Chapter 30: Care of Patients with Disorders of the Liver, Gallbladder, and Pancreas |DeWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse’s teaching has been successful? a. “I should call my doctor if I have any pain.” b. “I should be able to go back to work tomorrow.” c. “I should avoid fatty foods for a few weeks.” d. “I should let these Steri-Strips fall off on their own.” ANS: D The nurse should teach the patient to remove the bandages from the puncture site(s) the day after surgery and shower, leaving the Steri- Strips intact. Steri-Strips will fall off in 7 to10 days. The patient should notify the physician in cases of severe abdominal pain that is not relieved by medication or is worsening. Return to work is probable at 1 week post-surgery. The patient should adhere to a low-fat diet for several weeks and slowly introduce fattier foods to determine if they cause unpleasant symptoms. PTS:1 DIF: Cognitive Level: Application REF: 696 OBJ:11 TOP: Cholecystectomy: PostOp Teaching KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem? a. Cholecystitis b. Hepatitis c. Pancreatitis d. Gastroenteritis ANS: A Nausea and vomiting, fever, and leukocytosis occur with cholecystitis. Pain may be referred to the right clavicle, scapula, or shoulder. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea. PTS:1 DIF: Cognitive Level: Application REF: 696 OBJ:2 TOP: Cholecystitis: Signs and Symptoms KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan? a. To visualize the location of gallstones b. To assess amounts of inflammation and swelling c. To diagnose abnormal contraction of the gallbladder d. To assess composition of gallstones ANS: C The HIDA scan can diagnose abnormal contractions of the gallbladder, which occur in the presence of gallstones or a gallbladder that is not functioning properly. PTS:1 DIF: Cognitive Level: Comprehension REF: 696 OBJ:1 (theory) TOP: Cholelithiasis: HIDA Scan KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make? a. “Is there a reason that you want to have lithotripsy?” b. “Your doctor decides which procedure will be best.” c. “Gallstones are usually treated with surgery. Tell me more about your concerns.” d. “I understand that you are upset. Would you like to speak with a chaplain?” ANS: C Lithotripsy, or “shock wave” therapy, is rarely used for gallstones. The treatment of choice is gallbladder removal. By explaining that surgery is the treatment of choice but also asking the patient to elaborate, the nurse provides information and uses an open- ended statement to acknowledge the patient’s feelings. Asking the patient to list the reasons that he wants lithotripsy is not therapeutic or effective since the patient requires a cholecystectomy. While the physician does choose which procedure is best indicated, the nurse should not dismiss the patient’s concerns or deflect them and suggest that he speak with someone else. PTS:1 DIF: Cognitive Level: Application REF: 696 OBJ:2 TOP: Cholecystectomy vs. Lithotripsy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 5. A nurse is caring for a patient who is 4 hours postoperative after a laparoscopic cholecystectomy. The patient reports abdominal fullness and mild discomfort. After verifying that the patient’s vital signs are stable, what action is most important for the nurse to take next? a. Ambulate the patient. b. Notify the charge nurse. c. Position the patient in high Fowler. d. Administer the ordered PRN analgesic. ANS: A Retained carbon dioxide (CO2) used during a laparoscopic procedure causes “free air” pain, which may manifest as abdominal fullness and mild discomfort. Early and frequent ambulation helps the CO2 gas dissipate. The charge nurse does not require notification at this time. The nurse should position the patient upright after ambulation. If ambulation does not ease the patient’s discomfort, the nurse should then administer the PRN analgesic as ordered. PTS: 1 DIF: Cognitive Level: Analysis REF:696 OBJ: 2 TOP: Laparoscopic Surgery: “Free Air” KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 6. The nurse is caring for a patient who underwent a cholecystectomy 3 days ago. Which assessment finding best indicates to the nurse that the bile flow is no longer obstructed from entering the bowel?