Ignatavicius Ch 59: Care of Patients with Problems of the Biliary System and Pancreas Flashcards
A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond?
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.
a. Bile salts accumulate in the skin and cause the itching.
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.
After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?
a. Drinking at least 2 liters of water each day is suggested.
b. I will decrease the amount of fatty foods in my diet.
c. Drinking fluids with my meals will increase bloating.
d. I will avoid concentrated sweets and simple carbohydrates.
b. I will decrease the amount of fatty foods in my diet.
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.
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?
a. Ambulating in the hallway twice a day will help.
b. I will apply a cold compress to the painful area on your back.
c. Drinking a warm beverage can relieve this referred pain.
d. You should cough and deep breathe every hour.
a. Ambulating in the hallway twice a day will help.
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.
After teaching a client who has a history of cholelithiasis, the nurse assesses the clients understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching?
a. Lasagna, tossed salad with Italian dressing, and low-fat milk
b. Grilled cheese sandwich, tomato soup, and coffee with cream
c. Cream of potato soup, Caesar salad with chicken, and a diet cola
d. Roasted chicken breast, baked potato with chives, and orange juice
d. Roasted chicken breast, baked potato with chives, and orange juice
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.
A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort?
a. Administer morphine sulfate intravenously every 4 hours as needed.
b. Maintain nothing by mouth (NPO) and administer intravenous fluids.
c. Provide small, frequent feedings with no concentrated sweets.
d. Place the client in semi-Fowlers position with the head of bed elevated.
b. Maintain nothing by mouth (NPO) and administer intravenous fluids.
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.
After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?
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.
c. The best time to take the enzymes is immediately after I have a meal or a snack.
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.
A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first?
a. Assess the clients endotracheal tube with 40% FiO2.
b. Insert an indwelling Foley catheter to gravity drainage.
c. Place the clients nasogastric tube to low intermittent suction.
d. Start lactated Ringers solution through an intravenous catheter.
a. Assess the clients endotracheal tube with 40% FiO2.
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.
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?
a. I dont know. I wish I had an answer for you, but I dont.
b. Its 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.
a. I dont know. I wish I had an answer for you, but I dont.
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 clients 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.
A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first?
a. Bring the client to a quiet room for privacy.
b. Pull up a chair and sit next to the clients bed.
c. Determine whether the client feels like talking about his or her feelings.
d. Review the health care providers notes about the prognosis for the client.
c. Determine whether the client feels like talking about his or her feelings.
Before conducting an assessment about the clients 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 clients 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.
A nurse assesses clients at a community health center. Which client is at highest risk for pancreatic cancer?
a. A 32-year-old with hypothyroidism
b. A 44-year-old with cholelithiasis
c. A 50-year-old who has the BRCA2 gene mutation
d. A 68-year-old who is of African-American ethnicity
c. A 50-year-old who has the BRCA2 gene mutation
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.
A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute?
a. Temperature of 100.1 F (37.8 C)
b. Positive Murphys sign
c. Light-colored stools
d. Upper abdominal pain after eating
c. Light-colored stools
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.
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?
a. Administer intravenous morphine while the client sleeps.
b. Encourage the client to use the PCA pump upon awakening.
c. Contact the provider and request a different analgesic.
d. Ask a family member to initiate the PCA pump for the client.
b. Encourage the client to use the PCA pump upon awakening.
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.
A nurse cares for a client with acute pancreatitis. The client states, I am hungry. How should the nurse reply?
a. Is your stomach rumbling or do you have bowel sounds?
b. I need to check your gag reflex before you can eat.
c. Have you passed any flatus or moved your bowels?
d. You will not be able to eat until the pain subsides.
c. Have you passed any flatus or moved your bowels?
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.
A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge?
a. Do you have a one- or two-story home?
b. Can you check your own pulse rate?
c. Do you have any alcohol in your home?
d. Can you prepare your own meals?
a. Do you have a one- or two-story home?
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 clients safety.
A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer?
a. A 26-year-old with a body mass index of 21
b. A 33-year-old who frequently eats sushi
c. A 48-year-old who often drinks wine
d. A 66-year-old who smokes cigarettes
d. A 66-year-old who smokes cigarettes
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.
