N221 MedSurg Final Exam Questions
With Correct Answers
Functions of the gallbladder - ANSWER concentrates bile
stores bile
releases bile when food moves into intestines
cholelithiasis - ANSWER gallstones: hardened cholesterol stones formed from
bile crystallization
Can be caused by abnormalities in composition of bile, stasis in bile, or
inflammation of gallbladder
Cholelithiasis risk factors - ANSWER Obesity/DM
Female
Multiple pregnancies
weight fluctuations
oral contraceptive use
genetics
s/s of cholelithiasis - ANSWER Asymptomatic (until obstruction).
When obstruction occurs s/s=
Colicky pain (intermittent, RUQ. Can radiate to shoulder).
Pain often precipitated by a meal.
Nausea, vomiting, gas.
Sweating.
Jaundice, dark urine, pale stools (when bilirubin are released in urine and not
making way into digestion system
diagnosing cholelithiasis - ANSWER Primarily-- ultrasonography
MRCP
ERCP: diagnose and treat by removing some stones
Nursing care for ERCP - ANSWER Pre-procedure
-NPO
,-Receive moderate sedation
Post-Procedure
-Monitor for respiratory sedation
-Monitor for CNS depression
-Monitor vitals
-N/V care
-Monitor for early s/s of sepsis
-monitor for return of gag reflux before nutrition is started
Cholecystitis - ANSWER inflammation of the gallbladder; usually associated with
gallstones (90% of acute cases)
stone obstructs the bile outflow from the pouch and then bile remains in the
gallbladder and initiates a chemical reaction creating an autolysis and edema
S/S of cholecystitis - ANSWER Often precipitated by a large or fatty meal
fever & leukocytosis (may be due to bacterial infection)
jaundice, N/V, anorexia, fat intolerance, dark urine, grey stools, pain in upper
right quadrant that may radiate to back, feeling of fullness
Cholecystectomy Nursing Care - ANSWER surgical removal of the gallbladder
(can be laparoscopic or open)
-Monitor for pain/administer analgesics
-provide ice or hot pack to right shoulder (pain here due to gas inserted during
surgery)
-ambulation as early as possible
-monitor for s/s of infection
-educate about returning to work and activities (usually 1 week)
-educate about low fat diet for 4-6 weeks
open cholecystectomy care
-monitor t tube drain
Pancreas function - ANSWER Has both endocrine and exocrine function
Exocrine: produce enzymes that help to digest food (amylase, protease, lipase):
only active when in the duodenum
Endocrine: produce insulin that regulates our blood sugar
, acute pancreatitis - ANSWER Pancreatic duct becomes blocked and the
enzymes in pancreas become activated while they are still inside and can cause
damage. Autodigestion occurs causing tissue damage, and death
Caused by alcohol and gallstones/obstructions
Some patients recover fully, and some develop chronic pancreatitis
S/S of acute pancreatitis - ANSWER severe abdominal pain (mid epigastric,
acute onset, more severe after meals)
fever
mental confusion
jaundice
N/V
abdominal distention/rigidity
abdominal guarding
decreased bowel tones
increased pulse
decreased BP
cool and clammy skin
Turner's and Cullens signs 3-6 days after onset
turners sign (pancreatitis) - ANSWER flank ecchymosis
red/purple in the flank area
Cullen's sign - ANSWER ecchymosis in umbilical area, seen with pancreatitis
Mild acute pancreatitis - ANSWER lack of pancreatic necrosis with enlargement
of pancreas due to inflammatory edema
Risk for hypovolemic shock, fluid and electrolyte imbalances, sepsis
Severe acute pancreatitis - ANSWER tissue necrosis in parenchyma or in tissue
surrounding gland
digestion of gland with damage to blood vessels
Can cause infections, bleeding, thrombosis
Can develop into systemic organ failure
Lab values to know for pancreatitis - ANSWER increase in serum amylase
increase in serum lipase
WBC elevated
Decrease in calcium
Glucose elevations
With Correct Answers
Functions of the gallbladder - ANSWER concentrates bile
stores bile
releases bile when food moves into intestines
cholelithiasis - ANSWER gallstones: hardened cholesterol stones formed from
bile crystallization
Can be caused by abnormalities in composition of bile, stasis in bile, or
inflammation of gallbladder
Cholelithiasis risk factors - ANSWER Obesity/DM
Female
Multiple pregnancies
weight fluctuations
oral contraceptive use
genetics
s/s of cholelithiasis - ANSWER Asymptomatic (until obstruction).
When obstruction occurs s/s=
Colicky pain (intermittent, RUQ. Can radiate to shoulder).
Pain often precipitated by a meal.
Nausea, vomiting, gas.
Sweating.
Jaundice, dark urine, pale stools (when bilirubin are released in urine and not
making way into digestion system
diagnosing cholelithiasis - ANSWER Primarily-- ultrasonography
MRCP
ERCP: diagnose and treat by removing some stones
Nursing care for ERCP - ANSWER Pre-procedure
-NPO
,-Receive moderate sedation
Post-Procedure
-Monitor for respiratory sedation
-Monitor for CNS depression
-Monitor vitals
-N/V care
-Monitor for early s/s of sepsis
-monitor for return of gag reflux before nutrition is started
Cholecystitis - ANSWER inflammation of the gallbladder; usually associated with
gallstones (90% of acute cases)
stone obstructs the bile outflow from the pouch and then bile remains in the
gallbladder and initiates a chemical reaction creating an autolysis and edema
S/S of cholecystitis - ANSWER Often precipitated by a large or fatty meal
fever & leukocytosis (may be due to bacterial infection)
jaundice, N/V, anorexia, fat intolerance, dark urine, grey stools, pain in upper
right quadrant that may radiate to back, feeling of fullness
Cholecystectomy Nursing Care - ANSWER surgical removal of the gallbladder
(can be laparoscopic or open)
-Monitor for pain/administer analgesics
-provide ice or hot pack to right shoulder (pain here due to gas inserted during
surgery)
-ambulation as early as possible
-monitor for s/s of infection
-educate about returning to work and activities (usually 1 week)
-educate about low fat diet for 4-6 weeks
open cholecystectomy care
-monitor t tube drain
Pancreas function - ANSWER Has both endocrine and exocrine function
Exocrine: produce enzymes that help to digest food (amylase, protease, lipase):
only active when in the duodenum
Endocrine: produce insulin that regulates our blood sugar
, acute pancreatitis - ANSWER Pancreatic duct becomes blocked and the
enzymes in pancreas become activated while they are still inside and can cause
damage. Autodigestion occurs causing tissue damage, and death
Caused by alcohol and gallstones/obstructions
Some patients recover fully, and some develop chronic pancreatitis
S/S of acute pancreatitis - ANSWER severe abdominal pain (mid epigastric,
acute onset, more severe after meals)
fever
mental confusion
jaundice
N/V
abdominal distention/rigidity
abdominal guarding
decreased bowel tones
increased pulse
decreased BP
cool and clammy skin
Turner's and Cullens signs 3-6 days after onset
turners sign (pancreatitis) - ANSWER flank ecchymosis
red/purple in the flank area
Cullen's sign - ANSWER ecchymosis in umbilical area, seen with pancreatitis
Mild acute pancreatitis - ANSWER lack of pancreatic necrosis with enlargement
of pancreas due to inflammatory edema
Risk for hypovolemic shock, fluid and electrolyte imbalances, sepsis
Severe acute pancreatitis - ANSWER tissue necrosis in parenchyma or in tissue
surrounding gland
digestion of gland with damage to blood vessels
Can cause infections, bleeding, thrombosis
Can develop into systemic organ failure
Lab values to know for pancreatitis - ANSWER increase in serum amylase
increase in serum lipase
WBC elevated
Decrease in calcium
Glucose elevations
