MCA-2 Adaptive Quiz #1 Disorders of the Gallbladder: Biliary Tract Disorders
The nurse provides education to a patient about postoperative care after an open cholecystectomy. Which statement made by the patient indicates the need for further teaching? "I should consume a low-fat diet." "I am permitted to resume weightlifting." "I am permitted to engage in sexual intercourse." "It is important to perform deep-breathing exercises."
"I am permitted to resume weightlifting." Rationale Patients who have undergone open cholecystectomy should not lift heavy weights for up to four to six weeks after surgery. An open cholecystectomy is not associated with dietary restrictions; however, a low-fat diet is recommended. Sexual activities are not contraindicated in a patient who has undergone open cholecystectomy. Deep-breathing exercises help relieve stress, keep the lungs clear, and avoid atelectasis after surgery.
The nurse provides education to a patient about laparoscopic cholecystectomy. Which statement made by the patient indicates the need for further teaching? "Small punctures will be made into my abdomen." "I may be discharged the same day as the surgery." "I will have work restrictions for 4 to 6 weeks after the surgery." "An instrument with a camera attached is inserted into the abdomen."
"I will have work restrictions for 4 to 6 weeks after the surgery." Rationale 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. p. 1010
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. "I will monitor for bleeding." "I will encourage the patient to practice deep breathing." "I will most likely need to administer narcotics for pain control." "The patient will use a bedside commode for the first 24 hours after surgery." "The patient will need to return to the office in 7 to 10 days for removal of stitches."
"I will most likely need to administer narcotics for pain control." "The patient will use a bedside commode for the first 24 hours after surgery." "The patient will need to return to the office in 7 to 10 days for removal of stitches." Rationale With laparoscopic cholecystectomy, there are small incisions that are covered by small adhesive bandages that can be removed in about five days. The stitches dissolve over time. Patients who have undergone laparoscopic cholecystectomy can usually walk to the bathroom, so there is no need for a bedside commode. 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. pp. 1009-1010
When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? Do not return to work or normal activities for three weeks. Bile-colored drainage probably will drain from the incision. A lower-fat diet may be tolerated better for several weeks. Keep the bandages on and the puncture site dry until it heals.
A lower-fat diet may be tolerated better for several weeks. Rationale 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.
The nurse expects what physical finding in a patient with cholecystitis? Spider angioma Flapping tremors Abdominal rigidity Grey Turner's sign
Abdominal rigidity Rationale 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. p. 1006
The nurse teaches a caregiver about postoperative care for a patient who has undergone an open cholecystectomy. Which action by the caregiver may aggravate the patient's condition? Encouraging deep-breathing exercises Allowing bile to drain from the insertion site Ensuring that the room is sufficiently ventilated Avoiding the skin around the T-tube insertion site while cleaning
Avoiding the skin around the T-tube insertion site while cleaning Rationale Postoperative care for a patient who has undergone open cholecystectomy involves cleaning the skin around the insertion site with an antiseptic such as hydrogen peroxide. Deep-breathing exercises should be encouraged to prevent respiratory complications after the surgery. Bile drainage should be maintained. The caregiver should ensure that the room is sufficiently ventilated. p. 1009
The nurse teaches a caregiver about postoperative care for a patient who has undergone an open cholecystectomy. Which action by the caregiver may aggravate the patient's condition? <p>The nurse teaches a caregiver about postoperative care for a patient who has undergone an open cholecystectomy. Which action by the caregiver may aggravate the patient’s condition?</p> Encouraging deep-breathing exercises Allowing bile to drain from the insertion site Ensuring that the room is sufficiently ventilated Avoiding the skin around the T-tube insertion site while cleaning
Avoiding the skin around the T-tube insertion site while cleaning Rationale Postoperative care for a patient who has undergone open cholecystectomy involves cleaning the skin around the insertion site with an antiseptic such as hydrogen peroxide. Deep-breathing exercises should be encouraged to prevent respiratory complications after the surgery. Bile drainage should be maintained. The caregiver should ensure that the room is sufficiently ventilated. p. 1009
The nurse notes that a patient is scheduled for a gallbladder removal. The patient will sign a consent form for what procedure? Splenectomy Cholecystectomy Cholecystojejunostomy Pancreaticoduodectomy
Cholecystectomy Rationale 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 condition is associated with the formation of stones in the gallbladder? Biliary colic Cholangitis Cholecystitis Cholelithiasis
Cholelithiasis Rationale 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. pp. 1006-1007
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? Nadolol Lactulose Vasopressin Cholestyramine
Cholestyramine Rationale 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. pp. 985, 994
The nurse is caring for a patient with gallstones and expects what assessment finding? Tachycardia Hypotension Hyperglycemia Clay-colored stools
Clay-colored stools Rationale The presence of gallstones results in bile flow obstruction, which is manifested by fever, clay-colored stools, and dark urine. Tachycardia and hypotension are the clinical manifestations of acute pancreatitis. Hyperglycemia is seen in patients with chronic pancreatitis. p. 1009
During history-taking, a patient tells the nurse, "Gallstones were removed by passing shock waves into my gallbladder." Which procedure is the patient referring to? Cholecystojejunostomy Pancreaticoduodenectomy Balloon sphincteroplasty Extracorporeal shock-wave lithotripsy (ESWL)
Extracorporeal shock-wave lithotripsy (ESWL) Rationale Extracorporeal shock-wave lithotripsy (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. Cholecystojejunostomy is surgical removal of the gallbladder. Pancreaticoduodenectomy is the surgical formation of a means of communication between the gallbladder and jejunum. Balloon sphincteroplasty is an adjunct procedure used with extracorporeal shock-wave lithotripsy to dilate the biliary duct.
What is appropriate for the nurse to include when teaching a student nurse about open cholecystectomy? It involves insertion of a T-tube following surgery. It involves insertion of a needle into the core of the tumor. It involves resection of the proximal pancreas and duodenum. It involves administration of an embolic agent through a catheter.
It involves insertion of a T-tube following surgery. Rationale 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. p. 1008
The nurse should recommend what type of diet for a patient with acute cholecystitis? Low-fat Low-protein Low-calcium Low-carbohydrate
Low-fat Rationale Cholecystitis is inflammation of the gallbladder. Fats contribute to gallstone formation, worsening the inflammation; therefore, patients with cholecystitis should consume a low-fat diet. A diet low in protein is given to patients with kidney or liver disease. Patients with cholecystitis should be given a diet rich in calcium and carbohydrates. pp. 1009-1010
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? Obesity increases the risk, especially in women. Pregnancy is not a risk factor for cholelithiasis in women. The incidence of cholelithiasis is lower in women than in men. Gender differences in the incidence decrease after 40 years of age.
Obesity increases the risk, especially in women. Rationale 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. p. 1005
The nurse is providing postoperative care to a patient who underwent open cholecystectomy three days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider? Tolerance of a full-liquid diet Oral temperature of 101.8° F Report of pain at a level 5 on a scale of 0 to 10 An 8-hour fluid intake of 680 mL and an output of 660 mL
Oral temperature of 101.8° F Rationale An oral temperature of 101.8º F on the third postoperative day indicates a possible infection and requires further evaluation and modification of the nursing plan of care. Tolerating a full liquid diet and pain at a level of 5 on a 0 to 10 scale are appropriate outcomes at this time. Although fluid intake is low, it is in balance with the output; therefore, it would not be as high a priority as the increased temperature. pp. 1007-1008
A patient who has undergone laparoscopic cholecystectomy reports difficulty breathing. The nurse suspects that which patient activity is contributing to this difficulty? Resting in the supine position Sleeping for prolonged periods Performing isometric exercises Performing deep-breathing exercises
Performing deep-breathing exercises Rationale Carbon dioxide used to inflate the abdominal cavity for laparoscopic cholecystectomy may result in breathing difficulty by irritating the phrenic nerve and diaphragm. To counteract this, the patient should not be placed in the supine position, to help to move the gas pocket away from the abdomen. Prolonged sleep does not cause breathing difficulty in the patient after the surgery. Isometric exercises help strengthen muscles and do not result in breathing difficulty. Deep-breathing exercises relieve stress and can do not cause difficulty breathing.
A patient who is receiving treatment for cholelithiasis experiences severe nausea and six episodes of vomiting. The nurse identifies that which intervention will be beneficial to the patient? Administrating lactulose Administrating rifaximin Performing gastric decompression Performing endotracheal intubation
Performing gastric decompression Rationale Gastric decompression is performed to remove the gastric contents via a nasogastric tube to prevent aspiration of food contents and reduce the incidence of nausea and vomiting. Lactulose is a laxative and is used to treat constipation. Rifaximin is an antibiotic prescribed for patients with hepatic encephalopathy. Endotracheal intubation is a means of providing ventilation to the patient. p. 1007
The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? Encouraging exercise Assisting with ambulation Assisting with repositioning Providing oral care every two hours
Providing oral care every two hours Rationale Patients with cholecystitis may have severe nausea and vomiting. Therefore the nurse should give frequent oral care to the patient to avoid discomfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting. p. 1009
The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? Encouraging exercise Assisting with ambulation Assisting with repositioning Providing oral care every two hours
Providing oral care every two hours Rationale Patients with cholecystitis may have severe nausea and vomiting. Therefore the nurse should give frequent oral care to the patient to avoid discomfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting. p. 1009
During a follow-up visit, the nurse finds that the condition of a patient with cholelithiasis has improved. Which food included in the patient's diet most likely facilitated the improvement? Butter Yogurt Cheese Skim milk
Skim milk Rationale 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. p. 1008
Which type of monitoring should the nurse include in the care plan of a patient with cholecystitis? Monitoring gums for bleeding Monitoring blood glucose levels Monitoring serum albumin levels Monitoring serum creatinine levels
monitoring gums for bleeding Rationale Cholecystitis is associated with decreased production of prothrombin, a clotting factor, thereby putting the patient at risk of bleeding. Common bleeding sites are mucous membranes of the gums, mouth, and nose, as well as injection sites. A patient with cholecystitis does not show alterations in blood glucose, serum albumin, and serum creatinine levels. p. 1009
