EXAM 4 | CH 54 | Pancreas & Biliary problems

The nurse is preparing a patient for a magnetic resonance cholangiopancreatography (MRCP) scan. Which contrast medium does the nurse tell the patient will be administered before the procedure? Ketorolac Morphine Meperidine Gadolinium

Gadolinium Rationale The oral or IV contrast material gadolinium is given before an MRCP scan. Gadolinium does not contain iodine; therefore it does not carry the risk for an allergic reaction. Ketorolac, morphine, and meperidine are not helpful in MRI; these drugs are analgesics. p. 1179

The nurse is providing teaching about pancreatic enzyme replacement to a patient diagnosed with chronic pancreatitis. Which statement by the patient indicates the need for further teaching? "I will swallow the tablet without chewing." "I won't mix the enzyme with protein foods." "I will take my pancreatic enzymes after my antacid." "I will take the pancreatic enzyme half an hour before meals."

"I will take the pancreatic enzyme half an hour before meals." Rationale Pancreatic enzymes should be taken with meals and snacks, not a half hour before meals. The pill should be swallowed without chewing. The enzyme should not be mixed with protein foods. The pancreatic enzyme should be taken after an antacid. p. 1189

Case study

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Which patient has the highest risk for development of cholecystitis? 28-year-old white man who just had gastric bypass 55-year-old American Indian woman with Crohn disease 38-year-old African-American man with elevated cholesterol 32-year-old African-American female oncology patient receiving total parenteral nutrition (TPN)

55-year-old American Indian woman with Crohn disease Rationale The 55-year-old American Indian woman with Crohn disease has as risk factors for cholecystitis age, ethnicity, and the medical diagnosis of Crohn disease. This patient has more risk factors for cholecystitis than any of the other patients listed. The 28-year-old white man who just had gastric bypass only has two risk factors at this time. The 38-year-old African-American man has just cholesterol as a risk factor. The 32-year-old AfricanAmerican female oncology patient receiving TPN has only a diagnosis and TPN as risk factors. p. 1178

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to immediately contact the primary health care provider? a. Drainage from a fistula b. Diminished bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

ANS: A Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis. Absent bowel sounds, pain at the incision site, and NG tube drainage are normal postoperative findings.

The nurse is caring for a client who has possible acute pancreatitis. What serum laboratory findings would the nurse expect for this client? (Select all that apply.) a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte count

ANS: A, B, C, D, E, F All of these choices are correct. Amylase and lipase are pancreatic enzymes that are released during pancreatic inflammation and injury. Leukocytes also increased due to his inflammatory response. Pancreatic injury affects the ability of insulin to be released causing increased glucose levels. Bilirubin is also typically increased due to hepatobiliary obstruction. Calcium and magnesium levels decrease because fatty acids bind free calcium and magnesium causing a lowered serum level; these changes occur in the presence of fat necrosis.

The nurse is preparing a client who has chronic pancreatitis about how to prevent exacerbations of the disease. Which health teaching will the nurse include? (Select all that apply.) a. "Avoid alcohol ingestion." b. "Be sure and balance rest with activity." c. "Avoid caffeinated beverages." d. "Avoid green, leafy vegetables." e. "Eat small meals and high-calorie snacks."

ANS: A, B, C, E Clients who have chronic pancreatitis need to avoid GI stimulants, including alcohol, caffeine, and nicotine. Food and snacks need to be high-calorie to prevent additional weight loss. Green vegetables can be consumed if tolerated by the client.

A client has an external percutaneous transhepatic biliary catheter inserted for a biliary obstruction. What health teaching about catheter care would the nurse provide for the client? a. "Cap the catheter drain at night to prevent leakage and skin damage." b. "Position the drainage bag lower than the catheter insertion site." c. "Irrigate the catheter with an ounce of saline every night." d. "Pierce a hole in the top of the drainage bag to get rid of odors."

ANS: B An external temporary or permanent catheter drains bile by gravity into a bag that collects bile. Therefore, the drainage bag should be lower that the catheter insertion site. The catheter should not be capped or irrigated, and no holes should be made in the bag to prevent bile from having contact with the skin.

The nurse is caring for a client who is recovering from an open traditional Whipple surgical procedure. What action would the nurse take? a. Clamp the nasogastric tube. b. Place the patient in semi-Fowler position. c. Assess vital signs once every shift. d. Provide oral rehydration.

ANS: B Postoperative care for a patient recovering from an open Whipple procedure would include placing the client in a semi-Fowler position to reduce tension on the suture line and anastomosis sites and promote breathing, setting the nasogastric tube to low continuous suction to remove free air buildup and pressure, assessing vital signs frequently to assess fluid and electrolyte complications, and providing intravenous fluids.

A nurse assesses a client who is recovering from an open traditional Whipple surgical procedure. Which assessment finding(s) alert(s) the nurse to a complication from this surgery? (Select all that apply.) a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

ANS: B, C, D, E Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and acute kidney injury (urine output of 20 mL/6 hr) are common complications for which the nurse must assess the client after the Whipple procedure. Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure.

A nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy sign c. Clay-colored stools d. Upper abdominal pain after eating

ANS: C Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen in clients with either chronic or acute cholecystitis.

The nurse documents the vital signs of a client diagnosed with acute pancreatitis: Apical pulse = 116 beats/min Respirations = 28 breaths/min Blood pressure = 92/50 What complication of acute pancreatitis would the nurse suspect that the client might have? a. Electrolyte imbalance b. Pleural effusion c. Internal bleeding d. Pancreatic pseudocyst

ANS: C The client is exhibiting signs of hypovolemia most likely due to internal bleeding or hemorrhage. Due to decreased blood volume, the blood pressure is low and the heart rate increases to compensate for hypovolemia to ensure organ perfusion. Respirations often increase to increase oxygen in the blood.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

ANS: C The enzymes must be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.

A client is scheduled for a hepatobiliary iminodiacetic acid (HIDA) scan. What would the nurse include in client teaching about this diagnostic test? a. "You'll have to drink a contrast medium right before the test." b. "You'll need to do a bowel prep the nursing before the test." c. "You'll be able to drink liquids up until the test begins." d. "You'll have a large camera close to you during the test."

ANS: D Clients having a HIDA scan are NPO and receive an injectable nuclear medicine contrast. No bowel preparation is required. A large camera is close to the client for most of the test which can be a problem for clients who are claustrophobic.

Which symptom of chronic pancreatitis also occurs with acute pancreatitis? Ascites Abdominal pain Protein malabsorption Loss of exocrine function

Abdominal pain Rationale Abdominal pain occurs with both types of pancreatitis, though pain intensity does vary between the two. Ascites, loss of exocrine function, and protein malabsorption occur only with chronic pancreatitis. p. 1183

Which condition is the primary risk factor for chronic calcifying pancreatitis? Alcoholism Cholecystitis Viral infection Metabolic disturbances

Alcoholism Rationale Alcoholism is the primary risk factor for chronic calcifying pancreatitis. Cholecystitis is a risk factor for chronic obstructive pancreatitis. Metabolic disturbances and viral infection are risk factors for acute pancreatitis, not chronic calcifying pancreatitis. p. 1188

The patient has been NPO but is now tolerating food. ​ ​ What education will the nurse provide regarding nutrition?​ ​ Small and frequent meals are best.​ Use of alcohol and caffeine should be consumed in moderation.​ Expect to experience nausea and vomiting as you begin to consume foods.​ Low-carbohydrate, high-protein, and high-fat foods should be consumed.​

Answer: A​ Patients may experience nausea and vomiting but should not expect this to happen. High-carbohydrate, high-protein, and low-fat foods should be included in the diet. Alcohol and caffeine should be avoided.​

In preparing to care for the patient, which conditions does the nurse recognize as potential complications of acute pancreatitis? (Select all that apply.)​ ​ Strep throat​ Pleural effusion​ Diabetes mellitus​ Pancreatic infection​ Acute kidney failure​

Answer: B, C, D, E ​ All, with the exception of strep throat, are potential complications of acute pancreatitis.​

A patient with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which laboratory analysis is a priority in the nurse's assessment of this patient?​ ​ Lipase level​ Total bilirubin​ Liver function tests​ White blood cell count​

Answer: B​ Rationale: Excess circulating bilirubin present with chronic cholecystitis is responsible for pruritus and changes in stool and urine color. Cholecystitis is associated with several risks including hepatic disease, pancreatitis, and peritonitis. Monitoring liver function, pancreatic laboratory values, and white blood cell counts is also very important.​

A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis? Acute Chronic Calculous Acalculous

Chronic Rationale Patients with chronic cholecystitis are more likely to have jaundice and icterus caused by obstruction of bile flow, causing increased circulating levels of bilirubin. Patients with acute cholecystitis present with abdominal pain. Acalculous cholecystitis and calculous cholecystitis are both types of acute cholecystitis. p. 1179

Which assessment finding would the nurse monitor to evaluate the effectiveness of pancreatic enzyme therapy? Weight Urine output Blood glucose Consistency and number of stools

Consistency and number of stools Rationale If the pancreatic enzymes are effective, the patient should have less frequent, less fatty stools. Blood glucose monitoring is performed when patients receive total parenteral nutrition. Urine output does not indicate effectiveness of pancreatic enzyme therapy. Monitoring weight is necessary for patients who have fat and protein malabsorption. p. 1189

Which scan will provide the most reliable diagnosis of acute pancreatitis? Chest x-ray Abdominal ultrasound Contrast-enhanced CT Endoscopic retrograde cholangiopancreatography (ERCP)

Contrast-enhanced CT Rationale Contrast-enhanced CT provides more reliable images and diagnosis of acute pancreatitis. A chest x-ray will show elevation but is not diagnostic. An abdominal ultrasound is not helpful to view the whole pancreas. An ERCP is better for diagnosing pancreatic stones, not acute pancreatitis. p. 1186

The patient is being discharged to home.​ ​ What patient teaching will the nurse provide regarding when the patient should notify the health care provider?​

The patient should be instructed to notify the health care provider if acute abdominal pain occurs. Also, jaundice, clay-colored stools, or dark urine should be reported, because these are signs of biliary tract disease that may indicate complications as the disease progresses.​

Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis to dissolve remaining stone fragments? Ketorolac Morphine sulfate Bethanechol Ursodeoxycholic acid

Ursodeoxycholic acid Rationale Ursodeoxycholic acid is administered to dissolve remaining fragments of stones after ESWL. Ketorolac, morphine, and bethanechol are not indicated for dissolution of stones. p. 1180

Which complication is common for a patient with pancreatic cancer to develop? Infection Dyspepsia Eructation Venous emboli

Venous emboli Rationale The patient with pancreatic cancer is at a higher risk for developing venous emboli. This occurs because necrotic products of the pancreatic tumor have thromboplastic properties which, in turn, cause a hypercoagulable state. Decreased mobility and extensive surgical manipulation are also responsible for this infection. Dyspepsia (indigestion) and eructation (belching) are not common complications associated with pancreatic cancer. p. 1190

Which medication is administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply. One, some, or all responses may be correct. Imipenem Ranitidine Meperidine Pantoprazole Ciprofloxacin

Ranitidine Pantoprazole Rationale Ranitidine is a histamine receptor antagonist, and pantoprazole is a proton pump inhibitor. Both medications help decrease gastric acid secretion. Imipenem and ciprofloxacin are antibiotics. Meperidine is an opiate analgesic. p. 1186

A patient is diagnosed with acute pancreatitis. Which test is a sensitive indicator of biliary obstruction in this disorder? Serum amylase Serum bilirubin Alkaline phosphatase Serum alanine aminotransferase

Serum alanine aminotransferase Rationale Serum alanine aminotransferase is a sensitive indicator of biliary obstruction in acute pancreatitis. A threefold or greater rise in concentration indicates that the diagnosis of acute biliary pancreatitis is valid. Serum bilirubin, alkaline phosphatase, and serum amylase are diagnostic tests prescribed for a patient with acute pancreatitis but do not reflect biliary obstruction. p. 1185

A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this procedure? Mouth Vagina Rectum Umbilicus

Vagina Rationale Surgical removal of the gallbladder in women is most often accomplished via the vagina because it is easily decontaminated with betadine or other antiseptic, and it allows easy access into the peritoneal cavity. The surgeon makes a small internal incision through the cul-de-sac of Douglas, between the rectum and uterine wall, to access the gallbladder. The mouth and rectum do not provide easy access into a woman's peritoneal cavity. The umbilicus is used for removing the gallbladder in laparoscopic cholecystectomy. p. 1181

Which finding is consistent with a diagnosis of acute cholecystitis? Select all that apply. Vomiting Eructation Dysphagia Blumberg sign Right lower quadrant pain

Vomiting Eructation Blumberg sign Rationale Vomiting, eructation, and the Blumberg sign are common findings in patients diagnosed with acute cholecystitis. Dysphagia and right lower quadrant pain are not common findings in patients with acute cholecystitis. p. 1178

The nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members would the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.) a. Registered dietitian nutritionist b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Primary health care provider

ANS: A, C, E Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse would collaborate with the registered dietitian nutritionist, clinical pharmacist, and primary health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision.

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? (Select all that apply.) a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein foods."

ANS: A, E Client teaching related to self-management of enzyme replacement therapy would include taking the enzymes with meals and snacks but not mixing enzyme preparations with protein-containing foods. Clients would not crush enteric-coated preparations and should swallow tablets without chewing to minimize oral irritation and allow the drug to be released slowly. Wiping lips after taking enzymes also minimizes skin irritation.

A patient admitted for cholecystitis presents with these vital signs: blood pressure 145/92 mm Hg, pulse 108 beats/min, and temperature 101.8°F (38.7°C). Which action by the nurse is the priority? Request a stat ultrasound. Administer PRN ketorolac IV. Request an order to increase the IV fluids. Place the patient supine with the head of the bed flat.

Administer PRN ketorolac IV. Rationale The patient is febrile, tachycardic, and hypertensive, which is expected with inflammation and pain. Administering the PRN ketorolac (an NSAID) may reduce the fever and the pulse. Although dehydration may be a cause for tachycardia and fever, the patient is also hypertensive, so dehydration is less likely. A stat ultrasound is not indicated because the cause of the patient's pain and fever is established. The patient with acute abdominal pain will have worsened symptoms when placed supine with the bed flat. p. 1180

Which patient is more likely to develop gallstones?​ ​ 45-year-old Caucasian female with a family history of gallstones​ 55-year-old African-American male with a history of diabetes mellitus​ 62-year-old Hispanic/Latino female with a history of irritable bowel syndrome​ 60-year-old obese, American-Indian female with a history of diabetes mellitus​

Answer: D​ Rationale: Risk factors for developing gallstones include female gender, obesity, family history of gallstones, diabetes mellitus, American-Indian and Caucasian descent, rapid change in weight, and advanced age. More risk factors increase the likelihood of developing gallstones.

In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention?​ ​ Heart rate of 105 beats/min ​ Serum glucose of 136 mg/dL​ Blood pressure of 102/76 mm Hg​ Respiratory rate of 28 breaths/min

Answer: D​ Rationale: The patient with pancreatitis may develop pulmonary complications, pleural effusions, pulmonary infiltrates, and acute respiratory failure or ARDS. Increases in respiratory effort is an important assessment variable in the care of a patient with pancreatitis. Patients may also be hyperglycemic and hypovolemic. Assessing and treating endocrine function of the pancreas and perfusion variables are also important.​

A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition? Peritonitis Malnutrition Vitamin deficiency Chronic cholecystitis

Chronic cholecystitis Rationale Fever, yellowing of the skin and eyes, clay-colored stools, and dark urine are symptoms of chronic cholecystitis. These symptoms occur when repeated episodes of cystic duct obstruction cause chronic inflammation. Peritonitis is an infection of the peritoneal cavity in which the patient presents with a hard, distended abdomen. Patients with malnutrition are underweight for their height and have low albumin. Patients with a vitamin deficiency do not display these symptoms; symptoms are always dependent upon the vitamin in which the patient is deficient. p. 1179

A patient diagnosed with cholelithiasis has a gallstone lodged in the common bile duct. Which assessment finding is consistent with this diagnosis? Select all that apply. One, some, or all responses may be correct. Icterus Ascites Jaundice Hematochezia Light-amber urine

Icterus Jaundice Rationale Icterus is yellowing of the sclera, and jaundice is yellowing of the skin, both of which are found in patients with obstruction of the common bile duct. Ascites, hematochezia, and light-amber urine are not findings consistent with this diagnosis. p. 1179

Which finding is expected in a patient who has a liver function abnormality? Increased white blood cell (WBC) count Decreased level of lactate dehydrogenase Decreased level of aspartate aminotransferase Increase in serum levels of alkaline phosphatase

Increase in serum levels of alkaline phosphatase Rationale Alkaline phosphatase is an enzyme found in the liver, kidneys, and bones. An increase in serum levels of alkaline phosphatase indicates a liver function abnormality. An increased level of WBCs indicates inflammation or infection. When the liver is not functioning normally, the level of lactate dehydrogenase and aspartate aminotransferase are increased, not decreased. p. 1179

The nurse is assessing a patient in the emergency department. Which assessment finding would prompt the nurse to suspect a pancreatic pseudocyst? Select all that apply. One, some, or all responses may be correct. Jaundice Steatorrhea Odynophagia Palpable epigastric mass Epigastric pain radiating to the back

Jaundice Palpable epigastric mass Epigastric pain radiating to the back Rationale Patients with a pancreatic pseudocyst often have jaundice, a palpable epigastric mass, and epigastric pain that radiates to the back. Steatorrhea and odynophagia are not common findings of a pancreatic pseudocyst. p. 1188

A patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach? Normal weight Absence of infection Low serum cholesterol Ability to tolerate iodine

Normal weight Rationale Patients who undergo extracorporeal shock wave lithotripsy must be of normal weight and have cholesterol based, smaller gallstones and good gallbladder function. Iodine is not used in this procedure. The presence of infection and serum cholesterol levels are not factors to consider in candidates for this procedure. p. 1180

A nurse cares for a client with end-stage pancreatic cancer. The client asks, "Why is this happening to me?" How would the nurse respond? a. "I don't know. I wish I had an answer for you, but I don't." b. "It's important to keep a positive attitude for your family right now." c. "Scientists have not determined why cancer develops in certain people." d. "I think that this is a trial so you can become a better person because of it."

ANS: A The client is not asking the nurse to actually explain why the cancer has occurred. The client may be expressing his or her feelings of confusion, frustration, distress, and grief related to this diagnosis. Reminding the client to keep a positive attitude for his or her family does not address the client's emotions or current concerns. The nurse would validate that there is no easy or straightforward answer as to why the client has cancer. Telling a client that cancer is a trial is untrue and may negatively impact the client-nurse relationship.

A patient diagnosed with chronic cholecystitis develops jaundice and clay-colored stools. For which other sign or symptom would the patient be assessed? Select all that apply. One, some, or all responses may be correct. Icterus Ascites Asterixis Steatorrhea Peripheral edema

Icterus Steatorrhea Rationale Icterus and steatorrhea are common findings in late chronic cholecystitis. Ascites, asterixis, and peripheral edema are not common findings in patients with chronic cholecystitis. p. 1179

Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin? Lipase Trypsin Elastase Kallikrein

Kallikrein Rationale Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. These substances cause vasodilation and increased vascular permeability, compounding the hemorrhagic process. Lipase enzyme is involved in enzymatic fat necrosis. Trypsin activates elastase, which dissolves elastic fibers of the blood vessels and ducts. p. 1183

The nurse is caring for a client who was recently diagnosed with pancreatic cancer. What factors present risks for developing this type of cancer? (Select all that apply.) a. Diabetes mellitus b. Cirrhosis c. Smoking d. Female gender e. Family history f. Older age

ANS: A, B, C, E, F All of these choices are risk factors except that pancreatic cancer occurs most frequently in men.

The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Select all that apply.) a. Ascites b. Weight gain c. Steatorrhea d. Jaundice e. Polydipsia f. Polyuria

ANS: A, C, D, E, F The client who has chronic pancreatitis has all of these signs and symptoms except he or she loses weight. Ascites and jaundice result from biliary obstruction; ascites is associated with portal hypertension. Steatorrhea is fatty stool that occurs because lipase is not available in the duodenum; because it is released by the disease pancreas into the bloodstream. Polydipsia, polyuria, and polyphagia result from diabetes mellitus, a common problem seen in clients whose pancreas is unable to release adequate amounts of insulin.

The nurse is caring for a patient who has been admitted multiple times for pancreatitis. The patient has inflammation and fibrosis of the tissue and diminished pancreatic function. Which assessment finding is priority for this patient? Nicotine use Family support Alcohol consumption Adherence to prescribed medication regimen

Alcohol consumption Rationale Alcoholism is a common risk factor for pancreatitis. Nicotine use assessment is not necessary. Family support is important but is not priority. Adherence to the prescribed medication regimen is important but not priority. p. 1188

When the patient is asked about pain, he says that it is intense and continuous. He states that sometimes when he curls up in a fetal position the pain eases. ​ ​ Which medication does the nurse recognize that will provide the most comprehensive pain relief at this time? ​ ​ PCA morphine sulfate​ IM fentanyl (Sublimaze)​ PCA meperidine (Demerol)​ Oral hydromorphone (Dilaudid)​

Answer: A​ Meperidine is not a good choice because it can cause seizures, especially in older adults. While hydromorphone is a good choice with acute pancreatitis pain, IV is the best route. Fentanyl is a good alternative, but the route chosen should be IV or transdermal. Another option is epidural analgesia.​

A 68-year-old patient presents to the ED the day after Thanksgiving, stating that he has "eaten and drunk quite a bit." He states that about 1 hour ago he experienced a sudden onset of pain in the left upper quadrant that radiates to his left flank. He rates the pain as an 8 on a 0-to-10 scale. The patient is admitted with acute pancreatitis. Which laboratory finding corroborates the diagnosis of acute pancreatitis?​ ​ Serum lipase, 150 U/L​ Serum amylase, 200 U/L​ Serum glucose, 80 mg/dL​ White blood cells (WBCs), 6000 mcL​

Answer: B​ A serum amylase of 200 U/L is elevated (normal range is approximately 23 to 85 U/L). Lipase normal range is 0-160 U/L; WBC normal range is 4800-10,800 ccm; and glucose normal range is 82-110 mg/dL. Amylase, lipase, WBC, and glucose are often higher than normal in patients with acute pancreatitis.​

After teaching a client who has a history of cholelithiasis, the nurse assesses the client's understanding. Which menu selection indicates that the client understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

ANS: D Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

A client had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess? a. Urinary tract infection b. Chronic kidney disease c. Heart failure d. Fluid and electrolyte imbalances

ANS: D Due to the length and complexity of this type of surgery, the client is at risk for fluid and electrolyte imbalances. The nurse would assess for signs and symptoms of these imbalances so they can be managed early to prevent potentially life-threatening complications

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

ANS: B The client who has acute pancreatitis reports severe boring abdominal pain that is often rated by clients as a 10+ on a 0-10 pain scale. Nausea, vomiting, and fever may also occur, but that is not the client's priority for care.

Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas? Lipase Trypsin Elastase Kallikrein

Lipase Rationale The lipase enzyme is involved in enzymatic fat necrosis of both the endocrine and exocrine cells of the pancreas. Trypsin activates elastase, which dissolves the elastic fibers of the blood vessels and ducts. Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. p. 1183

Which laboratory result would the nurse review for a patient suspected of having cholecystitis? Select all that apply. One, some, or all responses may be correct. Platelets Hematocrit Liver function White blood cells Alkaline phosphate

Liver function White blood cells Alkaline phosphate Rationale Liver function, white blood cells, and alkaline phosphate are often elevated in patients with cholecystitis. Hematocrit and platelets are not often abnormal and therefore are not diagnostic. p. 1179

A patient reports severe mid-epigastric pain radiating to the left flank and back. The nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen and periumbilical area. The nurse suspects which cause of acute pain in this patient? Pancreatitis Biliary colic Cholecystitis Gastroenteritis

Pancreatitis Rationale Patients with acute pancreatitis will have severe mid-epigastric pain that radiates to the left side and back and may have generalized jaundice and a gray-blue discoloration caused by pancreatic enzyme leakage into the cutaneous tissue. Biliary colic and cholecystitis will present with right-sided abdominal pain. Patients with gastroenteritis will have generalized discomfort. p. 1185

A patient with a history of chronic pancreatitis presents with left upper quadrant pain, fever, and a palpable mass. A diagnosis of pancreatic abscess is made. Which intervention is most likely to promote a positive patient outcome? Performance of an abdominal ultrasound Administration of broad-spectrum IV antibiotics Placement of a percutaneous drain in the pancreatic abscess Measurement of serum electrolytes and a complete blood count

Placement of a percutaneous drain in the pancreatic abscess Rationale Patients who have a pancreatic abscess will appear ill, have an elevated temperature, and have a high risk for fatality without aggressive treatment. Drainage via the percutaneous drainage method or laparoscopy should be performed as soon as possible to prevent sepsis. An ultrasound does not distinguish between an abscess and a pseudocyst, so it is not helpful in this scenario. Antibiotics are indicated, but antibiotic therapy alone does not resolve the abscess. Blood cultures should be obtained to identify the infectious organism, rather than serum electrolytes and a complete blood count. p. 1183

Which factor is considered a risk factor in the development of cholelithiasis? Anemia Pregnancy Age younger than 40 years Low body mass index (BMI)

Pregnancy Rationale In pregnancy, hormone levels (progesterone and estrogen) are altered, which delays muscular contraction of the gallbladder and decreases the rate of bile emptying, thus increasing the risk for cholelithiasis. Similarly, hormonal changes and hormonal replacement therapy make women older than 40 years, not younger, more susceptible to the development of cholelithiasis. Obese women, not those with a low BMI, are at a high risk for developing cholelithiasis because of impaired fat metabolism and increased cholesterol. Anemia is not associated with the development of gallstones. p. 1178

The nurse is reviewing laboratory values of a patient diagnosed with cholecystitis. Elevations in which additional laboratory value would prompt the nurse to suspect pancreatic involvement? Select all that apply. One, some, or all responses may be correct. Serum lipase Serum amylase Alkaline phosphate White blood cell count Lactate dehydrogenase

Serum lipase Serum amylase Rationale Elevated levels of serum amylase and serum lipase indicate that the pancreas is involved with cholecystitis. Elevated levels of white blood cells indicate inflammation. Elevated levels of alkaline phosphate and lactate dehydrogenase indicate liver function abnormalities. p. 1185

The patient recently diagnosed with acute pancreatitis reports severe pain despite IV narcotic pain medication. Into which position would the nurse assist the patient to help decrease pain? Prone Supine Side-lying High-Fowler

Side-lying Rationale The side-lying position may decrease the abdominal pain of pancreatitis. Prone, supine, and high-Fowler positions are not indicated to decrease pain in pancreatitis. p. 1186