Prep-U Assessment and Management of Patients with Biliary Disorders chapter 44

2

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? 1. Malnutrition and acute pancreatitis 2. Alcohol consumption and smoking 3. Caffeine consumption and acute pancreatitis 4. Acute hepatitis and alcohol consumption

a

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? a) 30 mg/dL b) 50 mg/dL c) 70 mg/dL d) 90 mg/dL

a

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: a) Edema and inflammation b) Disseminated intravascular coagulopathy c) Pleural effusion d) Sepsis

2

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? 1. Potassium 2. Vitamin K 3. Vitamin B 4. Oral bile acids

d

A nurse is caring for a client in the emergency department who is complaining of severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value requires immediate intervention? a) Calcium level of 7.8 mg/dl b) Serum glucose level of 240 mg/dl c) White blood cell (WBC) count of 18,000 mm3 d) Troponin of 2.3 mcg/L

1

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? 1. Relieving abdominal pain 2. Preventing fluid volume overload 3. Maintaining adequate nutritional status 4. Teaching about the disease and its treatment

1

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? 1. Acute pain related to biliary spasms 2. Deficient knowledge related to prevention of disease recurrence 3. Anxiety related to unknown outcome of hospitalization 4. Imbalanced nutrition: Less than body requirements related to biliary inflammation

1

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? 1. Weight loss 2. Diarrhea 3. Fatigue 4. Hypertension

2

Which of the following groups of people are most likely affected by cholecystitis: 1. Children 2. Female 3. AIDS immunocompromised 4. Black males 5. Adolescents or young adults 6. Caucasasin males

1

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? 1. "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." 2. "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." 3. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." 4. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."

3

A client is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and reports of vague upper and midabdominal pain that increases in intensity at night. The client' health history indicates alcoholism, smoking of a pack of cigarettes daily, and diabetes for the past 20 years. Upon examination the nurse finds swelling in the feet and abdominal ascites. Based on the clinical manifestations, which condition is the most likely diagnosis? 1. Pancreatic pseudocysts 2. Acute pancreatitis with edema 3. Pancreatic carcinoma 4. Cholecystitis

2

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? 1. Increased serum calcium levels 2. Elevated urine amylase levels 3. Decreased liver enzyme levels 4. Decreased white blood cell count

3

A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ? 1. Serves as a storage unit for glucagon 2. Digests carbohydrates in the jejunum 3. Releases bile in response to cholecystokinin 4. Controls the flow of trypsin to digest proteins

2, 3, 4, 5

A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. 1. "The pancreas enlarges and atrophies with age." 2. "The pancreas develops fibrous material with age." 3. "The pancreas develops fatty deposits with age." 4. "The pancreas decreases secretion of enzymes with age." 5. "The pancreas decreases bicarbonate secretion with age."

1

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? 1. ERCP 2. MRI 3. CT 4. Ultrasound

3

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? 1. To decrease metabolism 2. To depress the central nervous system and increase the pain threshold 3. To reduce gastric and pancreatic secretions 4. To relieve nausea and vomiting

1

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? 1. Pancreatitis can elevate the diaphragm and alter the breathing pattern. 2. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. 3. Pancreatitis can atrophy the diaphragm and alter the breathing pattern. 4. Pancreatitis causes alterations to hemoglobin, impairing oxygenation.

1

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? 1. Assisting the client to turn, cough, and deep breathe every 2 hours 2. Teaching the client to choose low-fat foods from the menu 3. Performing range-of-motion (ROM) leg exercises hourly while the client is awake 4. Assisting the client to ambulate the evening of the operative day

c

Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy? a) Semi-Fowler's position b) Low-carbohydrate, low-protein diet immediately after surgery c) Observe color of sclera d) NPO status postop for 2 days

pigment stones

What type of stones are these they account for only 10% to 25% of cases of stones in the United States:

3

From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography? 1. Steven, suspected of having a tumor in the colon 2. Andrew, suspected of having esophageal abnormalities 3. Mark, suspected of having stones in the gallbladder 4. Sandra, suspected of having lesions in the liver

a

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a) Dysfunction of the pancreatic islet cells b) Inability for the liver to reabsorb serum glucose c) Ingestion of foods high in sugar d) Renal failure

c

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? a. 1 to 2 b. 3 to 5 c. 6 to 12 d. 13 to 18

1

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? 1. Deficient fluid volume 2. Excess fluid volume 3. Decreased cardiac output 4. Ineffective gastrointestinal tissue perfusion

3

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? 1. Placing the client in a semi-Fowler's position 2. Maintaining nothing-by-mouth (NPO) status 3. Administering morphine I.V. as ordered 4. Providing mouth care

c

A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to a) Presence of diabetes mellitus b) Cigarette smoking c) Age d) Dietary intake of fat

1

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? 1. It visualizes the gallbladder and bile duct. 2. It visualizes the liver and pancreas. 3. It shows the sizes of the abdominal organs and detects any masses. 4. It visualizes the biliary structures and pancreas via endoscopy.

2

A client with calculi in the gallbladder is said to have 1. Cholecystitis 2. Cholelithiasis 3. Choledocholithiasis 4. Choledochotomy

d

A patient is admitted to the health care center with severe abdominal pain rated at 10 on a 1-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP) as ordered. The nurse plans for which of the following goals following the administration of this mediation? a) To control BP b) To diagnose the cause of abdominal pain c) To control muscle spasms d) To increase the patient's pain threshold

2, 3, 4

A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.) 1. Amber-colored urine 2. Clay-colored feces 3. Pruritus 4. Jaundice 5. Pain in the left upper abdominal quadrant

4

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for? 1. X-ray 2. Oral cholecystography 3. Cholecystography 4. Ultrasonography

a

A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? a) Serum bilirubin level greater than 1.0 mg/dL b) Serum albumin concentration of 4.0 g/dL c) Serum ammonia concentration of 90 mg/dL d) Serum globulin concentration of 2.0 g/dL

1

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? 1. Providing intensive insulin therapy 2. Allowing a clear liquid diet during the acute phase 3. Administering oral analgesics around the clock 4. Maintaining a high-Fowler's position

4

Cholesterol stones account for what percentage of cases of gallbladder disease in the United States? 1. 15% 2. 25% 3. 60% 4. 75%

1

Clinical manifestations of common bile duct obstruction include all of the following except: 1. Light-colored urine 2. Clay-colored feces 3. Pruritus 4. Jaundice

4

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? 1. Placing the client on NPO (nothing by mouth) status for 2 days after surgery 2. Clamping the T-tube immediately after surgery 3. Placing the client in the semi-Fowler position immediately after surgery 4. Assessing the color of the sclera every shift

2

Which is a clinical manifestation of cholelithiasis? 1. Epigastric distress before a meal 2. Clay-colored stools 3. Abdominal pain in the upper left quadrant 4. Nonpalpable abdominal mass

3

Which of the following age groups is most frequently affected by cholecystitis: 1. Adolescent 2. Onset by age 12 3. Forty years old 4. 90 years old 5. 3 months to 3years old

Flatulence

Which of the following symptoms in cholecystitis is most likely due to intolerance of fatty stools: 1. Confusion 2. Headache 3. Muscle weakness 4. Painful muscle cramps 5. Flatulence 6. Bloody diarrhea

d

Which of the following terms most precisely refers to the incision of the common bile duct for removal of stones? a) Choledochotomy b) Choledochoduodenostomy c) Cholecystostomy d) Choledocholithotomy

1

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? 1. Decreases in the physiologic function of major organs 2. Increases in the bicarbonate output by the kidneys 3. Increases in the rate of pancreatic secretion 4. Development of local complications

a

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a) Reserving an antecubital site for a peripherally inserted central catheter (PICC) b) Providing generous servings at mealtime c) Providing the client with plenty of P.O. fluids d) Limiting I.V. fluid intake according to the physician's order

1, 3, 6

A client with severe abdominal pain and an abnormal computed tomography (CT) scan, which shows an enlarged pancreas, has been admitted to a medical unit today. The nurse anticipates including which actions in the client's plan of care? Select all that apply. 1. Use a pain scale throughout treatment. 2. Provide oral hygiene and gargling solutions. 3. Administer pain relief measures. 4. Assess current nutrtional status. 5. Encourage ambulation as tolerated. 6. Mantain nothing by mouth (NPO) diet.

b

The nurse identifies a potential collaborative problem of electrolyte imbalance for a patient with severe acute pancreatitis. Which of the following assessment findings would alert the nurse to an electrolyte imbalance associated with acute pancreatitis? a) Paralytic ileus and abdominal distention b) Muscle twitching and finger numbness c) Elevated blood glucose levels d) Hypotension

4

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? 1. "I can drive after 2 weeks." 2. "I can take a shower in a week." 3. "I should remain on bed rest for several days." 4. "I should wash the site with mild soap and water."

1, 2

The nurse reviews data collected during a health history with a client. Which finding(s) does the nurse identify that increases the client's risk of developing cholesterol gallbladder stones? Select all that apply. 1. Age 45 2. Female 3. Vegan eating plan 4. Body mass index 23 5. History of appendicitis

d

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

4

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? 1. To drain the pancreatic bed 2. To aid opening up of pancreatic duct 3. To prevent the occurrence of fibrosis 4. To avoid inflammation of the pancreas

1

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? 1. Frequent changes of positions 2. Placing the patient in the prone position 3. Perform chest physiotherapy 4. Suction the patient every 4 hours

1

Which enzyme aids in the digestion of fats? 1. Lipase 2. Amylase 3. Secretin 4. Trypsin

2

Which foods should be avoided following acute gallbladder inflammation? 1. Cooked fruits 2. Cheese 3. Coffee 4. Mashed potatoes

1

Which is a gerontological consideration associated with the pancreas? 1. Increased amount of fibrous material 2. Increased bicarbonate output 3. Increased rate of pancreatic secretion 4. Increased calcium absorption

2

Which of the following best describe cholecystitis: 1. Biliary tract inflammationm 2. Gallbladder inflammation 3. Inflammed Divertilitis 4. Inflammation of pancreas 5. Inflammation of urinary tract 6. Inflammed stomach

3

Which of the following characteristics is most frequently associated with cholecystitis: 1. Prmarily in men 2. BMI less than 19 3. Fat obese 4. IV drug use 5. Antibiotic use

b

Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels? a) Dry mouth, which makes the patient thirsty b) Frequent vomiting leading to loss of fluid volume c) Acetone in the urine d) High glucose levels in the blood

2

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? 1. Appendicitis 2. Pancreatitis 3. Cholecystitis 4. Peptic ulcer

2

Which of the following groups of people are most likely associated with cholecystitis: 1. Diabetics 2. Fertile (pregnant) 3. Children 4. Leukemic patients 5. Vegan

d

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Monitor pulse oximetry every hour. b) Withhold analgesics unless necessary. c) Instruct the client to cough only when necessary. d) Use incentive spirometry every hour.

3

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? 1. Serum calcium 2. Serum bilirubin 3. Serum amylase 4. Serum potassium

1

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? 1. Pain with abdominal distention and hypotension 2. Presence of blood in the client's stool and recent hypertension 3. Presence of easy bruising and bradycardia 4. Adventitious breath sounds and hypertension

1, 3, 4, 5

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas? Select all that apply. 1. "Internal secretion of hormones is the function of the endocrine pancreas." 2. "Internal secretion of hormones is the function of the exocrine pancreas." 3. "The endocrine pancreas secretes hormones through a ductless gland." 4. "The exocrine pancreas secretes hormones from excretory ducts." 5."The exocrine pancreas secretes pancreatic enzymes into the GI tract."

1, 2, 3

A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply). 1. An abnormal glucose tolerance 2. Glucosuria 3. Hyperglycemia 4. Elevated lipase level 5. Hypoglycemia

1

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? 1. decompression 2. instillation 3. gavage 4. llavage

2

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? 1. Disturbed body image 2. Impaired nutrition: less than body requirements 3. Nausea 4. Anxiety

2

The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? 1. "How many meals do you eat every day?" 2. "How much alcohol do you consume in a day?" 3. "When was the last time you took acetaminophen?" 4. "How often and how long do you exercise each day?

2

The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? 1. Toast 2. Coffee 3. Oatmeal 4. Orange slices

1

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: 1. yellow sclerae. 2. light amber urine. 3. circumoral pallor. 4. black, tarry stools.

1

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? 1. Withholding all oral intake, as ordered, to decrease pancreatic secretions 2. Administering meperidine, as ordered, to relieve severe pain 3. Limiting I.V. fluids, as ordered, to decrease cardiac workload 4. Keeping the client supine to increase comfort

1

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? 1. Increase respiratory effectiveness. 2. Eliminate the need for nasogastric intubation. 3. Improve nutritional status during recovery. 4. Decrease the amount of postoperative analgesia needed.

3

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient? 1. The patient requires more pain medication. 2. The patient is developing a paralytic ileus. 3. The patient has developed peritonitis. 4. The patient has developed renal failure.

3

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? 1. "The tube helps control fluid and electrolyte imbalance." 2. "The tube provides relief from nausea and vomiting." 3. "The tube allows the gastrointestinal tract to rest." 4. "The tube allows toxins to be removed."

2

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? 1. Administering an analgesic once per shift, as ordered, to prevent drug addiction 2. Positioning the client on the side with the knees flexed 3. Encouraging frequent visits from family and friends 4. Administering frequent oral feedings

5

Which of the following groups of people are most likely associated with cholecystitis: 1. Immunocompromised 2. African americans 3. Elderly 4. Males between 15 - 35 yrs old 5. Fair (causcasin) 6. Children

1

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? 1. Carbohydrate digestion 2. Protein synthesis 3. Fat digestion 4. Protein digestion

1

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: 1. cannot tolerate high-glucose concentration. 2. are at risk for gallbladder contraction. 3. are at risk for hepatic encephalopathy. 4. can digest high-fat foods.

1

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? 1. Hot roast beef sandwich with gravy 2. Mashed potatoes 3. White rice 4. Vanilla pudding

c

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a. 1 to 4 months b. 4 to 6 months c. 6 to 12 months d. Over 1 year