Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas Ignatavicius: Medical-Surgical Nursing, 8th Edition

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Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas Ignatavicius: Medical-Surgical Nursing, 8th Edition

Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. 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.”

2. 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? 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.”

3. 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.”

4. 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? 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

5. 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? 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-Fowler’s position with the head of bed elevated.

6. 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? 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.”

7. A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first? a. Assess the client’s endotracheal tube with 40% FiO2. b. Insert an indwelling Foley catheter to gravity drainage. c. Place the client’s nasogastric tube to low intermittent suction. d. Start lactated Ringer’s solution through an intravenous catheter.

8. 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 don’t know. I wish I had an answer for you, but I don’t.” b. “It’s 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.”

9. 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 client’s bed. c. Determine whether the client feels like talking about his or her feelings. d. Review the health care provider’s notes about the prognosis for the client.

10. A nurse assesses clients at a community health center. Which client is at the 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

11. 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 Murphy’s sign c. Light-colored stools d. Upper abdominal pain after eating

12. 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.

13. 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.”

14. 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?”

15. A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as a 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 wined. A 66-year-old who smokes cigarettes

16. 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? a. Drainage from a fistula b. Absent bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

17. A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take? a. Clamp the nasogastric tube. b. Place the client in semi-Fowler’s position. c. Assess vital signs once every shift. d. Provide oral rehydration.

MULTIPLE RESPONSE

1. 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.) a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

2. 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.) a. Body mass index of 46 b. Vegetarian diet c. Drinking 4 ounces of red wine nightly d. Pregnant with twins e. History of metabolic syndrome f. Glycosylated hemoglobin level of 15%

3. 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.) a. “Take a 20-minute walk at least 5 days each week.” b. “Attend local Alcoholics Anonymous (AA) meetings weekly.” c. “Choose whole grains rather than foods with simple sugars.” d. “Use cooking spray when you cook rather than margarine or butter.” e. “Stay away from milk and dairy products that contain lactose.” f. “We can talk to your doctor about a prescription for nicotine patches.”

4. A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? (Select all that apply.) a. Contact the provider immediately. b. Lower the head of the bed. c. Decrease intravenous fluids. d. Ask the client to bear down. e. Administer prescribed opioids.

5. A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.) a. Registered dietitian b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Health care provider

6. A nurse collaborates with unlicensed assistive personnel (UAP) to provide care for a client who is in the healing phase of acute pancreatitis. Which statements focused on nutritional requirements should the nurse include when delegating care for this client? (Select all that apply.) a. “Do not allow the client to eat between meals.” b. “Make sure the client receives a protein shake.” c. “Do not allow caffeine-containing beverages.” d. “Make sure the foods are bland with little spice.” e. “Do not allow high-carbohydrate food items.”

7. A nurse cares for a client with pancreatic cancer who is prescribed implanted radioactive iodine seeds. Which actions should the nurse take when caring for this client? (Select all that apply.) a. Dispose of dirty linen in a red “biohazard” bag. b. Place the client in a private room. c. Wear a lead apron when providing client care. d. Bundle care to minimize exposure to the client. e. Initiate transmission-based Precautions.

SHORT ANSWER

1. A nurse cares for a client with acute pancreatitis who has prescribed gentamicin (Garamycin) 3 mg/kg/day in 3 divided doses. The client weighs 264 lb. How many milligrams should the nurse administer for each dose? (Record your answer using a whole number.) ____ mg/dose 2. A nurse cares for a client who has prescribed 4 mg of calcium gluconate to infuse over 5 hours. The pharmacy provides 2 premixed infusion bags with 2 mg of calcium gluconate in 100 mL of D5W. At what rate should the nurse administer this medication? (Record your answer using a whole number.) ____ mL/hr

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