Chapter 44 Hinkle, Exam #3 PDF

Chapter 44: Management of Patients with Biliary Disorders 1. A nurse is assessing a client who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the client's pain, the nurse should anticipate that it may radiate to what region...

Chapter 44: Management of Patients with Biliary Disorders 1. A nurse is assessing a client who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the client's pain, the nurse should anticipate that it may radiate to what region? A. Left upper chest B. Inguinal region C. Neck or jaw D. Right shoulder om ANS: D Rationale: The client may have biliary colic with excruciating upper-right abdominal pain.c that radiates to the back or right shoulder. Pain from cholecystitis does not typically radiate to the left upper chest, inguinal area, neck, or jaw. ks PTS: 1 REF: p. 1418 an NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand tb NOT: Multiple Choice es 2. A client has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse explain the pathophysiology of this client's health problem? bt A. "Toxins have accumulated and inflamed your pancreas." B. "Bacteria likely migrated from your intestines and became lodged in your pancreas." C. "A virus that was likely already present in your body has begun to attack your pancreatic cells." D. "The enzymes that your pancreas produces have damaged the pancreas itself." ANS: D Rationale: Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the autodigestion of the pancreas. Less commonly, toxic substances and microorganisms are implicated as the cause of pancreatitis. PTS: 1 REF: p. 1430 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice om 3. A client's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the client's laboratory studies, what finding is most closely associated with this diagnosis? A. Increased bilirubin.c B. Decreased serum cholesterol C. Increased blood urea nitrogen (BUN) ks D. Decreased serum alkaline phosphatase level an ANS: A Rationale: If the flow of blood is impeded, bilirubin, a pigment derived from the tb breakdown of red blood cells, does not enter the intestines. As a result, bilirubin levels in the blood increase. Cholesterol, BUN, and alkaline phosphatase levels are not typically es affected. PTS: 1 REF: p. 1419 bt NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A nurse who provides care in a community clinic assesses a wide range of individuals. The nurse should identify which client as having the highest risk for chronic pancreatitis? A. A 45-year-old obese woman with a high-fat diet  B. An 18-year-old man who is a weekend binge drinker C. A 39-year-old man with chronic alcoholism D. A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day ANS: C Rationale: Excessive and prolonged consumption of alcohol accounts for most cases of chronic pancreatitis in Western societies. PTS: 1 REF: p. 1433 om NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice.c 5. A 37-year-old client presents at the emergency department (ED) reporting nausea and ks vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's spouse states that the client was on a drinking binge for an the past 2 days. The ED nurse should assist in assessing the client for what health problem? A. Severe pancreatitis with possible peritonitis tb B. Acute cholecystitis C. Chronic pancreatitis es D. Acute appendicitis with possible perforation ANS: A bt Rationale: Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis. PTS: 1 REF: p. 1430 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A client has been scheduled for an ultrasound of the gallbladder the following morning. What should the nurse do in preparation for this diagnostic study? A. Have the client refrain from food and fluids after midnight. om B. Administer the contrast agent orally 10 to 12 hours before the study. C. Administer the radioactive agent intravenously the evening before the study. D. Encourage the intake of 64 ounces of water 8 hours before the study..c ANS: A ks Rationale: An ultrasound of the gallbladder is most accurate if the client fasts overnight, so that the gallbladder is distended. Contrast and radioactive agents are not used when an performing ultrasonography of the gallbladder, as an ultrasound is based on reflected sound waves. tb PTS: 1 REF: p. 1421 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential es TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice bt 7. A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows to immediately report what assessment finding to the health care provider? A. Decreased breath sounds B. Drainage of bile-colored fluid onto the abdominal dressing C. Rigidity of the abdomen D. Acute pain with movement ANS: C Rationale: The location of the subcostal incision will likely cause the client to take shallow breaths to prevent pain, which may result in decreased breath sounds. The nurse should remind clients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be given for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal dressing. Increased om abdominal tenderness and rigidity should be reported immediately to the health care provider, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure..c PTS: 1 REF: p. 1427 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential ks TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply an NOT: Multiple Choice 8. A client with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago tb for relief of pain and to restore drainage of pancreatic secretions. The client has come to the office for a routine postsurgical appointment. The client is frustrated that the pain has es not decreased. What is the most appropriate initial response by the nurse? A. "The majority of clients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief." bt B. "Pain relief occurs by 6 months in most clients who undergo this procedure, but some people experience a recurrence of their pain." C. "Your health care provider will likely want to discuss the removal of your gallbladder to achieve pain relief." D. "You are probably not appropriately taking the medications for your pancreatitis and pain, so we will need to discuss your medication regimen in detail." ANS: B Rationale: Pain relief from a pancreaticojejunostomy often occurs by 6 months in more than 85% of the clients who undergo this procedure, but pain returns in a substantial number of clients as the disease progresses. This client had surgery 3 months ago; the client has 3 months before optimal benefits of the procedure may be experienced. There is no obvious indication for gallbladder removal and nonadherence is not the most likely factor underlying the pain. PTS: 1 REF: p. 1437 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply om NOT: Multiple Choice 9. A nurse is caring for a client who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory.c guidance for this client, the nurse should describe what aspect of this diagnostic procedure? ks A. The need to protect the incision postprocedure B. The use of moderate sedation an C. The need to infuse 50% dextrose during the procedure D. The use of general anesthesia tb ANS: B es Rationale: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not given and the procedure does not involve the creation of an incision. bt PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize what topic? A. Management of fluid balance in the home setting B. The need for blood glucose monitoring for the next week C. Signs and symptoms of intra-abdominal complications D. Appropriate use of prescribed pancreatic enzymes ANS: C om Rationale: Because of the early discharge following laparoscopic cholecystectomy, the client needs thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or pancreatic enzymes..c PTS: 1 REF: p. 1425 ks NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders an KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice tb 11. A nurse is preparing a plan of care for a client with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the es nurse prioritize? A. Disturbed body image B. Impaired skin integrity bt C. Nausea D. Risk for deficient fluid volume ANS: B Rationale: While each of the diagnoses may be applicable to a client with pancreatic drainage, the priority nursing diagnosis is Impaired Skin Integrity. The drainage is often perfuse and destructive to tissue because of the enzyme contents. Nursing measures must focus on steps to protect the skin near the drainage site from excoriation. The application of ointments or the use of a suction apparatus protects the skin from excoriation. PTS: 1 REF: p. 1438 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice om 12. A home health nurse is caring for a client discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the client who has had.c pancreatic surgery? A. Proteinuria and hyperkalemia B. Hemorrhage and hypercalcemia ks C. Weight loss and hypoglycemia an D. Malabsorption and hyperglycemia ANS: D tb Rationale: The nurse arrives at this diagnosis based on the complications of es malabsorption and hyperglycemia. These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a low-fat diet, and vitamin supplementation often are also required to meet the client's nutritional needs and bt restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery, but the electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common complication, but hypoglycemia is less likely. PTS: 1 REF: p. 1442 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain? A. Aspirin every 4 to 6 hours as prescribed B. Application of heat 15 to 20 minutes each hour C. Application of an ice pack for no more than 15 minutes D. Application of liniment rub to affected area om ANS: B Rationale: If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the abdominal cavity during the procedure), the nurse may recommend.c use of a heating pad for 15 to 20 minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding. ks PTS: 1 REF: p. 1425 an NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply tb NOT: Multiple Choice es 14. A client returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the client for signs and symptoms of what serious potential complication of this surgery? bt A. Diabetic coma B. Decubitus ulcer C. Wound evisceration D. Bile duct injury ANS: D Rationale: The most serious complication after laparoscopic cholecystectomy is a bile duct injury. Clients do not face a risk of diabetic coma. A decubitus ulcer is unlikely because immobility is not expected. Evisceration is highly unlikely, due to the laparoscopic approach. PTS: 1 REF: p. 1425 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice om 15. A client has been treated in the hospital for an episode of acute pancreatitis. The client has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes. What is the nurse's most appropriate response?.c A. Educate the client about the link between alcohol use and pancreatitis. B. Ensure that the client knows the importance of attending follow-up appointments. ks C. Refer the client to social work or spiritual care. an D. Encourage the client to connect with a community-based support group. ANS: D tb Rationale: After the acute attack has subsided, some clients may be inclined to return to es their previous drinking habits. The nurse provides specific information about resources and support groups that may be of assistance in avoiding alcohol in the future. Referral to Alcoholics Anonymous as appropriate or other support groups is essential. The client bt already has an understanding of the effects of alcohol, and follow-up appointments will not necessarily result in lifestyle changes. Social work and spiritual care may or may not be beneficial. PTS: 1 REF: p. 1433 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client is being treated for acute pain from an episode of pancreatitis. The nurse has identified a nursing diagnosis of Ineffective Breathing Pattern related to pain secondary to effects of surgery. Which intervention should the nurse perform in order to best address this diagnosis? A. Position the client supine to facilitate diaphragm movement. B. Administer corticosteroids by nebulizer as prescribed. C. Perform oral suctioning as needed to remove secretions. D. Administer analgesic per orders. om ANS: D Rationale: The client has ineffective breathing patterns due to pain. To increase the likelihood of the client being able to perform interventions for his/her respiratory status,.c it would be important to treat acute pain first. A supine position will result in increased pressure on the diaphragm and potentially decreased respiratory expansion. Steroids and oral suctioning are not indicated. ks an PTS: 1 REF: p. 1432 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders tb KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice es 17. A client with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that additional teaching is needed regarding this medication when the client bt states: A. "It is important that I see my health care provider for scheduled follow-up appointments while taking this medication." B. "I will take this medication for 2 weeks and then gradually stop taking it." C. "If I lose weight, the dose of the medication may need to be changed." D. "This medication will help dissolve small gallstones made of cholesterol." ANS: B Rationale: Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. This drug can reduce the size of existing stones, dissolve small stones, and prevent new stones from forming. Six to 12 months of therapy is required in many clients to dissolve stones, and monitoring of the client is required during this time. The effective dose of medication depends on body weight. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze om NOT: Multiple Choice 18. A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question.c which of the following foods on the tray? A. Fried chicken B. Mashed potatoes ks C. Dinner roll an D. Tapioca pudding ANS: A tb Rationale: The diet immediately after an episode of acute cholecystitis is initially limited es to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as fried chicken, as fatty foods may bring on an episode of cholecystitis. bt PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A nurse is assessing an older adult client with gallstones. The nurse is aware that the client may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly client may include what examples? A. Fever and pain B. Chills and jaundice C. Nausea and vomiting D. Signs and symptoms of septic shock ANS: D om Rationale: The elderly client may not exhibit the typical symptoms of fever, pain, chills jaundice, and nausea and vomiting. Symptoms of biliary tract disease in the elderly may be accompanied or preceded by those of septic shock, which include oliguria, hypotension, change in mental status, tachycardia, and tachypnea..c PTS: 1 REF: p. 1426 ks NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders an KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice tb 20. A nurse is creating a care plan for a client with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care es plan? A. Bed rest reduces the client's metabolism and reduces the risk of metabolic acidosis. bt B. Reduced activity protects the physical integrity of pancreatic cells. C. Bed rest lowers the metabolic rate and reduces enzyme production. D. Inactivity reduces caloric need and gastrointestinal motility. ANS: C Rationale: The acutely ill client is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. Staying in bed does not release energy from the body to fight the disease. PTS: 1 REF: p. 1433 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 21. The nurse is caring for a client who has just returned from the ERCP removal of gallstones. The nurse should monitor the client for signs of what complications? om A. Pain and peritonitis B. Bleeding and perforation C. Acidosis and hypoglycemia D. Gangrene of the gallbladder and hyperglycemia.c ANS: B ks Rationale: Following ERCP removal of gallstones, the client is observed closely for an bleeding, perforation, and the development of pancreatitis or sepsis. Blood sugar alterations, gangrene, peritonitis, and acidosis are less likely complications. tb PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential es TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice bt 22. A client with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the client should be informed that this procedure will involve the removal of which of the following? Select all that apply. A. Gallbladder B. Part of the stomach C. Duodenum D. Part of the common bile duct  E. Part of the rectum ANS: A, B, C, D Rationale: A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The rectum is not affected. PTS: 1 REF: p. 1441 om NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Select.c 23. An adult client has been admitted to the medical unit for the treatment of acute ks pancreatitis. What nursing action should be included in this client's plan of care? A. Measure the client's abdominal girth daily. an B. Limit the use of opioid analgesics. C. Monitor the client for signs of dysphagia. D. Encourage activity as tolerated. tb ANS: A es Rationale: Due to the risk of ascites, the nurse should monitor the client's abdominal girth. There is no specific need to avoid the use of opioids or to monitor for dysphagia, bt and activity is usually limited. PTS: 1 REF: p. 1433 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 24. A community health nurse is caring for a client whose multiple health problems include chronic pancreatitis. During the most recent home visit, the nurse learns that the client is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurse's most appropriate action? A. Administer a PRN dose of pancreatic enzymes as prescribed. B. Teach the client about the importance of abstaining from alcohol. C. Arrange for the client to be transported to the hospital. D. Insert an NG tube, if available, and stay with the client. ANS: C om Rationale: Chronic pancreatitis is characterized by recurring attacks of severe upper abdominal and back pain, accompanied by vomiting. The onset of these acute symptoms warrants hospital treatment. Pancreatic enzymes are not indicated and an NG tube would.c not be inserted in the home setting. Client education is a later priority that may or may not be relevant. ks PTS: 1 REF: p. 1433 an NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply tb NOT: Multiple Choice es 25. A student nurse is caring for a client who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments? bt A. Fluid output B. Oral intake C. Blood glucose levels D. BUN and creatinine levels ANS: C Rationale: In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels every 4 to 6 hours. Output should be monitored but in most cases it is not more important than serum glucose levels. A client on parenteral nutrition would have no oral intake to monitor. Blood sugar levels are more likely to be unstable than indicators of renal function. PTS: 1 REF: p. 1431 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice om 26. A client has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test?.c A. Glucose tolerance test B. ERCP C. Pancreatic biopsy ks D. Abdominal ultrasonography an ANS: A tb Rationale: A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making decisions about surgical resection of the pancreas. This es specific clinical information is not provided by ERCP, biopsy, or ultrasound. PTS: 1 REF: p. 1437 bt NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 27. A client has been admitted to the hospital for the treatment of chronic pancreatitis. The client has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize?  A. Educating the client about expectations and care following surgery B. Educating the client about the management of blood glucose after discharge C. Educating the client about postdischarge lifestyle modifications D. Educating the client about the potential benefits of pancreatic transplantation ANS: C Rationale: The client's lifestyle (especially regarding alcohol use) is a major determinant of the course of chronic pancreatitis. The disease is not often managed by surgery, and blood sugar monitoring is not necessarily indicated for every client after hospital om treatment. Transplantation is not an option. PTS: 1 REF: p. 1433 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders.c KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice ks 28. A client is receiving care in the intensive care unit for acute pancreatitis. The nurse is an aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication? tb A. Sudden increase in random blood glucose readings B. Increased abdominal girth accompanied by decreased level of consciousness es C. Fever, increased heart rate and decreased blood pressure D. Abdominal pain unresponsive to analgesics bt ANS: C Rationale: Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS). Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis. PTS: 1 REF: p. 1433 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 29. A client has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this client? A. Oral oxycodone om B. IV hydromorphone C. IM meperidine D. Oral naproxen.c ANS: B ks Rationale: The pain of acute pancreatitis is often very severe and pain relief may require parenteral opioids such as morphine, fentanyl, or hydromorphone. There is no clinical an evidence to support the use of meperidine for pain relief in pancreatitis. Opioids are preferred over NSAIDs. tb PTS: 1 REF: p. 1431 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies es TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice bt 30. A client has just been diagnosed with chronic pancreatitis. The client is underweight and in severe pain and diagnostic testing indicates that over 80% of the client's pancreas has been destroyed. The client asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response? A. "The symptoms of pancreatitis mimic those of much less serious illnesses." B. "Your body doesn't require pancreatic function until it is under great stress, so it is easy to go unnoticed."  C. "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost." D. "It's likely that your other organs were compensating for your decreased pancreatic function." ANS: C Rationale: By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been lost. Late detection is not usually attributable to the vagueness of symptoms. The pancreas contributes continually to om homeostasis and other organs are unable to perform its physiologic functions. PTS: 1 REF: p. 1429 NAT: Client Needs: Physiological Integrity: Physiological Adaptation.c TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice ks an 31. A client has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the client is most likely to require which of the following situations? tb A. Inpatient rehabilitation B. Rehabilitation in the home setting es C. Intensive physical therapy D. Hospice care bt ANS: D Rationale: Pancreatic carcinoma has only a low survival rate regardless of the stage of disease at diagnosis or treatment. As a result, there is a higher likelihood that the client will require hospice care than physical therapy and rehabilitation. PTS: 1 REF: p. 1440 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 32. A client is admitted to the ICU with acute pancreatitis. The client's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of clients with acute pancreatitis have what health issue? A. Type 1 diabetes B. An impaired immune system C. Undiagnosed chronic pancreatitis om D. An amylase deficiency ANS: C.c Rationale: Eighty percent of clients with acute pancreatitis have biliary tract disease or a history of long-term alcohol abuse. These clients usually have had undiagnosed chronic ks pancreatitis before their first episode of acute pancreatitis. Diabetes, an impaired immune function, and amylase deficiency are not specific precursors to acute an pancreatitis. PTS: 1 REF: p. 1429 tb NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders es KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice bt 33. A client is admitted to the unit with acute cholecystitis. The health care provider has stated that surgery will be scheduled in 4 days. The client asks why the surgery is being put off for a week when he has a "sick gallbladder." What rationale would underlie the nurse's response? A. Surgery is delayed until the client can eat a regular diet without vomiting. B. Surgery is delayed until the acute symptoms subside. C. The client requires aggressive nutritional support prior to surgery. D. Time is needed to determine whether a laparoscopic procedure can be used. ANS: B Rationale: Unless the client's condition deteriorates, surgical intervention is delayed just until the acute symptoms subside (usually within a few days). There is no need to delay surgery pending an improvement in nutritional status, and deciding on a laparoscopic approach is not a lengthy process. PTS: 1 REF: p. 1422 NAT: Client Needs: Safe, Effective Care Environment: Management of Care om TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice.c 34. A client with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure? ks A. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure. an B. Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR. C. A laparoscopic approach allows for the removal of the entire gallbladder. tb D. A laparoscopic approach can be performed under conscious sedation. es ANS: A Rationale: Open surgery has largely been replaced by laparoscopic cholecystectomy bt (removal of the gallbladder through a small incision through the umbilicus). As a result, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. Both approaches allow for removal of the entire gallbladder and must be performed under general anesthesia in an operating theater. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 35. A client with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the client will undergo what intervention? A. Laparoscopic cholecystectomy B. Methyl tertiary butyl ether (MTBE) infusion C. Intracorporeal lithotripsy om D. Extracorporeal shock wave therapy (ESWL) ANS: A.c Rationale: Most of the nonsurgical approaches, including lithotripsy and dissolution of gallstones, provide only temporary solutions to gallstone problems and are infrequently ks used. Cholecystectomy is the preferred treatment. an PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders tb KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice es 36. A nurse is caring for a client with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The client asks how this medicine is going to help his symptoms. The nurse bt should be aware of what aspect of this drug's pharmacodynamics? A. It inhibits the synthesis of bile. B. It inhibits the synthesis and secretion of cholesterol. C. It inhibits the secretion of bile. D. It inhibits the synthesis and secretion of amylase. ANS: B Rationale: UDCA acts by inhibiting the synthesis and secretion of cholesterol, thereby desaturating bile. UDCA does not directly inhibit either the synthesis or secretion of bile or amylase. PTS: 1 REF: p. 1422 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice om 37. A nurse is providing discharge education to a client who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods? A. High-fiber foods.c B. Low-purine, nutrient-dense foods C. Low-fat foods high in proteins and carbohydrates ks D. Foods that are low-residue and low in fat an ANS: C Rationale: The nurse encourages the client to eat a diet that is low in fats and high in tb carbohydrates and proteins immediately after surgery. There is no specific need to increase fiber or avoid purines. A low-residue diet is not indicated. es PTS: 1 REF: p. 1427 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders bt KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 38. A client presents to the emergency department (ED) reporting severe right upper quadrant pain. The client states that the family doctor said the pain was caused by gallstones. The ED nurse should recognize what possible complication of gallstones? A. Acute pancreatitis B. Atrophy of the gallbladder  C. Gallbladder cancer D. Gangrene of the gallbladder ANS: D Rationale: In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are compressed, compromising its vascular supply. Gangrene of the gallbladder with perforation may result. Pancreatitis, atrophy, and cancer of the gallbladder are not plausible complications. om PTS: 1 REF: p. 1430 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders.c KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice ks 39. A client's assessment and diagnostic testing are suggestive of acute pancreatitis. an When the nurse is performing the health interview, what assessment question(s) addresses likely etiologic factors? Select all that apply. A. "How many alcoholic drinks do you typically consume in a week?" tb B. "Have you ever been tested for diabetes?" C. "Have you ever been diagnosed with gallstones?" es D. "Would you say that you eat a particularly high-fat diet?" E. "Does anyone in your family have cystic fibrosis?" bt ANS: A, B, C, D Rationale: Eighty percent of clients with acute pancreatitis have biliary tract disease such as gallstones or a history of long-term alcohol abuse. Diabetes and high-fat consumption are also associated with pancreatitis. Cystic fibrosis is not a noted etiologic factor for pancreatitis. PTS: 1 REF: p. 1429 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 44: Assessment and Management of Clients With Biliary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select om.c ks an tb es bt