Question 1

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

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 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?

Accepted Answer

Serum and urine amylase levels are elevated when the pancreas becomes inflamed.One cause of pancreatitis is gallbladder disease; another causative factor is alcohol intake.The nurse should tactfully explore this subject with the client before documenting the findings and notifying the provider.The client may need to be NPO or on clear liquids,but the nurse does not have enough information yet to determine this.

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?

Accepted Answer

The client is not asking the nurse actually to explain why the cancer has occurred,but simply to validate that no easy or straightforward answer can be found.

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?

Accepted Answer

Drainage from the JP drain initially appears serosanguineous in color.The drainage will appear bile-colored within 24 hours.The nurse does not need to notify the surgeon,milk the tubing,or irrigate the drain because this is an expected finding.

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?

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 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?

Accepted Answer

Grayish-blue discoloration on the flanks (Turner's sign)indicates pancreatic enzyme leakage into the peritoneal cavity.This presents a risk of shock for the client,so IV access should be maintained with at least one large-bore patent IV catheter.The client may or may not need surgery; usually a fetal position helps with pain,and having an NG tube would not take priority over IV access.

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?

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 operation.Restriction of sweets is not required.

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?

Accepted Answer

In chronic cholecystitis,bile duct obstruction results in the absence of urobilinogen to color the stool.Excess circulating bilirubin turns the urine dark and foamy.The other assessment findings do not correlate with chronic cholecystitis.

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?

Accepted Answer

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

Question 10

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

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 (NG)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 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?

Accepted Answer

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

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?

Accepted Answer

A transhepatic biliary catheter (T-tube)decompresses extrahepatic ducts to promote the flow of bile.When bile flows normally,it reaches the large intestine,where bile is converted to urobilinogen,coloring the stools brown.The other findings would not indicate successful T-tube placement.

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?

Accepted Answer

Clients with cholelithiasis should avoid foods high in fat and cholesterol,such as whole milk,butter,and fried foods.Lasagna,2% milk,grilled cheese,cream,and butter all have high levels of fat.The meal with the least amount of fat is the chicken breast dinner.

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?

Accepted Answer

The nurse assesses the skin around the drainage tube for redness or skin irritation,which can be severe from leakage of pancreatic enzymes.The nurse applies a skin barrier such as Stomahesive around the drainage tube to prevent excoriation.A side-lying position may be more comfortable for the client.The drainage tube should not be clamped or irrigated without specific orders.

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?

Accepted Answer

Using the ABCs,airway and oxygenation status should always be assessed first.Next,the nurse should assess the IV line (circulation).After that,the other two items can be assessed.

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?

Accepted Answer

Mutations in both 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 17

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

Accepted Answer

A client with chronic pancreatitis needs 4000 to 6000 calories per day for optimum nutrition and healing.The client may have additional restrictions if he or she has other health problems such as diabetes.The nurse should collaborate with the registered dietitian to help the client plan nutritional intake.

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?

Accepted Answer

The provider will discontinue the T-tube.The other statements are accurate.

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?

Accepted Answer

Spasm of the hand when a blood pressure cuff is applied (Trousseau's sign)is indicative of hypocalcemia.The client's calcium level is low.The sodium level is high,but that is not related to Trousseau's sign.Creatinine and potassium levels are normal.

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?

Accepted Answer

Edema and low urine output following the Whipple procedure most likely are caused by hypoalbuminemia.Low albumin leads to third spacing of fluids and decreased intravascular fluids.As a result,edema and low urine output develop.Adding a colloid solution to the client's IV regimen will help shift edematous fluid from the interstitial space back into the intravascular space.Increasing the client's IV infusion rate will worsen the edema unless additional protein is added.Blood glucose monitoring and NG tubes are not related to this problem.

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