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

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.

Answer 1

retrograde endoscopy.

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.

Answer 2

common bile duct obstruction.

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

Answer 3

Coughing and deep breathing

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."

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.

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

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."

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

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.

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.

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.

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.

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.

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."

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."

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.

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.

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.

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?"

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.

Question 21

A client with a T tube following choledochostomy asks the nurse why the tube is being clamped during mealtimes. The most accurate response by the nurse is

A) "It causes less pain during mealtime."
B) "It helps keep the common bile duct patent."
C) "It helps with digestion of fats in the meal."
D) "It will help the tube to come out more quickly."

Question 22

A client who underwent laparoscopic cholecystectomy asks the nurse how soon he/she can return to work. The nurse would respond that the final decision is up to the surgeon, but that clients can usually resume work after

A) 24 hours.
B) 3 to 4 days.
C) 5 to 7 days.
D) 2 weeks.

Question 23

A nurse assessing the first 24 hours of drainage from a T tube inserted during surgery for cholelithiasis would record as normal the T-tube output of

A) less than 50 ml.
B) 100 to 200 ml.
C) 300 to 500 ml.
D) 500-1000 ml.

Question 24

A client with acute pancreatitis has a drop in blood pressure from (142/80) to (105/65) mm Hg at 2 hours after admission. The client has not voided and has become short of breath. The nurse would anticipate that the abnormal laboratory value consistent with these manifestations is

A) hypercalcemia.
B) hyperglycemia.
C) hypoalbuminemia.
D) hypokalemia.

Question 25

A client is admitted with acute pancreatitis. The orders are for "pancreatic rest." The nurse would implement which of the following? (Select all that apply.)

A) Administering pancreatic enzymes with meals
B) Bed rest with appropriate positioning
C) Immediate insertion of an NG tube
D) Withholding foods and liquids

Question 26

A client is being admitted for the eighth exacerbation of chronic pancreatitis in 2 years. The client is frail and emaciated and becomes agitated when the nurse asks about pain medication. Which referral can the nurse make to best meet this client's needs and address potential complications of the condition? The nurse should request a referral to a

A) chaplain for spiritual distress related to the chronic nature of the disease.
B) chemical dependency counselor to assess and treat substance abuse.
C) medical nutritionist to assess and treat the client's malnutrition.
D) surgeon to assess whether or not this client can be treated surgically.

Question 27

A client who had pancreatic surgery has been started on medication therapy with pancrelipase (Pancrease). The manifestation that the nurse would report as an indication that the dosage may be insufficient is

A) black, tarry stools.
B) clay-colored stools.
C) constipation.
D) steatorrhea.

Question 28

The nurse planning the care of a client admitted with severe pancreatitis would anticipate the diet order of

A) clear liquids.
B) enteral feedings.
C) NPO with TPN.
D) soft, low fat.

Question 29

Health promotion activities a nurse could recommend to a client in order to prevent pancreatitis include (Select all that apply)

A) avoiding alcohol abuse.
B) eating a high-protein diet.
C) getting regular exercise.
D) losing weight if needed.

Question 30

A client who had onset of acute pancreatitis 6 days ago has a respiratory rate of 26 with fine crackles throughout lung fields, and seems a little confused and agitated. The nurse would continue to assess this client for manifestations of

A) adult respiratory distress syndrome.
B) atelectasis and pneumonitis.
C) pneumonia.
D) tension pneumothorax.

Question 31

A client being discharged after an episode of acute pancreatitis asks the nurse why items such as coffee/tea, spicy foods, and heavy meals should be avoided. The nurse should reply

A) "Eating these items may disrupt your sleep and you will need lots of rest."
B) "So that you won't get reflux disease, which is a common complication."
C) "Those things stimulate the pancreas too much and may give you another attack."
D) "Your sense of taste has been altered, and often people don't like these any more."