Gall Bladder Disease
Which item reported in a patient's history increases the risk of developing cholelithiasis? 1. Antibiotic use 2. Vasodilator therapy 3. Anticholinergic therapy 4. Oral contraceptive use
1. Antibiotic use 2. Vasodilator therapy 3. Anticholinergic therapy 4. Oral contraceptive use Oral contraceptives affect cholesterol production, thereby resulting in gallbladder cholesterol saturation, which causes gallbladder diseases such as cholelithiasis. Antibiotics, vasodilators, and anticholinergics do not affect cholesterol production and metabolism.
The client two (2) hours postoperative laparoscopic cholecystectomy is complaining of severe pain in the right shoulder. Which nursing intervention should the nurse implement? 1. Apply a heating pad to the abdomen for 15 to 20 minutes. 2. Administer morphine sulfate intravenously after diluting with saline. 3. Contact the surgeon for an order to x-ray the right shoulder. 4. Apply a sling to the right arm, which was injured during surgery.
1. Apply a heating pad to the abdomen for 15 to 20 minutes.
Which condition is associated with the formation of stones in the gallbladder? 1. Biliary colic 2. Cholangitis 3. Cholecystitis 4. Cholelithiasis
1. Biliary colic 2. Cholangitis 3. Cholecystitis 4. Cholelithiasis Cholelithiasis is the formation of stones in the gallbladder. The pain associated with cholelithiasis is called biliary colic. Cholangitis is inflammation of bile ducts. Inflammation of the gallbladder is called cholecystitis.
Which surgical instrument is used preoperatively in a patient who will be undergoing an open cholecystectomy? 1. Biliary stent 2. Laparoscope 3. Catheter with wire basket 4. Transhepatic biliary catheter
1. Biliary stent 2. Laparoscope 3. Catheter with wire basket 4. Transhepatic biliary catheter Open cholecystectomy involves the removal of the gallbladder through a right subcostal incision. A transhepatic biliary catheter is used preoperatively in patients who are undergoing an open cholecystectomy. A transhepatic biliary catheter is inserted for palliative care when inoperable liver, pancreatic, or bile duct carcinoma obstructs the bile flow. A laparoscope is an instrument inserted during laparoscopic procedures. Biliary stents and catheters with wire baskets are used during endoscopy.
Which data should the nurse expect to assess in the client who had an upper gastrointestinal (UGI) series? 1. Chalky white stools. 2. Increased heart rate. 3. A firm hard abdomen. 4. Hyperactive bowel sounds.
1. Chalky white stools.
A patient tells the nurse, "Gallstones were removed by passing shockwaves into my gallbladder." Which procedure is the patient referring to? 1. Cholecystojejunostomy 2. Pancreaticoduodectomy 3. Balloon sphincteroplasty 4. Extracorporeal shock-wave lithotripsy (ESWL)
1. Cholecystojejunostomy 2. Pancreaticoduodectomy 3. Balloon sphincteroplasty 4. Extracorporeal shock-wave lithotripsy (ESWL) ESWL is a procedure involving the use of high energy shock waves to disintegrate gallstones. This method is used when endoscopic procedures cannot be used to remove the stones.
Which dietary substance would the nurse recommend limiting for a patient with acute cholecystitis? 1. Fat 2. Protein 3. Calcium 4. Carbohydrates
1. Fat 2. Protein 3. Calcium 4. Carbohydrates After cholecystectomy, it is important to follow dietary restrictions. A diet low in fat decreases the workload of the liver.
A client with gallbladder disease is scheduled for oral cholecystography. For the evening meal prior to the test, the nurse would plan to provide a list of foods from which diet type? A. Liquid B. Fat-free C. Low-protein D. High-carbohydrate
A. Liquid B. Fat-free C. Low-protein D. High-carbohydrate Normal dietary intake of fat needs to be maintained during the days preceding the test to empty bile from the gallbladder. A low-fat or fat-free diet is prescribed on the evening before the test
The nurse is teaching a student nurse about postoperative care for a patient that has undergone laparoscopic cholecystectomy. Which statements made by the student nurse indicate the need for further teaching? (select all that apply) 1. "I will monitor for bleeding." 2. "I will encourage the patient to practice deep breathing." 3. "I will most likely need to administer narcotics for pain control." 4. "The patient will use a bedside commode for the first 24 hours after surgery." 5. "The patient will need to return to the office in 7 to 10 days for removal of stitches."
1. "I will monitor for bleeding." 2. "I will encourage the patient to practice deep breathing." 3. "I will most likely need to administer narcotics for pain control." 4. "The patient will use a bedside commode for the first 24 hours after surgery." 5. "The patient will need to return to the office in 7 to 10 days for removal of stitches." Postoperative pain can usually be controlled with over-the-counter pain relievers. A cholecystectomy may result in changes in prothrombin time and may cause bleeding. Therefore the nurse should monitor for bleeding. Deep-breathing exercises should be encouraged to prevent postoperative pneumonia and to help relieve the patient's discomfort.
Which food in the patient's diet would likely facilitate improvement in the condition of cholelithiasis? 1. Butter 2. Yogurt 3. Cheese 4. Skim milk
1. Butter 2. Yogurt 3. Cheese 4. Skim milk Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.
The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective? 1. "I will take my lipid-lowering medicine at the same time each night." 2. "I may experience some discomfort when I eat a high-fat meal." 3. "I need someone to stay with me for about a week after surgery." 4. "I should not splint my incision when I deep breathe and cough."
2. "I may experience some discomfort when I eat a high-fat meal."
The client is four (4) hours postoperative open cholecystectomy. Which data warrant immediate intervention by the nurse? 1. Absent bowel sounds in all four (4) quadrants. 2. The T-tube has 60 mL of green drainage. 3. Urine output of 100 mL in the past three (3) hours. 4. Refusal to turn, deep breathe, and cough.
4. Refusal to turn, deep breathe, and cough.
The nurse is caring for a client with gallbladder disease who is experiencing nutrition problems due to biliary obstruction. The nurse understands that obstruction of which passage is related to the client's condition? A. Cystic duct B. Liver canaliculi C. Common bile duct D. Right hepatic duct
A. Cystic duct B. Liver canaliculi C. Common bile duct D. Right hepatic duct The gallbladder receives bile from the liver through the cystic duct.
A client with an acute attack of cholecystitis has a cholecystectomy with a choledochostomy. The client returns from surgery with a T-tube connected to a drainage bag. What would the nurse conclude is the purpose of the T-tube? A. Decrease edema B. Permit drainage of bile C. Insert antibiotic medication D. Provide irrigation of the gallbladder
A. Decrease edema B. Permit drainage of bile C. Insert antibiotic medication D. Provide irrigation of the gallbladder The T-tube provides a passageway for bile to move through the common bile duct in the presence of edema; it does not reduce edema.
The nurse is giving instructions to a client with cholecystitis about food to exclude from the diet. Which food item identified by the client indicates that the educational session was successful? A. Fresh fruit B. Brown gravy C. Fresh vegetables D. Poultry without skin
A. Fresh fruit B. Brown gravy C. Fresh vegetables D. Poultry without skin The client with cholecystitis would decrease overall intake of dietary fat. Foods that need to be avoided include sausage, gravies, fatty meats, fried foods, products made with cream, and desserts
The nurse is caring for a client who had a laparoscopic cholecystectomy 1 day ago. The nurse plans pain-management techniques, knowing that the severity of the client's pain can be related to which factor? A. Positioning of the client during surgery B. How long the client had pain before surgery C. The type of general anesthesia used during surgery D. The use of nonsteroidal anti-inflammatory medications before surgery
A. Positioning of the client during surgery B. How long the client had pain before surgery C. The type of general anesthesia used during surgery D. The use of nonsteroidal anti-inflammatory medications before surgery The duration of the operation, the degree of tissue trauma, and the positioning of the client during surgery all may contribute to the presence and severity of postoperative pain.
A client with cholecystitis is placed on a low fat, high protein diet. What nutrient should the nurse teach the client is included with this diet? A. Skim milk B. Boiled beef C. Poached eggs D. Steamed broccoli
A. Skim milk B. Boiled beef C. Poached eggs D. Steamed broccoli
Which statement made by the patient indicates the need for further teaching about laparoscopic cholecystectomy? 1. "Small punctures will be made in my abdomen." 2. "I may be discharged the same day as the surgery." 3. "I will have work restrictions for six weeks after my surgery." 4. "An instrument with a camera will be inside my abdomen."
1. "Small punctures will be made in my abdomen." 2. "I may be discharged the same day as the surgery." 3. "I will have work restrictions for six weeks after my surgery." 4. "An instrument with a camera will be inside my abdomen." Laparoscopic cholecystectomy is a minimally invasive surgery that involves removal of the gallbladder. Postoperative pain is minimal, and the patient can resume his or her work within one week of the surgery. The procedure involves making small punctures into the abdomen through which an instrument called a laparoscope is inserted. The patient is discharged on the day of surgery or a day after. The laparoscope has a camera attached to it, which is inserted through the punctures
Which condition is associated with acalculous cholecystitis? 1. Cholangitis 2. Choledolithiasis 3. Diabetes mellitus 4. Acute pancreatitis
1. Cholangitis 2. Choledolithiasis 3. Diabetes mellitus 4. Acute pancreatitis Acalculous cholecystitis is an inflammatory process that occurs in the absence of obstruction and is associated with diabetes mellitus. Cholangitis and choledolithiasis are complications of cholelithiasis, not acalculous cholecystitis. Acute pancreatitis is not associated with acalculous cholecystitis
Which signs and symptoms should the nurse report to the health-care provider for the client recovering from an open cholecystectomy? Select all that apply. 1. Clay-colored stools. 2. Yellow-tinted sclera. 3. Amber-colored urine. 4. Wound approximated. 5. Abdominal pain.
1. Clay-colored stools. 2. Yellow-tinted sclera. 5. Abdominal pain.
Which information would the nurse provide to the patient after a laparoscopic cholecystectomy? 1. Do not return to work or normal activities for three weeks. 2. Bile-colored drainage probably will drain from the incision. 3. A lower-fat diet may be tolerated better for several weeks. 4. Keep the bandages on and the puncture site dry until it heals.
1. Do not return to work or normal activities for three weeks. 2. Bile-colored drainage probably will drain from the incision. 3. A lower-fat diet may be tolerated better for several weeks. 4. Keep the bandages on and the puncture site dry until it heals. Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.
Which dietary advice will the nurse give a patient after a cholecystectomy? (select all that apply) 1. Eat a high-fiber diet 2. Limit intake of water 3. Use the same diet as before 4. Have small but frequent meals 5. Avoid or keep fats to a minimum
1. Eat a high-fiber diet 2. Limit intake of water 3. Use the same diet as before 4. Have small but frequent meals 5. Avoid or keep fats to a minimum Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small and frequent meals helps digestion and prevents nausea. Fats are harder to digest. After cholecystectomy, it is essential that the patient has an adequate intake of water, around 2500 to 3000 mL per day. The patient should not have the usual foods that he or she used to consume; modifications are needed to facilitate easy digestion of food in the absence of the gallbladder.
The nurse is providing discharge instructions to a patient who has undergone a laparoscopic cholecystectomy. Which information would the nurse include in the teaching? (select all that apply) 1. Eat foods rich in fatty acids 2. Report development of jaundice 3. You can shower the day after surgery 4. You can return to work the day of surgery 5. Eat several small meals and snacks each day
1. Eat food rich in fatty acids 2. Report development of jaundice 3. You can shower the day after surgery 4. You can return to work the day of surgery 5. Eat several small meals and snacks each day Foods rich in fiber and calcium should be included in the diet to prevent constipation and hypocalcemia. It is helpful to eat three small meals and two or three snacks daily rather than three large meals to help reduce the flow of bile after the surgery. Eating fat-rich foods will stimulate the release of bile. Therefore the patient should consider eating light meals.
A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. What are the points that a nurse can include in this explanation? (select all that apply) 1. Gallbladder is removed through 1 to 4 small punctures on the abdominal wall. 2. Gallbladder is removed through an incision made on the right subcostal region. 3. The procedure is done with a laparoscope and grasping forceps under anesthesia. 4. The patient can be discharged on the day of operation or the next and resume his work after a week. 5. The gallbladder is removed through an incision on the abdomen, and a catheter is inserted to drain any fluids or effusion.
1. Gallbladder is removed through 1 to 4 small punctures on the abdominal wall. 2. Gallbladder is removed through an incision made on the right subcostal region. 3. The procedure is done with a laparoscope and grasping forceps under anesthesia. 4. The patient can be discharged on the day of operation or the next and resume his work after a week. 5. The gallbladder is removed through an incision on the abdomen, and a catheter is inserted to drain any fluids or effusion. Laparoscopic cholecystectomy involves making 1 to 4 punctures on the abdominal wall, and the gall bladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two because the recovery is fast. This procedure does not involve incisions.
The nurse is planning discharge teaching for a patient after a laser laparoscopic cholecystectomy. The nurse explains to the patient about self-care at home. Which statements of the patient indicate that the patient has understood the discharge teachings? (select all that apply) 1. I cannot bathe or shower for 10 days. 2. I can have normal food that is low in fat. 3. I may have mild shoulder pain for a week. 4. I should not lift heavy weights for a few days. 5. I should have only a liquid diet for the first week.
1. I cannot bathe or shower for 10 days. 2. I can have normal food that is low in fat. 3. I may have mild shoulder pain for a week. 4. I should not lift heavy weights for a few days. 5. I should have only a liquid diet for the first week. After the procedure, the diet should be high in fiber and low in fat. Having mild shoulder pain after cholecystectomy is common due to diaphragmatic irritation. After cholecystectomy, it is essential that the patient doesn't lift heavy weights so that abdominal pressure doesn't increase. The patient can bathe and shower normally after a couple of days. The patient doesn't need to follow a liquid diet.
What dietary recommendation should the nurse give to a patient with chronic gallbladder disease? 1. Include dairy products. 2. Maintain a low-protein diet. 3. Include fat-soluble vitamins. 4. Increase the intake of refined cereals.
1. Include dairy products. 2. Maintain a low-protein diet. 3. Include fat-soluble vitamins. 4. Increase the intake of refined cereals. Patients with chronic gallbladder diseases have a deficiency of fat-soluble vitamins. Therefore the nurse should include fat-soluble vitamins in the patient's diet plan. Dairy products are rich in saturated fats, which are contraindicated for patients with gallbladder disease because dairy stimulates the gallbladder, causing pain. A low-protein diet is given to patients with kidney disease because improper functioning of the kidneys reduces the ability to excrete the nitrogenous waste. As a result, these substances accumulate in the brain, leading to neurologic complications. Refined cereals have less fiber content. However, patients with gallbladder disease require a diet high in fiber because fiber is known to reduce the risk of developing gallstones, thereby preventing complications.
Which information would the nurse include when teaching a student nurse about an open cholecystectomy? 1. Insertion of a T-tube following surgery 2. Insertion of a needle into the core of the tumor 3. Resection of the proximal pancreas and duodenum 4. Administration of an embolic agent through a catheter
1. Insertion of a T-tube following surgery 2. Insertion of a needle into the core of the tumor 3. Resection of the proximal pancreas and duodenum 4. Administration of an embolic agent through a catheter Open cholecystectomy involves removal of the gallbladder through an abdominal incision. The T-tube facilitates drainage from the common bile duct into an external collection device. The T-tube is then discontinued, and the insertion point heals spontaneously. Radiofrequency ablation involves insertion of a needle into the core of the tumor and is performed on patients with liver cancer. The Whipple procedure is used in pancreatic cancer and involves resection of the proximal pancreas and duodenum. Administration of an embolic agent through the catheter into the artery near the tumor is done in chemoembolization, which is a treatment option for patients with liver cancer.
A patient has been diagnosed with cholelithiasis. Which findings would indicate possible obstructed bile flow? (select all that apply) 1. Jaundice 2. Steatorrhea 3. Dark, tarry stools 4. Dark-amber urine 5. Bleeding tendencies
1. Jaundice 2. Steatorrhea 3. Dark, tarry stools 4. Dark-amber urine 5. Bleeding tendencies Manifestations of obstructed bile flow in a patient with cholelithiasis include jaundice, dark, amber urine, which foams when shaken, clay-colored (not dark, tarry) stools, pruritus, intolerance for fatty foods (nausea, sensation of fullness, anorexia), bleeding tendencies, and steatorrhea. Dark, tarry stools are not a manifestation of obstructed bile flow; clay stools are.
Which subjective description of pain does the nurse expect in a patient who has cholecystitis? 1. Left flank pain with intermittent exacerbations 2. Right lower quadrant pain with rebound tenderness 3. Right upper quadrant pain radiating to the shoulder and scapula 4. Epigastric pain that intensifies when the patient is lying down
1. Left flank pain with intermittent exacerbations 2. Right lower quadrant pain with rebound tenderness 3. Right upper quadrant pain radiating to the shoulder and scapula 4. Epigastric pain that intensifies when the patient is lying down The pain of cholecystitis is in the region of the gallbladder (right upper quadrant), which is inflamed as a result of infection and irritation from bile. The pain may be referred to the right shoulder and scapula.
A patient with gallbladder disease has frequent episodes of severe vomiting. Which interventions would the nurse include in the patient's plan of care? (select all that apply) 1. Monitor vital signs. 2. Rinse the mouth daily. 3. Perform gastric decompression. 4. Place the patient on a low-fat diet. 5. Instruct the patient to gargle with salt water before every meal.
1. Monitor vital signs. 2. Rinse the mouth daily 3. Perform gastric decompression. 4. Place the patient on a low-fat diet. 5. Instruct the patient to gargle with salt water before every meal The nurse should monitor for the patient's vital signs to reduce the risk of any complications. It may be necessary to insert a nasogastric tube and use gastric decompression for patients with severe nausea and vomiting. Because the patient is vomiting frequently, the nurse should rinse the patient's mouth every two hours to provide comfort. Consuming fat may stimulate the gallbladder; the patient should be placed on a low-fat diet. Water high in salt content is an emetic and may provoke vomiting. Therefore the nurse should not instruct the patient to gargle with salt water.
The nurse finds that a patient with cholelithiasis is experiencing severe itching. The laboratory findings reveal a 2.1 mg/dL bilirubin level. The nurse expects that which medication will be prescribed? 1. Nadolol 2. Lactulose 3. Vasopressin 4. Cholestyramine
1. Nadolol 2. Lactulose 3. Vasopressin 4. Cholestyramine Bilirubin levels in a healthy individual are between 0.3 and 1.9 mg/dL. The patient's laboratory reports indicate hyperbilirubinemia, which results in jaundice. Moreover, the patient has severe itching, which is a sign of pruritus. Pruritus that is accompanied by jaundice is treated with cholestyramine. Nadolol is a beta blocker used for patients with cirrhosis to reduce bleeding from varices. Lactulose is used for relieving constipation. Vasopressin is a vasoconstrictor drug that controls bleeding from the varices and maintains hemostasis.
A patient returns to the surgical center 10 days after a cholecystectomy for his postoperative checkup. His wife is with him and is asking whether she should be concerned about having cholelithiasis as well. What is the most appropriate response by the nurse? 1. Obesity increases the risk, especially in women. 2. Pregnancy is not a risk factor for cholelithiasis in women. 3. The incidence of cholelithiasis is lower in women than in men. 4. Gender differences in the incidence decrease after 40 years of age
1. Obesity increases the risk, especially in women. 2. Pregnancy is not a risk factor for cholelithiasis in women. 3. The incidence of cholelithiasis is lower in women than in men. 4. Gender differences in the incidence decrease after 40 years of age Obesity causes increased secretion of cholesterol in bile, increasing the prevalence of cholelithiasis. Gender differences in the incidence of cholelithiasis decrease after 50 years of age. Pregnancy is a high risk factor for cholelithiasis, and multiparous women have the greatest risk of all. Cholelithiasis is more common in women than in men.
Which function do bile salts facilitate in the body? 1. Protein metabolism 2. Vitamin absorption 3. Glucose metabolism 4. Ammonia elimination
1. Protein metabolism 2. Vitamin absorption 3. Glucose metabolism 4. Ammonia elimination Bile salts help in the absorption of vitamins and the digestion of food. Proteases are the enzymes that metabolize proteins. Glucose is metabolized by the liver, and ammonia is eliminated by the kidneys.
The nurse is providing discharge instructions to a patient and caregiver following a laparoscopic cholecystectomy. Which of these measures will be included in the discharge teaching? (select all that apply) 1. Resume normal activities gradually within one week. 2. Eat a low-fat diet for several weeks after the surgery. 3. Keep the bandages on the puncture sites for three days. 4. Report any bile-colored drainage or pus from any incision. 5. Empty and measure the contents of the bile bag from the T tube every day.
1. Resume normal activities gradually within one week. 2. Eat a low-fat diet for several weeks after the surgery. 3. Keep the bandages on the puncture site for three days. 4. Report any bile-colored drainage or pus from any incision. 5. Empty and measure the contents of the bile bag from the T tube every day. After a laparoscopic cholecystectomy, the nurse should instruct the patient to gradually resume normal activities, usually within one week. The nurse should also instruct the patient to have liquids for the rest of the day and eat light meals for a few days. The amount of fat in the postoperative diet depends on the patient's tolerance of fat. A low-fat diet may be helpful if the flow of bile is reduced (usually only in the early postoperative period) or if the patient is overweight. Sometimes the patient is instructed to restrict fats for four to six weeks. Otherwise, no special dietary instructions are needed other than to eat nutritious meals and avoid excessive fat intake. The bandages are to be removed the day after the surgery. Patients need to report any bile-colored drainage or pus from any incision. Patients who undergo a laparoscopic cholecystectomy will not have a T-tube present.
Which substance is involved in the development of cholelithiasis? 1. Sodium 2. Calcium 3. Albumin 4. Globulin
1. Sodium 2. Calcium 3. Albumin 4. Globulin Cholelithiasis occurs due to an imbalance in the system that maintains calcium, bile salts, and cholesterol in a solution form, thereby resulting in precipitation. Albumin, sodium, and globulin are not involved in the formation of cholelithiasis
The nurse expects what physical finding in a patient with cholecystitis? 1. Spider angioma 2. Flapping tremors 3. Abdominal rigidity 4. Grey Turner's sign
1. Spider angioma 2. Flapping tremors 3. Abdominal rigidity 4. Grey Turner's sign Physical findings in patients with cholecystitis are abdominal rigidity and tenderness in the right upper quadrant. A spider angioma is a manifestation of liver cirrhosis wherein the patient has a small, dilated blood vessel with a red center and branching of the blood vessel. Flapping tremors are seen in patients with hepatic encephalopathy, which is characterized by rapid flexion and extension movements when asked to stretch the hand. Grey Turner's sign is a manifestation of acute pancreatitis characterized by bluish discoloration of the flanks.
The nurse notes that a patient is scheduled for a gallbladder removal. The patient will sign a consent form for what procedure? 1. Splenectomy 2. Cholecystectomy 3. Cholecystojejunostomy 4. Pancreaticoduodectomy
1. Splenectomy 2. Cholecystectomy 3. Cholecystojejunostomy 4. Pancreaticoduodectomy Cholecystectomy is the surgical removal of the gallbladder. Splenectomy is removal of the spleen. Cholecystojejunostomy is a surgical formation of means of communication between the gallbladder and jejunum. Pancreaticoduodectomy involves removal of the pancreas, gallbladder, and other organs.
Which factor explains why patients with cholelithiasis experience pruritus? 1. The solubility of bilirubin in urine 2. The deposition of bile salts in tissues 3. The bile not flowing into the duodenum 4. The decreased absorption of vitamin K
1. The solubility of bilirubin in urine 2. The deposition of bile salts in tissues 3. The bile not flowing into the duodenum 4. The decreased absorption of vitamin K Pruritus is manifested by itching and is caused by deposition of bile salts in skin tissues. Solubility of bilirubin in the urine results in amber-colored urine that foams on shaking; it does not result in pruritus. When bile does not flow into the duodenum, it accumulates in the systemic circulation and results in obstructive jaundice, not pruritus. Vitamin K is an important element in the clotting pathway. Its decreased absorption may cause clotting problems, resulting in bleeding.
The nurse has taught the client with suspected gallbladder disease about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement? A. "I know I must sign the consent form." B. "I hope the throat spray keeps me from gagging." C. "I'm glad I don't have to lie still for this procedure." D. "I'm glad some intravenous medication will be given to relax me."
A. "I know I must sign the consent form." B. "I hope the throat spray keeps me from gagging." C. "I'm glad I don't have to lie still for this procedure." D. "I'm glad some intravenous medication will be given to relax me. "The client does have to lie still for ERCP, which takes about 1 hour to perform
The nurse has given instructions to a client with biliary disease who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? A. "I will continue to take vitamin supplements." B. "This medication will help lower my cholesterol." C. "This medication would only be taken with water." D. "A high-fiber diet is important while taking this medication."
A. "I will continue to take vitamin supplements." B. "This medication will help lower my cholesterol." C. "This medication would only be taken with water." D. "A high-fiber diet is important while taking this medication." The use of flavored products or fruit juices can improve the taste.
The nurse is caring for a client with possible cholelithiasis who is being prepared for intravenous cholangiography and is teaching the client about the procedure. Which statement indicates that the client understands the purpose of this test? A. "My gallbladder will be irrigated." B. "This procedure will drain my gallbladder." C. "They will put medication in my gallbladder." D. "They are going to look at my gallbladder and ducts."
A. "My gallbladder will be irrigated." B. "This procedure will drain my gallbladder." C. "They will put medication in my gallbladder." D. "They are going to look at my gallbladder and ducts." An intravenous cholangiogram is done for diagnostic purposes. It outlines both the gallbladder and the ducts, so gallstones that have moved into the ductal system can be detected.
An ultrasound examination of the gallbladder is scheduled for a client with a suspected diagnosis of cholecystitis. Correct instructions about the procedure would include which statement made by the nurse? A. "This procedure may cause discomfort." B. "This test requires that you lie still for short intervals." C. "This procedure is preceded by the administration of oral tablets." D. "This procedure requires that you not eat or drink anything for 24 hours before the test."
A. "This procedure may cause discomfort." B. "This test requires that you lie still for short intervals." C. "This procedure is preceded by the administration of oral tablets." D. "This procedure requires that you not eat or drink anything for 24 hours before the test." Ultrasound examination of the gallbladder is a noninvasive procedure and frequently is used for emergency diagnosis of acute cholecystitis. The client will need to lie still during the test. It is a painless test and does not require the administration of oral tablets as preparation
The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item(s) are acceptable in the diet? A. Baked fish B. Fried chicken C. Sauces and gravies D. Fresh whipped cream
A. Baked fish B. Fried chicken C. Sauces and gravies D. Fresh whipped cream The client with cholecystitis needs to decrease overall intake of dietary fat. Foods that need to be avoided include sauces and gravies, fatty meats, fried foods, products made with cream, and heavy desserts
A Penrose drain is in place on the first postoperative day in a client who has undergone a cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate? A. Change the dressing. B. Continue to monitor the drainage. C. Notify the primary health care provider (PHCP). D. Use a pen to circle the amount of drainage on the dressing.
A. Change the dressing. B. Continue to monitor the drainage. C. Notify the primary health care provider (PHCP). D. Use a pen to circle the amount of drainage on the dressing. Serosanguinous drainage with a small amount of bile is expected from the Penrose drain for the first 24 hours. Drainage then decreases, and the drain is usually removed within 48 hours. A sterile dressing covers the site and would be changed if wet to prevent infection and skin excoriation
The nurse is assessing a client 24 hours after a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? A. Clamp the T-tube. B. Irrigate the T-tube. C. Notify the surgeon. D. Document the findings.
A. Clamp the T-tube. B. Irrigate the T-tube. C. Notify the surgeon. D. Document the findings. Following cholecystectomy, drainage from the T-tube is initially bloody and then turns a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day
For which clinical indicator would the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? (SATA) A. Dark urine B. Yellow skin C. Pain on urination D. Clay-colored stool E. Coffee-ground vomitus
A. Dark urine B. Yellow skin C. Pain on urination D. Clay-colored stool E. Coffee-ground vomitus
Which clinical finding would the nurse expect to find when performing a health history and physical assessment on a client with acute cholecystitis and biliary colic? (SATA) A. Diarrhea with black feces B. Intolerance to foods high in fat C. Vomiting coffee-ground emesis D. Gnawing pain when stomach is empty E. Pain that radiates to the right shoulder
A. Diarrhea with black feces B. Intolerance to foods high in fat C. Vomiting coffee-ground emesis D. Gnawing pain when stomach is empty E. Pain that radiates to the right shoulder
The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply. A. Fever B. Positive Cullen's sign C. Complaints of indigestion D. Palpable mass in the left upper quadrant E. Pain in the upper right quadrant after a fatty meal F. Vague lower right quadrant abdominal discomfort
A. Fever B. Positive Cullen's sign C. Complaints of indigestion D. Palpable mass in the upper left quadrant E. Pain in the upper right quadrant after a fatty meal During an acute episode of cholecystitis, the client may complain of severe right upper quadrant pain that radiates to the right scapula or shoulder or experience epigastric pain after a fatty or high-volume meal. Fever and signs of dehydration would also be expected, as well as complaints of indigestion, belching, flatulence, nausea, and vomiting.
The nurse is assessing a client with acute cholecystitis. The nurse notes that the client's sclerae are yellow. How would the nurse document this finding? A. Icterus B. Uveitis C. Jaundice D. Conjunctivitis
A. Icterus B. Uveitis C. Jaundice D. Conjunctivitis Icterus describes yellowing of the sclerae specifically.
A client has cholelithiasis with possible obstruction of the common bile duct. Before surgery is scheduled, which consideration would the nurse make when determining the client's nutritional status? A. Is the client deficient in vitamins A, D, and K? B. Does the client eat adequate amounts of dietary fiber? C. Does the client consume excessive amounts of protein? D. Are the client's levels of potassium and folic acid increased?
A. Is the client deficient in vitamins A, D, and K? B. Does the client eat adequate amounts of dietary fiber? C. Does the client consume excessive amounts of protein? D. Are the client's levels of potassium and folic acid increased? Bile promotes the absorption of fat-soluble vitamins; an obstruction of the common bile duct limits the flow of bile into the duodenum, limiting absorption of vitamins A, D, and K.
A client is returned to the surgical unit after an abdominal cholecystectomy. Which is the main reason why the nurse would assess for clinical indicators of respiratory complications? A. Length of time required for surgery is prolonged B. Incision is in close proximity to the client's diaphragm C. Client's resistance is lowered because of bile in the blood D. Bloodstream is invaded by microorganisms from the biliary tract
A. Length of time required for surgery is prolonged B. Incision is in close proximity to the client's diaphragm C. Client's resistance is lowered because of bile in the blood D. Bloodstream is invaded by microorganisms from the biliary tract The location of the incision results in pain on inspiration or coughing. The subsequent reluctance to cough and breathe deeply facilitates respiratory complications from retained secretions
The nurse is caring for a client with common bile duct obstruction. The nurse would anticipate that the primary health care provider (PHCP) will prescribe which diet for this client? A. Low fat B. High protein C. High carbohydrate D. Low in water-soluble vitamins
A. Low fat B. High protein C. High carbohydrate D. Low in water-soluble vitamins Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum. Bile acids or bile salts are produced by the liver to emulsify or break down fats.
The nurse is reviewing the risk factors for cholecystitis. Which of the following would the nurse identify as risk factors for cholecystitis? Select all that apply. A. Male B. Female C. Low-fat diet D. Rapid weight loss E. Body mass index 20.5 kg/m2 F. Serum cholesterol level 160 mg/dL (4.7 mmol/L)
A. Male B. Female C. Low-fat diet D. Rapid weight loss E. Body mass index 20.5 kg/m2 F. Serum cholesterol level 160 mg/dL There are several risk factors for the development of cholecystitis, including being a female of any age (although risk increases with aging), fat-restricted diets, prolonged fasting, rapid weight loss, obesity, and hyperlipidemia.
The nurse is assessing a client with cholecystitis due to an obstructing cholelithiasis. The nurse notes that the client's stools are foul-smelling and oily. How would the nurse document this finding? A. Melena B. Diarrhea C. Steatorrhea D. Hyperbilirubinemia
A. Melena B. Diarrhea C. Steatorrhea D. Hyperbilirubinemia Lack of bile in the small intestines leads to oily, foul-smelling stools due to the body's inability to digest and absorb fat. This is known as steatorrhea.
A client has been diagnosed with cholelithiasis. Which fact about the condition would the nurse recall when assessing this client for risk factors? A. Men are more likely to be affected than women B. Young people are affected more frequently than older people C. Individuals who are obese are more prone to this condition than those who are thin D. People who are physically active are more apt to develop this condition than those who are sedentary
A. Men are more likely to be affected than women B. Young people are affected more frequently than older people C. Individuals who are obese are more prone to this condition than those who are thin D. People who are physically active are more apt to develop this condition than those who are sedentary
The nurse is creating a care plan for a client diagnosed with acute cholecystitis who does not want surgery and has chosen conservative management. The client is experiencing nausea, vomiting, and severe pain. Which interventions would the nurse expect? Select all that apply. A. Nothing-by-mouth (NPO) diet. B. Administer analgesics as needed. C. Administer antidiarrheals as needed. D. Administer fat-soluble vitamins. E. Maintenance diet after acute episode with low-fat foods
A. Nothing-by-mouth (NPO) diet. B. Administer analgesics as needed. C. Administer antidiarrheals as needed D. Administer fat-soluble vitamins. E. Maintenance diet after acute episode with low-fat foods Treatment of cholecystitis is usually surgical; however, the condition can also be conservatively managed. Conservative management includes the administration of intravenous (IV) fluids and an NPO diet with possible nasogastric (NG) tube placement, later progressing to a low-fat diet and the administration of antiemetics, analgesics, fat-soluble vitamins, anticholinergics, and antibiotics as appropriate
The nurse in a medical-surgical unit is caring for a client with cholecystitis. When viewing the client's chart, the nurse notes that which findings place the client at an increased risk for cholecystitis? Select all that apply. A. Obesity B. Pregnancy C. Male gender D. Genetic factors E. Sickle cell disease F. Hormone replacement therapy
A. Obesity B. Pregnancy C. Male gender D. Genetic factors E. Sickle cell disease F. Hormone replacement therapy
The nurse is assessing female clients and identifies that which client has the greatest risk of developing gallbladder disease? A. Older than age 40 and obese B. Older than age 40 with a low serum cholesterol level C. Less than 40 years of age with a history of high fat intake D. Less than 40 years of age with a family history of gallstones
A. Older than age 40 and obese B. Older than age 40 with a low serum cholesterol level C. Less than 40 years of age with a history of high fat intake D. Less than 40 years of age with a family history of gallstones The characteristics known as the 4 Fs (female, fat, forty, and fertile) are well-established risk factors for gallbladder disease
A client with cholelithiasis is scheduled for a lithotripsy. Which would the nurse include in the client's teaching plan? A. Opioids will be available for postprocedural pain B. Fever is a common response after this procedure C. Heart palpitations often occur after the procedure D. Anesthetics are not necessary during the procedure
A. Opioids will be available for postprocedural pain B. Fever is a common response after this procedure C. Heart palpitations often occur after the procedure D. Anesthetics are not necessary during the procedure
The nurse is reviewing the clinical manifestations of cholecystitis. Which of the following would the nurse identify as a sign or symptom of cholecystitis? Select all that apply. A. Pale yellow urine B. Clay-colored stools C. Positive Blumberg sign D. Localized right lower quadrant pain E. Epigastric pain with radiation to the right shoulder
A. Pale yellow urine B. Clay-colored stools C. Positive Blumberg sign D. Localized right lower quadrant pain E. Epigastric pain with radiation to the right shoulder
A client with cholecystitis is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching? A. Rice B. Whole milk C. Broiled fish D. Baked chicken
A. Rice B. Whole milk C. Broiled fish D. Baked chicken Bile acids or bile salts are produced by the liver to emulsify or break down fats. Blockage of the common bile duct impedes the flow of bile from the gallbladder to the duodenum, thus preventing breakdown of fatty intake
The nurse is providing preoperative teaching to a client scheduled for a laparoscopic cholecystectomy. Which intervention would be of highest priority in the preoperative teaching plan? A. Teaching leg exercises B. Teaching coughing and deep-breathing exercises C. Providing instructions regarding food and fluid restrictions D. Assessing the client's understanding of the surgical procedure
A. Teaching leg exercises B. Teaching coughing and deep-breathing exercises C. Providing instructions regarding food and fluid restrictions D. Assessing the client's understanding of the surgical procedure After cholecystectomy, respirations tend to be shallow because deep breathing is painful as a result of the location for the surgical procedure
A nurse is obtaining a past medical history for a client suspected of cholecystitis. Which finding would the nurse report to the primary health care provider? A. The client has a BMI of 22.9. B. The client has a history of surgeries. C. The client is taking oral contraceptives. D. The client reports eating small, frequent meals.
A. The client has a BMI of 22.9. B. The client has a history of surgeries. C. The client is taking oral contraceptives. D. The client reports eating small, frequent meals. The nurse would report that the client is taking oral contraceptives because the incidence of cholecystitis is higher with clients on this medication
A client with suspected gallbladder disease is scheduled for an oral cholecystogram. The nurse asks the dietary department to bring low-fat foods for the evening meal for which purpose? A. To keep cholesterol levels on the lower side B. To prevent contraction of the gallbladder before testing C. To make sure that the client is eating a heart-healthy diet D. To keep protein levels low because of the risk for kidney toxicity
A. To keep cholesterol levels on the lower side B. To prevent contraction of the gallbladder before testing C. To make sure that the client is eating a heart-healthy diet D. To keep protein levels low because of the risk for kidney toxicity Normal dietary intake of fat would be maintained during the days preceding an oral cholecystogram to empty bile from the gallbladder, and a low-fat diet is prescribed on the evening before the test. The low-fat diet prevents contraction of the gallbladder and allows accumulation of the contrast substance needed for radiographic visualization
The nurse is developing a list of home care instructions for a client being discharged after a laparoscopic cholecystectomy. Which instructions would the nurse include in the postoperative discharge plan of care? Select all that apply. A. Wound care B. Follow-up care C. Activity restrictions D. Dietary instructions E. Deep-breathing exercises
A. Wound care B. Follow-up care C. Activity restrictions D. Dietary instructions E. Deep-breathing exercises The type of planning and instructions required vary with the individual client and the type of surgery. Specific instructions that this client needs to receive before discharge would include wound care, activity restrictions, dietary instructions, postoperative medication instructions, personal hygiene, and follow-up appointments.
A client suspected of cholelithiasis is admitted to the hospital. Upon assessment, the nurse notes that the client is jaundiced. Which diagnostic imaging would be most important for the client to obtain? A. X-ray B. Discogram C. Dual energy x-ray D. Endoscopic retrograde cholangiopancreatography
A. X-ray B. Discogram C. Dual energy x-ray D. Endoscopic retrograde cholangiopancreatography
The nurse is caring for a client with cholelithiasis. Which clinical manifestation would the nurse expect if the client develops obstructive jaundice? A. Yellow sclera B. Pain on urination C. Dark brown stools D. Coffee-ground emesis
A. Yellow sclera B. Pain on urination C. Dark brown stools D. Coffee-ground emesisYellow sclera results from failure of bile to enter the intestines, with subsequent backup into the biliary system and diffusion into blood. Bilirubin is carried into all body regions, including skin and mucous membranes.
