Deck 49: Assessment and Management of Patients With Biliary Disorders

Question 1

A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the patients 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

Answer 1

Right shoulder

Question 2

A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patients health problem?

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.

Answer 2

The enzymes that your pancreas produces have damaged the pancreas itself.

Question 3

A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is
Performing the health interview, what assessment questions address likely etiologic factors? Select all that apply.

A) How many alcoholic drinks do you typically consume in a week?
B) Have you ever been tested for diabetes?
C) Have you ever been diagnosed with gallstones?
D) Would you say that you eat a particularly high-fat diet?
E) Does anyone in your family have cystic fibrosis?

Answer 3

How many alcoholic drinks do you typically consume in a week?
Have you ever been diagnosed with gallstones?

Question 4

A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients laboratory studies, what finding is most closely associated with this diagnosis?

A) Increased bilirubin
B) Decreased serum cholesterol
C) Increased blood urea nitrogen (BUN)
D) Decreased serum alkaline phosphatase level

Question 5

A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should identify which of the following patients 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

Question 6

A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem?

A) Severe pancreatitis with possible peritonitis
B) Acute cholecystitis
C) Chronic pancreatitis
D) Acute appendicitis with possible perforation

Question 7

A patient 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 patient refrain from food and fluids after midnight.
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.

Question 8

A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician?

A) Decreased breath sounds
B) Drainage of bile-colored fluid onto the abdominal dressing
C) Rigidity of the abdomen
D) Acute pain with movement

Question 9

A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse?

A) The majority of patients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief.
B) Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain.
C) Your physician 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.

Question 10

A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?

A) The need to protect the incision postprocedure
B) The use of moderate sedation
C) The need to infuse $50 \%$ dextrose during the procedure
D) The use of general anesthesia

Question 11

A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics?

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

Question 12

A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize?

A)Disturbed Body Image
B)Impaired Skin Integrity
C) Nausea
D) Risk for Deficient Fluid Volume

Question 13

A home health nurse is caring for a patient 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 patient who has had pancreatic surgery?

A) Proteinuria and hyperkalemia
B) Hemorrhage and hypercalcemia
C) Weight loss and hypoglycemia
D) Malabsorption and hyperglycemia

Question 14

A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain?

A) Aspirin every 4 to 6 hours as ordered
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

Question 15

A patient returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the patient for signs and symptoms of what serious potential complication of this surgery?

A) Diabetic coma
B) Decubitus ulcer
C) Wound evisceration
D) Bile duct injury

Question 16

A patient has been treated in the hospital for an episode of acute pancreatitis. The patient 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 after discharge. What is the nurses most appropriate response?

A) Educate the patient about the link between alcohol use and pancreatitis.
B) Ensure that the patient knows the importance of attending follow-up appointments.
C) Refer the patient to social work or spiritual care.
D) Encourage the patient to connect with a community-based support group.

Question 17

A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform in order to best address this diagnosis?

A) Position the patient supine to facilitate diaphragm movement.
B) Administer corticosteroids by nebulizer as ordered.
C) Perform oral suctioning as needed to remove secretions.
D) Maintain the patient in a semi-Fowlers position whenever possible.

Question 18

A patient with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that additional teaching is needed regarding this medication when the patient states:

A) It is important that I see my physician 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.

Question 19

A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?

A) Fried chicken
B) Mashed potatoes
C) Dinner roll
D) Tapioca pudding

Question 20

A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may include what?

A) Fever and pain
B) Chills and jaundice
C) Nausea and vomiting
D) Signs and symptoms of septic shock

Question 21

A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?

A) Bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis.
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.

Question 22

The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse should monitor the patient for signs of what complications?

A) Pain and peritonitis
B) Bleeding and perforation
C) Acidosis and hypoglycemia
D) Gangrene of the gallbladder and hyperglycemia

Question 23

A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the patient 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

Question 24

An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this patients plan of care?

A) Measure the patients abdominal girth daily.
B) Limit the use of opioid analgesics.
C) Monitor the patient for signs of dysphagia.
D) Encourage activity as tolerated.

Question 25

A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate action?

A) Administer a PRN dose of pancreatic enzymes as ordered.
B) Teach the patient about the importance of abstaining from alcohol.
C) Arrange for the patient to be transported to the hospital.
D) Insert an $\mathrm{NG}$ tube, if available, and stay with the patient.

Question 26

A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments?

A) Fluid output
B) Oral intake
C) Blood glucose levels
D) BUN and creatinine levels

Question 27

A patient 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?

A) Glucose tolerance test
B) ERCP
C) Pancreatic biopsy
D) Abdominal ultrasonography

Question 28

A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient 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 patient about expectations and care following surgery
B) Educating the patient about the management of blood glucose after discharge
C) Educating the patient about postdischarge lifestyle modifications
D) Educating the patient about the potential benefits of pancreatic transplantation

Question 29

The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has been moved to an air bed. What would be the nurses best response?

A) Air beds allow the care team to reposition her more easily while shes on bed rest.
B) Air beds are far more comfortable than regular beds and shell likely have to be on bed rest a long
Time.
C) The bed automatically moves, so shes less likely to develop pressure sores while shes in bed.
D) The bed automatically moves, so she is likely to have less pain.

Question 30

A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

A) Sudden increase in random blood glucose readings
B) Increased abdominal girth accompanied by decreased level of consciousness
C) Fever, increased heart rate and decreased blood pressure
D) Abdominal pain unresponsive to analgesics

Question 31

A patient 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 patient?

A) Oral oxycodone
B) IV hydromorphone (Dilaudid)
C) IM meperidine (Demerol)
D) Oral naproxen (Aleve)

Question 32

A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that over $80 \%$ of the patients pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurses best response?

A) The symptoms of pancreatitis mimic those of much less serious illnesses.
B) Your body doesnt 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) Its likely that your other organs were compensating for your decreased pancreatic function.

Question 33

A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the patient is most likely to require which of the following?

A) Inpatient rehabilitation
B) Rehabilitation in the home setting
C) Intensive physical therapy
D) Hospice care

Question 34

A patient is admitted to the ICU with acute pancreatitis. The patients family asks what causes acute pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what?

A) Type 1 diabetes
B) An impaired immune system
C) Undiagnosed chronic pancreatitis
D) An amylase deficiency

Question 35

A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick gallbladder. What rationale would underlie the nurses response?

A) Surgery is delayed until the patient can eat a regular diet without vomiting.
B) Surgery is delayed until the acute symptoms subside.
C) The patient requires aggressive nutritional support prior to surgery.
D) Time is needed to determine whether a laparoscopic procedure can be used.

Question 36

A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?

A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
B) Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an $\mathrm{OR}$ .
C) A laparoscopic approach allows for the removal of the entire gallbladder.
D) A laparoscopic approach can be performed under conscious sedation.

Question 37

A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?

A) Laparoscopic cholecystectomy
B) Methyl tertiary butyl ether (MTBE) infusion
C) Intracorporeal lithotripsy
D) Extracorporeal shock wave therapy (ESWL)

Question 38

A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The patient askshow this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drugs 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.

Question 39

A nurse is providing discharge education to a patient who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?

A) High-fiber foods
B) Low-purine, nutrient-dense foods
C) Low-fat foods high in proteins and carbohydrates
D) Foods that are low-residue and low in fat

Question 40

A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain. The patient states that his family doctor told him he had 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