Question 1

A nurse assesses a client who has cholecystitis.Which clinical manifestation indicates that the condition is chronic rather than acute?

Accepted Answer

Jaundice,clay-colored stools,and dark urine are more commonly seen with chronic cholecystitis.The other symptoms are seen equally with both chronic and acute cholecystitis.

Question 2

A nurse prepares to discharge a client with chronic pancreatitis.Which question should the nurse ask to ensure safety upon discharge?

Accepted Answer

A client recovering from chronic pancreatitis should be limited to one floor until strength and activity increase.The client will need a bathroom on the same floor for frequent defecation.Assessing pulse rate and preparation of meals is not specific to chronic pancreatitis.Although the client should be encouraged to stop drinking alcoholic beverages,asking about alcohol availability is not adequate to assess this client's safety.

Question 3

A nurse assesses clients at a community health center.Which client is at highest risk for pancreatic cancer?

Accepted Answer

Mutations in both the BRCA2 and p16 genes increase the risk for developing pancreatic cancer in a small number of cases.The other factors do not appear to be linked to increased risk.

Question 4

After teaching a client who is prescribed pancreatic enzyme replacement therapy,the nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

The enzymes should be taken immediately before eating meals or snacks.If the client cannot swallow the capsules whole,they can be opened up and the powder sprinkled on applesauce,mashed fruit,or rice cereal.The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin.Protein items will be dissolved by the enzymes if they are mixed together.

Question 5

A nurse assesses a client with cholelithiasis.Which assessment findings should the nurse identify as contributors to this client's condition? (Select all that apply.)

Accepted Answer

Obesity,pregnancy,and diabetes are all risk factors for the development of cholelithiasis.A diet low in saturated fats and moderate alcohol intake may decrease the risk.Although metabolic syndrome is a precursor to diabetes,it is not a risk factor for cholelithiasis.The client should be informed of the connection.

Question 6

A nurse cares for a client who is prescribed patient-controlled analgesia (PCA)after a cholecystectomy.The client states,"When I wake up I am in pain." Which action should the nurse take?

Accepted Answer

The nurse should encourage the client to use the PCA pump prior to napping and upon awakening.Administering additional intravenous morphine while the client sleeps places the client at risk for respiratory depression.The nurse should also evaluate dosages received compared with dosages requested and contact the provider if the dose or frequency is not adequate.Only the client should push the pain button on a PCA pump.

Question 7

After teaching a client who has a history of cholelithiasis,the nurse assesses the client's understanding.Which menu selection made by the client indicates the client clearly understands the dietary teaching?

Accepted Answer

Clients with cholelithiasis should avoid foods high in fat and cholesterol,such as whole milk,butter,and fried foods.Lasagna,low-fat milk,grilled cheese,cream,and cream of potato soup all have high levels of fat.The meal with the least amount of fat is the chicken breast dinner.

Question 8

A nurse cares for a client who is recovering from an open Whipple procedure.Which action should the nurse take?

Accepted Answer

Postoperative care for a client recovering from an open Whipple procedure should include placing the client in a semi-Fowler's position to reduce tension on the suture line and anastomosis sites,setting the nasogastric tube to low suction to remove free air buildup and pressure,assessing vital signs frequently to assess fluid and electrolyte complications,and providing intravenous fluids.

Question 9

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery.The client reports pain in the shoulder blades.How should the nurse respond?

Accepted Answer

The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen.The nurse assists the client with early ambulation to promote absorption of the carbon dioxide.Cold compresses and drinking a warm beverage would not be helpful.Coughing and deep breathing are important postoperative activities,but they are not related to discomfort from carbon dioxide.

Question 10

A nurse assesses a client who is recovering from a Whipple procedure.Which clinical manifestations alert the nurse to a complication from this procedure? (Select all that apply.)

Accepted Answer

Myocardial infarction (chest pain),pulmonary embolism (shortness of breath),adynamic ileus (lack of bowel sounds or flatus),and renal failure (urine output of 20 mL/6 hr)are just some of the complications for which the nurse must assess the client after the Whipple procedure.Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure.

Question 11

A nurse teaches a client who is recovering from acute pancreatitis.Which statements should the nurse include in this client's teaching? (Select all that apply.)

Accepted Answer

The client should be advised to stay sober,and AA is a great resource.The client requires a low-fat diet,and cooking spray is low in fat compared with butter or margarine.If the client smokes,he or she must stop because nicotine can precipitate an exacerbation.A nicotine patch may help the client quit smoking.The client must rest until his or her strength returns.The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones.Dairy products do not cause a problem.

Question 12

After teaching a client who is recovering from laparoscopic cholecystectomy surgery,the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the teaching?

Accepted Answer

After cholecystectomy,clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients.Good fluid intake is healthy for all people but is not related to the surgery.Drinking fluids between meals helps with dumping syndrome,which is not seen with this procedure.Restriction of sweets is not required.

Question 13

A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer.Which action should the nurse take first?

Accepted Answer

Before conducting an assessment about the client's feelings,the nurse should determine whether he or she is willing and able to talk about them.If the client is open to the conversation and his or her room is not appropriate,an alternative meeting space may be located.The nurse should be present for the client during this time,and pulling up a chair and sitting with the client indicates that presence.Because the nurse is assessing the client's response to a terminal diagnosis,it is not necessary to have detailed information about the projected prognosis; the nurse knows that the client is facing an end-of-life illness.

Question 14

A nurse cares for a client with end-stage pancreatic cancer.The client asks,"Why is this happening to me?" How should the nurse respond?

Accepted Answer

The client is not asking the nurse to actually explain why the cancer has occurred.The client may be expressing his or her feelings of confusion,frustration,distress,and grief related to this diagnosis.Reminding the client to keep a positive attitude for his or her family does not address the client's emotions or current concerns.The nurse should validate that there is no easy or straightforward answer as to why the client has cancer.Telling a client that cancer is a trial is untrue and may diminish the client-nurse relationship.

Question 15

A nurse plans care for a client with acute pancreatitis.Which intervention should the nurse include in this client's plan of care to reduce discomfort?

Accepted Answer

The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production.IV fluids should be used to prevent dehydration.The client may need a nasogastric tube.Pain medications should be given around the clock and more frequently than every 4 to 6 hours.A fetal position with legs drawn up to the chest will promote comfort.

Question 16

A nurse cares for a client who has obstructive jaundice.The client asks,"Why is my skin so itchy?" How should the nurse respond?

Accepted Answer

In obstructive jaundice,the normal flow of bile into the duodenum is blocked,allowing excess bile salts to accumulate on the skin.This leads to itching,or pruritus.The other statements are not accurate.

Question 17

A nurse assesses a client who is recovering from an open Whipple procedure.Which action should the nurse perform first?

Accepted Answer

Using the ABCs,airway and oxygenation status should always be assessed first,so checking the endotracheal tube is the first action.Next,the nurse should start the IV line (circulation).After that,the Foley catheter can be inserted and the nasogastric tube can be set.

Question 18

A nurse assesses a client who is recovering from a Whipple procedure.Which assessment finding alerts the nurse to urgently contact the health care provider?

Accepted Answer

Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis.Absent bowel sounds,pain at the incision site,and NG tube drainage are normal postoperative findings.

Question 19

A nurse cares for a client with acute pancreatitis.The client states,"I am hungry." How should the nurse reply?

Accepted Answer

Paralytic ileus is a common complication of acute pancreatitis.The client should not eat until this has resolved.Bowel sounds and decreased pain are not reliable indicators of peristalsis.Instead,the nurse should assess for passage of flatus or bowel movement.

Question 20

A nurse assesses clients on the medical-surgical unit.Which client should the nurse identify as at high risk for pancreatic cancer?

Accepted Answer

Risk factors for pancreatic cancer include obesity,older age,high intake of red meat,and cigarette smoking.Sushi and wine intake are not risk factors for pancreatic cancer.

Quiz 59: Care of Patients with Problems of the Biliary System and Pancreas