Exam 1 Biliary System Questions

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client? A) "Inflammation is confined to only the pancreas." B) "Normal function returns after about 2 weeks." C) "Inflammation spreads to the surrounding glands." D) "Tissue necrosis occurs within the pancreas."

A) "Inflammation is confined to only the pancreas." There are two forms of pancreatitis-inflammatory and necrotizing. Interstitial pancreatitis is characterized by diffuse enlargement of the pancreas due to inflammatory edema confined only to the pancreas itself; normal function returns after about 6 months. Necrotizing pancreatitis is life-threatening and tissue necrosis occurs within the pancreas as well as the surrounding glands

A client is admitted to the health care center with severe abdominal pain rated 10 on a 1-to-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP), as ordered. The nurse plans for which goal after administration of this mediation? A) To increase the client's pain threshold B) Control blood pressure C) Control muscle spasms D) Diagnose the cause of the abdominal pain

A) increase the client's pain threshold Morphine, fentanyl, and hydromorphone act by depressing the central nervous system, thereby increasing the client's pain threshold.

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) Elevated urine amylase levels C) Decreased liver enzyme levels D) Decreased white blood cell count

B) 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.

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? A) Disturbed body image B) Impaired nutrition: less than body requirements C) Nausea D) Anxiety

B) Impaired nutrition: less than body requirements While each diagnosis may be applicable to this client, the priority nursing diagnosis is impaired nutrition: less than body requirements. The physician, nurse, and dietitian emphasize to the client and family the importance of avoiding alcohol and foods that have produced abdominal pain and discomfort in the past. Oral food or fluid intake is not permitted during the acute phase.

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic? A) Call the provider B) Put them to semi-fowler's position C) Administer analgesics to the client D) Give the client a full meal

C) Administer analgesics to the client. The pain of acute cholecystitis may be so severe that the client requires analgesics. During an attack of biliary colic, the nurse should ensure that the client rests. The nurse should not give the client a full meal; instead, the nurse should monitor the client's ability to digest a bland liquid diet. The nurse should also administer antispasmodics or analgesics as prescribed to relieve pain and discomfort.

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? A) Low-sodium, high-potassium, low-fat diet B) High-carbohydrate, high-protein, low-fat diet C) Low-carbohydrate, high-potassium diet D) High-carbohydrate, low-protein, low-fat diet

D) High-carbohydrate, low-protein, low-fat diet The nurse should provide a high-carbohydrate, low-protein, low-fat diet when tolerated. These foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond.

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? A) Impaired nutritional status B) Deficient fluid volume C) Constipation D) Risk of infection

Deficient fluid volume Clients with acute pancreatitis often experience deficient fluid volume, which can lead to hypovolemic shock. Vomiting, hemorrhage (in hemorrhagic pancreatitis), and plasma leaking into the peritoneal cavity may cause the volume deficit. Hypovolemic shock will cause a decrease in cardiac output. Gastrointestinal tissue perfusion will be ineffective if hypovolemic shock occurs, but this wouldn't be the primary nursing diagnosis.

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?

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

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) Folic acid E) Essential fatty acids

A) A B) D C) K E) Essential fatty acids A low-fat diet should be supplemented with vitamins A, D, K, and essential fatty acids. These vitamins are fat-soluble and will need to be administered if the client does not have adequate fat intake. Folic acid is not a fat-soluble vitamin.

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Select all that apply. A) Clay colored stools B) Jaundice C) Pruritus D) Dark Urine E) Weight Gain

A) Clay colored stools B) Jaundice C) Pruritus D) Dark Urine 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.

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 his diagnosis? A) Recent weight loss and temperature elevation B) Blood in stools and recent hypertension C) Adventitious breath sounds and hypertension D) Presence of easy bruising and bradycardia

A) Recent weight loss and temperature elevation Assessment findings associated with pancreatitis include recent weight loss and temperature elevation. Inflammation of the pancreas causes a response that elevates temperature and leads to abdominal pain that typically occurs with eating. Nausea and vomiting may occur as a result of pancreatic tissue damage that's caused by the activation of pancreatic enzymes. The client may experience weight loss because of the lost desire to eat. 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.

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 Ultrasound C) Percutaneous transhepatic cholangiography 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 with a history of pancreatitis seeks medical attention for increasing episodes of abdominal pain. Which assessment finding(s) indicate to the nurse that the client is experiencing chronic pancreatitis? Select all that apply. A) Anorexia B) Weight Loss C) Rectal Bleeding D) Constipation E) Foul Smelling Stools

A, B, E Chronic pancreatitis is characterized by recurring attacks of severe upper abdominal and back pain, accompanied by vomiting. Weight loss is a major problem in chronic pancreatitis. More than 80% of clients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. Malabsorption occurs late in the disease when as little as 10% of pancreatic function remains. As a result, digestion, especially of proteins and fats, is impaired. The stools become frequent, frothy, and foul-smelling because of impaired fat digestion which results in stools with a high-fat content referred to as steatorrhea. Constipation and rectal bleeding are not symptoms associated with chronic pancreatitis.

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? A) Encourage the client to deep breathe and cough. B) Place the client in semi-Fowler's position. C) Instruct the client on the proper use of an incentive spirometer. D) Encourage the client to ambulate frequently.

B) Place the client in semi-Fowler's position. A client with severe biliary colic is in extreme pain and has a very difficult time taking a deep breath due to severe pain on inspiration. Placing the client in upright or semi-Fowler's position best promotes adequate breathing and best supports the client's function. Ambulation, deep breathing and coughing, and incentive spirometry may be too difficult or impossible for the client with severe biliary colic symptoms.

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) N/V B) Weight Loss C) Fatigue D) Constipation

B) Weight loss Weight loss is most common in the client 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.

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? A) Administering meperidine B) Withhold all oral intake C) Limiting I.V. fluids, D) Keeping the client supine

B) Withhold all oral intake The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Pain relief may require parenteral opioids such as morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). No clinical evidence supports the use of meperidine for pain relief in pancreatitis, and, in fact, accumulation of its metabolites can cause CNS irritability and possibly seizures. Pancreatitis places the client at risk for fluid volume deficit from fluid loss caused by increased capillary permeability. Therefore, this client needs fluid resuscitation, not fluid restriction. A client with pancreatitis is most comfortable lying on the side with knees flexed.

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? A) Tetany related to hypercalcemia B) Muscle pain related to referred pain manifestations C Tetany related to hypocalcemia D) Muscle spasm related to hypokalemia

C) 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.

Which foods should be avoided following acute gallbladder inflammation? A) Coffee B) Mashed Potatoes C) Cooked Fruits D) Cheese

D) Cheese The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is: A) Jaundice B) Fever C) Severe abdominal pain D) Mental agitation

C) Severe abdominal pain The pain of acute pancreatitis is often very severe, necessitating the liberal use of analgesics. Jaundice is indicative of a bile duct obstruction. Fever and mental agitation are not indicative of pancreatitis.

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

A) 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.

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas? Select all that apply. A) "Internal secretion of hormones is the function of the endocrine pancreas." B) "Internal secretion of hormones is the function of the exocrine pancreas." C) "The endocrine pancreas secretes hormones through a ductless gland." D) "The exocrine pancreas secretes hormones from excretory ducts." E) "The exocrine pancreas secretes pancreatic enzymes into the GI tract."

A) "Internal secretion of hormones is the function of the endocrine pancreas." C) "The endocrine pancreas secretes hormones through a ductless gland." D) "The exocrine pancreas secretes hormones from excretory ducts." E) "The exocrine pancreas secretes pancreatic enzymes into the GI tract." The pancreas has both endocrine and exocrine functions. The endocrine pancreas secretes hormones internally through a ductless gland. The exocrine pancreas secretes external hormones from excretory ducts. Also, the exocrine pancreas secretes pancreatic enzymes into the GI tract.

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 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 is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." C) "This 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."

A) "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 client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? A) Administer pain-relieving medication B) Administer electrolytes C) Administer a low-fat diet D) Administer plasma E) Assist the client with a semi-Fowler position

A) Administer pain-relieving medication B) Administer electrolytes D) Administer plasma E) Assist the client to a semi-Fowler position The nurse promptly reports decreased blood pressure (BP) and reduced urine output, which indicate hypovolemia and shock or renal failure. The treatment goals for acute pancreatitis focus on relieving pain, maintaining circulatory and fluid volume, and decreasing the production of pancreatic enzymes. Intravenous replacement of fluid and electrolytes should begin immediately because of the loss of fluid in the body. If hypotension is evident, plasma should be administered to maintain BP within an acceptable range. Fluids are administered intravenously and may be accompanied by infusion of blood or blood products to maintain blood volume and to prevent or treat hypovolemic shock. Low serum calcium and magnesium concentrations may occur and require prompt treatment. The nurse maintains the client in a semi-Fowler position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. A low-fat diet, with small frequent meals, should be initiated after control of symptoms; it is not an immediate priority.

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) Assisting the client to turn, cough, and deep breathe every 2 hours B) Teaching the client to choose low-fat foods from the menu C) Performing range-of-motion (ROM) leg exercises hourly while the client is awake D) Assisting the client to ambulate the evening of the operative day

A) 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.

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 digestion D) Protein synthesis

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.

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

A) 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 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? A) Clay-colored feces B) Anemia C) Pruritius D) Pallor E) Jaundice

A) Clay-colored feces C) Pruritus E) Jaundice 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.

Which is a clinical manifestation of cholelithiasis? A) Clay-colored stools B) Non-palpable abdominal mass C) Upper left quadrant pain D) Lack of fever

A) 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 client recovering from a cholecystectomy has decreased breath sounds bilaterally in the lower lobes. Which action(s) will the nurse take to improve the client's respiratory function? Select all that apply. A) Have client use incentive spirometer as prescribed B) Splint affected area C) Assist patient with ambulation D) Raise the head of the bed E) Encourage deep breathing and coughing every hour

A) Have client use incentive spirometer as prescribed B) Splint affected area C) Assist patient with ambulation D) Raise the head of the bed E) Encourage deep breathing and coughing every hour Clients undergoing biliary tract surgery are especially prone to pulmonary complications. Using a pillow, blanket, or hand to splint the abdomen will reduce pain and enable the client to take deeper breaths. Raising the head of the bed helps the client to achieve the goal of improved respiratory function. Early ambulation prevents pulmonary complications. The client should be reminded to take deep breaths and cough every hour to expand the lungs fully and prevent atelectasis. The early and consistent use of incentive spirometry also helps improve respiratory function. Splinting the surgical area helps relieve pain when repositioning and taking deep breaths.

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

A) 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) Lipase B) Amylase C) Trypsin D) Secretin

A) 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.

A nurse admits a wealthy client who is 8 weeks postpartum after her third child and overweight. The client reports severe right upper quadrant pain that radiates to the back after eating Thanksgiving dinner with turkey and gravy earlier in the evening. What factors lead the nurse to suspect gallbladder disease? Select all that apply. A) Multiparous B) Eating a high fat diet C) Female gender D) Wealthy E) Obese

A) Multiparous B) Eating a high fat diet C) Female gender E) Obese Cholelithiasis affects approximately 50% of women by the age of 70 years. Two to three times more women than men develop cholesterol stones and gallbladder disease, particularly those who are multiparous, eat a high fat diet, and obese. Wealth is not associated with cholelithiasis.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? A) Pancreatic Necrosis B) Shock C) Tetany D) Multiple Organ Failure

A) 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 nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. A) "The pancreas enlarges and atrophies with age." B) "The pancreas develops fibrous material with age." C) "The pancreas decreases secretion of enzymes with age." D) "The pancreas develops fatty deposits with age." E) "The pancreas decreases bicarbonate secretion with age."

B) "The pancreas develops fibrous material with age." C) "The pancreas decreases secretion of enzymes with age." D) "The pancreas develops fatty deposits with age." E) "The pancreas decreases bicarbonate secretion with age." Age-related changes to the pancreas include: the development of fibrous material and fatty deposits, as well as decreased secretion of both pancreatic enzymes and bicarbonate. The pancreas remains the same size as the client ages and atrophy is not a normal age-related finding.

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 prevents nausea and vomiting" B) "The tube allows the gastrointestinal tract to rest" C) "The tube prevents you from getting an infection" D) "The tube provides you nutrition"

B) "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.

An older adult client is diagnosed with acute pancreatitis. Using what the nurse understands about gerontologic considerations related to acute pancreatitis, what concept does the nurse understand? Select all that apply. A) As the client ages, the size of the pancreas decreases B) As the client ages, there is an increased mortality rate for acute pancreatitis C) As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. D) As the client ages, the pattern of complications related to acute pancreatitis changes.

B) As the client ages, there is an increased mortality rate for acute pancreatitis. C) As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. D) As the client ages, the pattern of complications related to acute pancreatitis changes. Gerontologic considerations must be remembered when caring for older adult clients with acute pancreatitis. Clients of all ages may develop acute pancreatitis; however, mortality rate for acute pancreatitis increases as the client ages. Additionally, as the client ages, the pattern of complications related to acute pancreatitis changes and the risk of developing multiple organ dysfunction syndrome (MODS) increases with age. The size of the pancreas does not decrease as the client ages.

A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action? A) Administer pain medication B) Contact the health provider C) Get the patient's vital signs D) Document the finding

B) Contact the health care provider A client who is post op from open abdominal surgery is at risk for internal bleeding, which may manifest as rigidity of the abdomen. The nurse's priority is to contact the health care provider. Additional interventions will be necessary but contacting the health care provider is priority.

A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply. A) Sickle cell anemia B) Diabetes C) Cystic Fibrosis D) Obesity E) Changes in Weight

B) Diabetes C) Cystic Fibrosis D) Obesity E) Changes in Weight Risk factors for the development of gallstones (cholelithiasis) may include: changes in weight, obesity, cystic fibrosis, and diabetes. All of these conditions impact fat metabolism, increasing the risk of developing cholesterol gallstones. Sickle cell disease does not impact the development of gallstones.

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) Oatmeal B) Toast C) Coffee D) Fruit

C) 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 is diagnosed with a tumor on the head of the pancreas. Which treatment(s) will the nurse anticipate being prescribed to prepare the client for surgery? Select all that apply A) Heparin IV B) High protein diet C) Blood component therapy D) Pancrelipase E) Vitamin K supplements

B) High protein diet C) Blood component therapy D) Pancrelipase E) Vitamin K supplements Before extensive surgery can be performed, a period of preparation is necessary because the client's nutritional status and physical condition are quite often compromised. A high-protein diet is often prescribed. Blood component therapy is frequently required. Pancreatic enzymes (such as pancrelipase) which aid in digestion are often prescribed. Preoperative preparation also includes vitamin K to minimize postoperative complications. Anticoagulants like heparin are not prescribed prior to surgery for a tumor on the head of the pancreas as they could increase the risk of bleeding.

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? A) Develop no complications B) Maintain normal respiratory status C) Maintain satisfactory pain control D) Achieving fluid and electrolyte balance

B) Maintain normal respiratory status Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? A) 1 to 2 B) 3 to 5 C) 6 to 12 D) 13 to 18

C) 6 to 12 Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (eg, GI symptoms, pruritus, headache) is required during this time.

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) Placing the client in a semi-Fowler's position B) Preserve NPO status C) Administering morphine I.V. as prescribed D) Provide mouth care

C) Administering morphine I.V. as ordered The nurse should address the client's pain issues first by administering morphine I.V. 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.

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? A) Checking for development of edema and ascites B) Allowing the patient to be at strict bedrest C) Assessing the color of the sclera every shift D) Ensuring they get full meals after surgery

C) Assessing the color of the sclera every shift If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the sclerae.

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) Preventing fluid overload B) Helping the patient achieve adequate nutrition C) Relieving abdominal pain D) Helping the patient understand treatment

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 should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: A) Serum calcium B) Serum amylase C) Serum lipase D) Serum bilirubin

C) Serum lipase Serum amylase and lipase levels are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated days longer than amylase.

A nurse cares for a client who is post op open cholecystectomy and has a T-tube in place. Which clinical situation will the nurse notify the health care provider about as a possible complication of the surgery? A) Absence of blood or serous fluid in the T-tube. B) Greater than 250 mL bile output from the T-tube in 24 hours. C) Significantly reduced bile output from the T-tube. D) Finding the T-tube placed below the level of the incision.

C) Significantly reduced bile output from the T-tube. A T-tube is placed after open cholecystectomy to drain excess bile. The T-tube should remain below the level of the incision in order to ensure proper drainage. The nurse should report an output of greater than 500 mL in 24 hours or a significantly reduced bile output from the T-tube. There should not be bloody or serous output from the T-tube.

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) Dietary intake of fat B) Presence of diabetes C) Smoking D) Age

D) 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.

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) Move the patient to a completely upright position B) Provide medications orally C) Check vital signs every hour D) Measure blood glucose concentration every 4 to 6 hours

D) 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.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? A) Administer analgesic once each shift B) Frequent oral feedings C) Visits from family and friends D) Position the client on the side with knees flexed

D) 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.