritoneal cavity can cause circulatory collapse; this is a life-threatening event that requires immediate intervention. Crackles indicate an accumulation of fluid in the alveoli associated with hypervolemia, not hypovolemia. Gastric reflux occurs with gastroesophageal reflux disease (GERD), not with pancreatitis. Jugular vein distention indicates hypervolemia, not hypovolemia.
A client is scheduled for a cholecystectomy and asks the primary nurse about the function of the gallbladder. What should the nurse identify is the function of the gallbladder when providing preoperative teaching? A. Stores and concentrates bile B. Releases bile into the pancreatic duct C. Connects the common bile duct and the pancreas D. Controls the flow of fat through the sphincter of Oddi
A. Stores and concentrates bile Rationale: The gallbladder concentrates and stores about 90 mL of bile, which is discharged in response to the entrance of fatty food into the duodenum. The gallbladder releases bile into the cystic duct. The common bile duct is connected directly to the pancreas. The sphincter of Oddi controls the release of bile into the duodenum; dietary fat progresses from the stomach to the duodenum and then to the rest of the intestinal tract.
A nurse provides teaching for a client who is scheduled for a cholecystectomy. In the initial postoperative period, the nurse explains that the most important part of the treatment plan is what? A. Early ambulation B. Coughing and deep breathing C. Wearing antiembolic elastic stockings D. Maintenance of a nasogastric tube
B. Coughing and deep breathing Rationale: The client who has a cholecystectomy will have difficulty taking deep breaths and coughing because of the location of the surgical incision. Therefore it is important to instruct the client preoperatively to improve compliance with the procedure in the early postop period. Although ambulation, antiembolism stockings, and maintaining a nasogastric tube, if ordered, are important postoperative procedures, maintaining the airway and preventing further pulmonary problems is the priority.
A slightly overweight client is to be discharged from the hospital after a cholecystectomy. What is most important for the nurse to include in teaching the client about nutrition? A. Listing low-protein foods that may be included in the diet B. Explaining that fatty foods may not be tolerated for several weeks C. Teaching the importance of a low-calorie diet to promote weight reduction D. Encouraging the intake of high vitamin C, vitamin A, and zinc foods at each meal
B. Explaining that fatty foods may not be tolerated for several weeks Rationale: Bile, which aids in fat digestion, is not as concentrated as before surgery. Once the body adapts to the absence of the gallbladder, the client should be able to tolerate a regular diet that contains fat. Initially the client should avoid fatty foods unless otherwise indicated. A low-protein diet is not necessary. Although teaching the client about a low-calorie diet to promote weight reduction is important, it is not as important as temporary avoidance of fatty foods with the gradual resumption of a regular diet. While vitamin C, vitamin A, and zinc are important, they are not the priority.
The nurse prepares an intravenous solution of lactated Ringer solution to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. Which condition will improve if the administration of lactated Ringer solution is effective? A. Urinary stasis B. Paralytic ileus C. Metabolic acidosis D. Increased potassium level
B. Metabolic acidosis Rationale: Lactated Ringer solution is an alkaline solution that replaces bicarbonate ions lost from T-tube bile drainage, thus preventing or treating acidosis. Urinary stasis is unrelated to the effectiveness of the administration of intravenous lactated Ringer solution. Paralytic ileus is unrelated to the effectiveness of the administration of intravenous lactated Ringer solution. An increased potassium level is unrelated to the effectiveness of the administration of intravenous lactated Ringer solution.
A nurse in the postanesthesia care unit (PACU) is providing care to a client who had an abdominal cholecystectomy and observes serosanguineous drainage on the abdominal dressing. What is the next nursing action? A. Change the dressing. B. Reinforce the dressing. C. Replace the tape with Montgomery ties. D. Support the incision with an abdominal binder.
B. Reinforce the dressing.
A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, what would the nurse expect to observe? A. Melena B. Steatorrhea C. Hard, dry stool D. Ribbon-shaped stool
B. Steatorrhea Rationale: Decreased secretion of lipase from the pancreas limits fat breakdown in the small intestine, resulting in increased fat content in feces; steatorrhea is soft, frothy, foul-smelling feces. Melena refers to black, tarry stool containing digested blood; melena is caused by upper gastrointestinal bleeding. Hard, dry stool reflects constipation; stools associated with pancreatitis are soft and frothy. Ribbon-shaped stool is associated with obstruction of the descending or sigmoid colon.
A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client? A. Prone B. Supine C. Left Sims D. Trendelenburg
C. Left Sims Rationale: Retained carbon dioxide can irritate the phrenic nerve. Placing the client in the left Sims position helps to move the gas pocket away from the diaphragm. Deep breathing and ambulation should be encouraged. Prone, supine, and Trendelenburg positions will not help to alleviate the problem but could aggravate the problem.
A client is admitted to the hospital for acute pancreatitis. The nurse obtains the client's vital signs, performs a physical assessment, and reviews the client's health history. What is the priority intervention by the nurse? A. Reduce environmental stimuli. B. Continue to monitor the client's vital signs. C. Institute constant observation of the client. D. Assess the client for alcohol withdrawal symptoms.
D. Assess the client for alcohol withdrawal symptoms.
The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. Which will be most appropriate to include in the client's dietary plan? A. Offer soft-textured foods to reduce the digestive burden B. Offer low-cholesterol foods to avoid further formation of gallstones C. Increase protein intake to promote tissue healing and improve energy reserves D. Decrease fat intake to avoid stimulation of the cholecystokinin mechanism for bile release
D. Decrease fat intake to avoid stimulation of the cholecystokinin mechanism for bile release Rationale: Fat intake stimulates cholecystokinin release that signals the gallbladder to contract, causing pain. Soft-textured foods are unnecessary. Eating low-cholesterol foods to avoid further formation of gallstones is not true for all clients with cholecystitis; low-cholesterol foods are necessary if the cholecystitis is precipitated by cholelithiasis and the stones are composed of cholesterol. An increase in protein intake is necessary to promote tissue healing and improve energy reserves after a cholecystectomy, but is not as important as fat intake for cholecystitis.
