Question 1

The nurse explains that for a client who is a poor surgical risk, one of the nonsurgical alternatives for gallstone disease is
A) abdominal ultrasound.
B) laser therapy.
C) retrograde endoscopy.
D) T-tube placement.

Accepted Answer

Retrograde endoscopy for stone removal is an important nonsurgical alternative. To remove a gallstone from the common bile duct, the physician passes an endoscope orally into the duodenum, and then passes a wire snare into the common bile duct through the ampulla of Vater, securing and removing the obstructing stone.

Question 2

A client with a history of cholelithiasis presents at the hospital with nausea and vomiting, abdominal pain, and jaundice. The nurse would assess the client for
A) common bile duct obstruction.
B) infarct of the hepatic vein.
C) perforation of the gallbladder.
D) spasm of the biliary tree.

Accepted Answer

Jaundice appears only when common bile duct obstruction is present. Bilirubin, which is normally excreted through the colon, is now in the circulating volume because of the blocked common bile duct and is deposited in the skin and in the urine, causing dark urine, light-colored stools, jaundice, and itching.

Question 3

A client has returned from an open cholecystectomy. The nurse places the highest priority on which intervention?
A) Coughing and deep breathing
B) Early ambulation
C) Wearing anti-embolic hose
D) Use of a nasogastric tube

Accepted Answer

After cholecystectomy, clients find it difficult to take deep breaths and cough independently because of the location of the incision. Preventing pneumonia is a critical outcome of the diagnosis Risk for Injury.

Question 4

A client has been diagnosed with cancer of the gallbladder. Which statement by the client would lead the nurse to feel concern for this client's coping?
A) "After my chemotherapy is over, I think I will retire and do a lot of traveling.
B) "I'm going to see a lawyer and update my will and advance directives."
C) "It's hard deciding if I should have chemo or radiation because both have bad results."
D) "My doctors say there is no agreement on the best treatment."

Accepted Answer

The prognosis for gallbladder cancer is poor; only about 5% of clients with unresectable cancer are alive at the end of the first year after diagnosis. There is no agreement on the best treatment and neither chemotherapy nor radiation therapy offers good outcomes.

Question 5

A nurse is providing discharge instructions for a post-cholecystectomy client. The nurse would view the goals for teaching had been effective when the client states he/she would
A) call the physician if gas occurs.
B) notify the physician of jaundice or itching.
C) remain indoors until the dressings are removed.
D) report dark-colored stools to the clinic.

Accepted Answer

The nurse should be sure that the client knows which manifestations to report to the physician and how to contact the physician. The client should be instructed to report fever, jaundice, dark-colored urine, pale-colored stools, and pruritus.

Question 6

The nursing diagnosis that would serve as the primary guide when providing care to a client with cystic fibrosis (CF) is
A) Constipation
B) Fluid Volume Excess
C) Ineffective Airway Clearance
D) Swallowing, Impaired

Accepted Answer

Nursing management of the client with CF focuses on two major nursing diagnoses: Ineffective Airway Clearance and Imbalanced Nutrition: Less than Body Requirements.

Question 7

In evaluating a client for the presence of gallbladder disease, the nurse would recognize that the client's statement most suggestive of this problem is
A) "I am having difficulty swallowing."
B) "I get a sharp, stabbing pain every time I take a deep breath or cough."
C) "I have a terrible pain in my stomach; it is so bad I can feel it in my shoulder."
D) "I have a very strong craving for fatty foods like bacon and eggs fried in butter."

Accepted Answer

The most specific and characteristic manifestation of gallstone disease is pain, or biliary colic, which is caused by spasm of the biliary ducts as they try to dislodge stones. This pain usually follows the temporary obstruction of the gallbladder outlet. Characteristically, the pain starts in the upper midline area, and it may radiate around to the back and right shoulder blade, although some clients report that it passes straight through to the back and substernal areas.

Question 8

A client with acute pancreatitis has developed a Cullen's sign. Which nursing diagnosis takes priority for this client?
A) Acute Pain
B) Altered Nutrition
C) Imbalanced Fluid Volume
D) Ineffective Breathing Patterns

Accepted Answer

Severe hemorrhagic pancreatitis may produce two distinctive manifestations: Turner's sign (bluish discoloration of the left flank) and Cullen's sign (bluish discoloration of the periumbilical area). Cullen's sign indicates bleeding into the peritoneum, making the client's priority problem Imbalanced Fluid Volume.

Question 9

The nurse recognizes that the client with gallstones who would be the best candidate for treatment with extracorporeal shock wave lithotripsy (ECSL) is a client with
A) common bile duct stones.
B) liver disease.
C) stones that are 6 cm in diameter.
D) two gallstones.

Accepted Answer

The client should have symptomatic cholelithiasis with fewer than four stones, each smaller than 3 cm in diameter, and no history of liver or pancreatic disease. Contraindications to ECSL are the presence of common bile duct stones, recent acute cholecystitis, cholangitis, and pancreatitis.

Question 10

The nurse would explain that Whipple's operation involves
A) excavation of a pancreatic abscess and implantation of an external drain.
B) removal of the head of the pancreas and portions of the stomach and duodenum.
C) surgical removal of a pancreatic pseudocyst and implantation of an external drain.
D) surgical removal of the tail of the pancreas and portions of the colon.

Accepted Answer

Surgical management of pancreatic cancer includes Whipple's operation, which involves a pancreatoduodenectomy with removal of the distal third of the stomach, the duodenum, common bile duct, gallbladder, and head of the pancreas.

Question 11

A client had an endoscopic retrograde papillotomy for stone removal and has returned to the nursing unit. The client is asking for ice chips. What assessment takes priority? The nurse should assess the client's
A) bowel sounds.
B) gag reflex.
C) sedation level.
D) vital signs.

Accepted Answer

During this procedure, a local anesthetic is sprayed at the back of the client's throat to facilitate passing the endoscope. The nurse should carefully check for the return of the gag reflex before allowing oral intake. This is the priority assessment as the client is asking for ice chips. The client has probably received sedation for the procedure, making an assessment of sedation level important as well. Vital signs are monitored frequently post-procedure. Bowel sounds are the last priority as the client did not receive general anesthesia.

Question 12

The morning after admission, a client being treated for gallstones begins to vomit about every 15 minutes and is complaining of abdominal pain. The most appropriate action by the nurse would be to
A) encourage the client to ambulate.
B) offer clear fluids.
C) prepare to insert a nasogastric tube.
D) turn the client to the right side.

Accepted Answer

If the client continues vomiting, the nurse should obtain an order for a nasogastric tube with a suction attachment to relieve the distention and vomiting. Suction also removes the gastric juices that stimulate cholecystokinin, which in turn causes painful contractions of the gallbladder.

Question 13

A client returned to the nursing unit after cholecystectomy with common bile duct exploration has bile leaking from around the wound. The most appropriate nursing intervention at this time would be to
A) assess the client further, asking about pain.
B) reassure the client that this is normal and reinforce the dressing.
C) monitor the client for elevations in blood pressure and pulse.
D) encourage the client to change position in bed.

Accepted Answer

The risk of bile leakage into the abdominal cavity is more specific for surgeries that involve the gallbladder. With hemorrhage and bile leakage, the client feels severe pain and tenderness in the right upper quadrant; the abdominal girth increases; bile or blood may leak from the wound; blood pressure drops; and tachycardia develops.

Question 14

In preparing the teaching plan on dietary changes after discharge for a client with chronic pancreatitis, the nurse would know that the statement most indicative of the client's understanding of the information is
A) "I won't be eating any more French fries or drinking hard liquor."
B) "A chicken breast and a glass of white wine sound like a good dinner."
C) "I'm anxious to cooperate if it means I can get rid of this pain permanently."
D) "My diet doesn't sound too bad; lots of people have to watch what they eat."

Accepted Answer

For alcohol-related pancreatitis, total abstinence from alcohol is imperative and sometimes successful in itself for pain relief. A low-fat diet should be prescribed and may reduce painful stimulation of pancreatic enzyme secretion. Clients should understand the benefits of eating small, frequent meals high in protein, low in fat, and moderate to high in carbohydrates.

Question 15

The nurse is providing discharge instructions to a client going home with a T tube after an open cholecystectomy. Goals for teaching have been met when the client says
A) "For drainage that is thick with mucus or blood, I can irrigate the T tube."
B) "I will need to milk the tube every 4 hours and record the drainage."
C) "The tube can be used to administer stone dissolving medications"
D) "This tube will stay in for 1-2 weeks and I should watch for diminishing drainage."

Accepted Answer

The T tube will be removed in 1-2 weeks. Drainage should gradually diminish. Drainage that is thick with blood or mucus needs to be reported to the physician. Milking the tube is not recommended. Stone dissolving medications are given orally.

Question 16

To attempt to alleviate the pain of a client with acute pancreatitis, the nurse would place the client in the
A) prone position with a pillow under the abdomen.
B) semi-Fowler position with a small pillow under the knees.
C) side-lying position with a pillow splinting the abdomen.
D) supine position with a cold pack to the abdomen.

Accepted Answer

Positioning (side-lying knee-chest position with a pillow pressed against the abdomen, or sitting position with the trunk flexed), back rubs, relaxation techniques, and a quiet environment all help promote comfort and rest.

Question 17

When a client is admitted to the hospital for treatment of acute cholecystitis, the nurse would anticipate that the immediate medical management will be
A) antibiotic therapy.
B) provided by a medical nutritionist.
C) systemic corticosteroid administration.
D) total parenteral nutrition.

Accepted Answer

Clients suspected of having acute cholecystitis may need to be hospitalized, and initial management should include administration of antibiotics effective against organisms found in the bile in approximately 80% of cases.

Question 18

Activities the nurse could suggest to a client interested in preventing gallstone formation include which of the following?
A) Drink only bottled water.
B) Increase the amount of protein eaten each day.
C) Limit the amount of calcium in the diet.
D) Maintain a low-fat diet.

Accepted Answer

Health promotion activities that can help limit or prevent gallstone formation include maintaining a low-fat diet, maintaining ideal body weight, and limiting the number of one's pregnancies. Low-carbohydrate diets and physical activity also seem to help.

Question 19

A nurse is teaching a client and spouse about insulin administration. The spouse becomes quite upset, saying "Why are we having to use insulin at home? The diagnosis is pancreatitis! How did you make him a diabetic?" The best response by the nurse is
A) "I see you are upset. Let me answer your questions before we talk about insulin."
B) "I'm sorry you're upset. But you both need to understand how to use insulin."
C) "When so much endocrine tissue is damaged, the client becomes diabetic."
D) "Would you like the diabetic educator to come talk with you both?"

Accepted Answer

The client who loses a great deal of endocrine pancreatic tissue, either through scarring from chronic pancreatitis or from surgical resection, will develop diabetes and will need insulin administration for the rest of the client's life. However, the spouse is too upset to be able to learn, and attending to the psychosocial needs takes precedence before teaching can be done.

Question 20

The nurse recognizes that the individual at highest risk for development of gallstones is
A) a 20-year-old black man with sickle cell disease.
B) a 35-year-old white woman being treated for breast cancer.
C) a 49-year-old white man with a sedentary lifestyle.
D) a 60-year-old white woman being treated for obesity.

Accepted Answer

The incidence of gallstones increases with age, as do the risks associated with cholelithiasis. Women account for almost 70% of clients treated for gallstones, although studies have suggested that the death rate is higher in men. Other disorders that are associated with an increased incidence of gallstones are diabetes mellitus, obesity, Crohn's diseases, and cirrhosis.

Quiz 46: Management of Clients with Exocrine Pancreatic and Biliary Disorders

The nurse explains that for a client who is a poor surgical risk, one of the nonsurgical alternatives for gallstone disease is

A client with a history of cholelithiasis presents at the hospital with nausea and vomiting, abdominal pain, and jaundice. The nurse would assess the client for

A client has returned from an open cholecystectomy. The nurse places the highest priority on which intervention?

A client has been diagnosed with cancer of the gallbladder. Which statement by the client would lead the nurse to feel concern for this client's coping?

A nurse is providing discharge instructions for a post-cholecystectomy client. The nurse would view the goals for teaching had been effective when the client states he/she would

The nursing diagnosis that would serve as the primary guide when providing care to a client with cystic fibrosis (CF) is

In evaluating a client for the presence of gallbladder disease, the nurse would recognize that the client's statement most suggestive of this problem is

A client with acute pancreatitis has developed a Cullen's sign. Which nursing diagnosis takes priority for this client?

The nurse recognizes that the client with gallstones who would be the best candidate for treatment with extracorporeal shock wave lithotripsy (ECSL) is a client with

The nurse would explain that Whipple's operation involves

A client had an endoscopic retrograde papillotomy for stone removal and has returned to the nursing unit. The client is asking for ice chips. What assessment takes priority? The nurse should assess the client's

The morning after admission, a client being treated for gallstones begins to vomit about every 15 minutes and is complaining of abdominal pain. The most appropriate action by the nurse would be to

A client returned to the nursing unit after cholecystectomy with common bile duct exploration has bile leaking from around the wound. The most appropriate nursing intervention at this time would be to

In preparing the teaching plan on dietary changes after discharge for a client with chronic pancreatitis, the nurse would know that the statement most indicative of the client's understanding of the information is

The nurse is providing discharge instructions to a client going home with a T tube after an open cholecystectomy. Goals for teaching have been met when the client says

To attempt to alleviate the pain of a client with acute pancreatitis, the nurse would place the client in the

When a client is admitted to the hospital for treatment of acute cholecystitis, the nurse would anticipate that the immediate medical management will be

Activities the nurse could suggest to a client interested in preventing gallstone formation include which of the following?

A nurse is teaching a client and spouse about insulin administration. The spouse becomes quite upset, saying "Why are we having to use insulin at home? The diagnosis is pancreatitis! How did you make him a diabetic?" The best response by the nurse is

The nurse recognizes that the individual at highest risk for development of gallstones is