Deck 62: Care of Patients With Problems of the Biliary System and Pancreas

Question 1

The client with obstructive jaundice asks the nurse why his skin is so itchy.Which is the nurse's best response?

A) "Bile salts accumulate in the skin and cause the itching."
B) "Toxins released from an inflamed gallbladder lead to itching."
C) "Itching is caused by the release of calcium into the skin."
D) "Itching is caused by a hypersensitivity reaction."

Answer 1

"Bile salts accumulate in the skin and cause the itching."

Question 2

A client is admitted for suspected cholecystitis.On reviewing laboratory results,the nurse notes that the client's amylase is elevated.Which action by the nurse is best?

A) Document the finding in the chart.
B) Ask the client about drinking habits.
C) Notify the health care provider.
D) Place the client on clear liquids.

Answer 2

Ask the client about drinking habits.

Question 3

The nurse is caring for a client with end-stage pancreatic cancer.The client asks the nurse,"Why is this happening to me?" Which is the nurse's best response?

A) "I don't know. I wish I had an answer for you, but I don't."
B) "It's important to keep a positive attitude for your family right now."
C) "Scientists have not determined why cancer develops in certain people."
D) "I think that this is a trial so you can become a better person because of it."

Answer 3

"I don't know. I wish I had an answer for you, but I don't."

Question 4

The nurse is caring for a client who has just undergone traditional cholecystectomy surgery and has a Jackson-Pratt (JP)drain in place.The nurse notes serosanguineous drainage present in the drain.Which is the nurse's priority action?

A) Gently milk the drain tubing.
B) Notify the surgeon immediately.
C) Document the finding in the client's chart.
D) Irrigate the drain with sterile normal saline.

Question 5

The nurse is caring for a client who has just been diagnosed with end-stage pancreatic cancer.The nurse assesses the client's emotional response to the diagnosis.Which is the nurse's initial action for the assessment?

A) Bring the client to a quiet room for privacy.
B) Pull up a chair and sit next to the client's bed.
C) Determine whether the client feels like talking about his or her feelings.
D) Review the health care provider's notes about the prognosis for the client.

Question 6

The nurse is caring for a client with acute pancreatitis.During the physical assessment,the nurse notes a grayish-blue discoloration of the client's flanks.Which is the nurse's priority action?

A) Prepare the client for emergency surgery.
B) Place the client in high Fowler's position.
C) Insert a nasogastric (NG) tube to low intermittent suction.
D) Ensure that the client has a patent large-bore IV site.

Question 7

The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery.Which statement by the client indicates understanding of the instructions?

A) "I will drink at least 2 liters of fluid a day."
B) "I need a diet without a lot of fatty foods."
C) "I should drink fluids between meals rather than with meals."
D) "I will avoid concentrated sweets and simple carbohydrates."

Question 8

The nurse is caring for a client with cholecystitis.Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

A) Abdomen that is hyperresonant to percussion
B) Hyperactive bowel sounds and diarrhea
C) Clay-colored stools and dark amber urine
D) Rebound tenderness in the right upper quadrant

Question 9

The nurse is providing discharge teaching for a client who will be receiving pancreatic enzyme replacement at home.Which statement by the client indicates that additional teaching is needed?

A) "The capsules can be opened and the powder sprinkled on applesauce if needed."
B) "I will wipe my lips carefully after I drink the enzyme preparation."
C) "The best time to take the enzymes is immediately after I have a meal or a snack."
D) "I will not mix the enzyme powder with food or liquids that contain protein."

Question 10

The nurse is caring for a client with acute pancreatitis.Which nursing intervention best reduces discomfort for the client?

A) Administering morphine sulfate IV every 4 to 6 hours as needed
B) Maintaining NPO status for the client with IV fluids
C) Providing small, frequent feedings, with no concentrated sweets
D) Placing the client in semi-Fowler's position at elevation of 30 degrees

Question 11

The nurse is caring for a postoperative client who reports pain in the shoulder blades following laparoscopic cholecystectomy surgery.Which direction does the nurse give to the nursing assistant to help relieve the client's pain?

A) "Ambulate the client in the hallway."
B) "Apply a cold compress to the client's back."
C) "Encourage the client to take sips of hot tea or broth."
D) "Remind the client to cough and deep breathe every hour."

Question 12

The nurse is caring for a client who had a T-tube placed 3 days ago.Which assessment finding indicates to the nurse that the procedure was successful?

A) Sclera that is slightly icteric
B) Positive Blumberg's sign
C) Soft, brown, formed stool this morning
D) Sips of clear liquid tolerated without nausea

Question 13

The nurse is teaching a client with a history of cholelithiasis to select menu items for dinner.Which selections made by the client indicate that the nurse's teaching was effective?

A) Lasagna, tossed salad with Italian dressing, 2% milk
B) Grilled cheese sandwich, tomato soup, coffee with cream
C) Caesar salad with chicken, soft breadstick with butter, diet cola
D) Roasted chicken breast, baked potato with chives, hot tea with sugar

Question 14

The nurse is caring for a client who has undergone surgery to drain a pancreatic pseudocyst with placement of a pancreatic drainage tube.Which nursing intervention prevents complications from this procedure?

A) Positioning the client in a right side-lying position
B) Applying a skin barrier around the drainage tube site
C) Clamping the drainage tube for 2 hours every 12 hours
D) Irrigating the drainage tube daily with 30 mL of sterile normal saline

Question 15

The postanesthesia care unit nurse is caring for a client who has just undergone an open Whipple procedure.The client has multiple tubes and drains in place after the surgery.Which does the nurse assess first?

A) Endotracheal tube with 40% fraction of inspired oxygen (FiO₂)
B) Foley catheter to bedside drainage
C) Nasogastric tube to low intermittent suction
D) Triple-lumen IV catheter with lactated Ringer's solution

Question 16

The nurse is teaching a community group about pancreatic cancer.Which risk factor does the nurse instruct is known for development of this type of cancer?

A) Hypothyroidism
B) Cholelithiasis
C) BRCA2 gene mutation
D) African-American ethnicity

Question 17

The nurse is caring for a client with chronic pancreatitis.Which instruction by the nurse is most appropriate?

A) "You will need to limit your protein intake."
B) "We need to call the dietitian to get help in planning your diet."
C) "You cannot eat concentrated sweets any longer."
D) "Try to eat less red meat and more chicken and fish."

Question 18

The nurse is providing discharge teaching for a client who will be going home with a T-tube following cholecystectomy surgery.Which statement by the client indicates the need for additional teaching?

A) "I will keep the drainage bag lower than the tube itself."
B) "I will inspect the T-tube drainage site daily for signs of infection."
C) "I will be careful not to pull on the tube or to accidentally pull it out."
D) "I will slowly pull about an inch of the tube out each day until it's out."

Question 19

A client is hospitalized with acute pancreatitis.The nursing assistant reports to the nurse that when a blood pressure cuff was applied,the client's hand had a spasm.Which additional finding does the nurse correlate with this condition?

A) Serum calcium, 5.8 mg/dL
B) Serum sodium, 166 mEq/L
C) Serum creatinine, 0.9 mg/dL
D) Serum potassium, 4.2 mEq/dL

Question 20

The nurse is caring for a client who had undergone a Whipple procedure 2 days previously.The nurse notes that the client's hands and feet are edematous,and urine output has decreased from the previous day.Which intervention does the nurse expect to provide for the client?

A) Increase the client's IV fluid infusion rate.
B) Monitor the client's blood sugar level every 4 hours.
C) Add colloids to the client's IV solutions.
D) Reinsert the client's nasogastric (NG) tube.

Question 21

The nurse is caring for a client after a Whipple procedure.Which manifestations might indicate that a complication from the operation has occurred?

A) Urinary retention
B) Substernal chest pain
C) Shortness of breath
D) Lack of bowel sounds or flatus
E) Urine output of 20 mL/6 hr

Question 22

The nurse is caring for a client with acute pancreatitis.The client's health care provider has ordered gentamicin (Garamycin)3 mg/kg/day in three divided doses.The client weighs 264 lb.The client will receive _______ milligrams/dose of Garamycin.

Question 23

The nurse is caring for a client with cholecystitis.The client is a poor historian and is unable to tell the nurse when the symptoms started.Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

A) Temperature of 100.1° F (37.8° C)
B) Positive Murphy's sign
C) Light-colored stools
D) Upper abdominal pain after eating

Question 24

The nurse is caring for a female client with cholelithiasis.Which assessment findings from the client's history and physical examination may have contributed to development of the condition?

A) Body mass index (BMI) of 46
B) Vegetarian diet
C) Drinking 4 ounces of red wine nightly
D) Pregnant with twins
E) History of metabolic syndrome
F) Glycosylated hemoglobin level of 15%

Question 25

The nurse is caring for a client who is being discharged from the hospital after an attack of acute pancreatitis.Which discharge instructions does the nurse provide for the client to help prevent a recurrence?

A) "Take a 20-minute walk at least 5 days each week."
B) "Attend local Alcoholics Anonymous (AA) meetings weekly."
C) "Choose whole grains rather than foods with simple sugars."
D) "Use cooking spray when you cook rather than margarine or butter."
E) "Stay away from milk and dairy products that contain lactose."
F) "We can talk to your doctor about a prescription for nicotine patches."