cholecystitis Nclex questions

Pancreatitis, NCLEX ScienceMedicineNursing melissa-knight Save cholecystitis Nclex questions 19 terms Ungkana_DPreview Pancreatitis NCLEX (ATI, Evolve, Lew...13 terms Jennster17Preview Exam 4- Cirrhosis NCLEX Teacher 26 terms RegisteredNurse22 Preview Diabet Teacher ssa Twenty-four hours after endoscopic retrograde cholangiopancreatography (ERCP), a client develops left upper quadrant abdominal pain and has a temperature of 101° F (38.3° C). What is the nurse's best action?

• Administer acetaminophen for control of fever and pain.
• Document the finding, because it is a normal postprocedure event.
• Notify the health care provider.
• Increase the IV fluid rate.

...ANS: C

The client who has undergone an ERCP may develop complications such as perforation or sepsis manifested by fever and abdominal pain. The nurse should report these symptoms to the health care provider immediately.After receiving lactulose the day before, the client reports having seven loose stools in the past 12 hours. Based on this data, what laboratory findings would the nurse expect?

• Hypokalemia
• Hyponatremia
• Hypercalcemia
• Hyperglycemia

...ANS: A

Because lactulose can cause the client to have several loose stools daily, the nurse should monitor serum electrolyte levels, particularly the serum potassium level for hypokalemia.Which client is most at risk for the development of gallstones?

• 22-year-old woman who is 1 month postpartum
• 65-year-old woman after a liquid protein diet
• 70-year-old man with peptic ulcer disease
• 33-year-old man with type 2 diabetes

...ANS: B

Liquid protein diets increase susceptibility to gallstones by releasing cholesterol from tissues, which is then excreted as crystals in the bile.

A client had a transhepatic biliary catheter placed 3 days ago. Which clinical manifestation would indicate that the procedure was successful?

• The client's sclera remains icteric.
• The client's stools are brown in color.
• The client's urine is a dark amber color.
• The client's catheter has blood return on aspiration.

...ANS: B

A transhepatic biliary catheter 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 client is admitted to the medical dept. with a dx of r/o acute pancreatitis. which laboratory values should the nurse monitor to confirm this dx?

• creatinine and BUN
• troponin and CK-MB
• serum amylase and lipase
• serum bilirubin and calcium

serum amylase and lipase: serum amylase increases within 2 to 12 hrs of the onset of acute pancreatitis to 2 to 3 times normal and returns to normal in 3 to 4 days; lipase elevates and remains elevated for 7 to 14 days which client problem has priority for the client dx with acute pancreatitis?

• risk for fluid volume deficit
• alteration in comfort

3. imbalanced nutrition: less than body requirements

• knowledge deficit

alteration in comfort: autodigestion of the pancreas results in severe epigastric pain, accompanied by nausea, vomiting, abdominal tenderness and muscle guarding the nurse is preparing to administer am medications to clients. which medication should the nurse question before administering?

• pancreatic enzymes to the client who has finished breakfast
• the pain medication, morphine, to the client who has a respiratory rate of 20
• the loop diuretic to the client who has a serum potassium level of 3.9 mEq/L
• the beta blocker to the client who has an apical pulse of 68

pancreatic enzymes to the client who has finished breakfast: pancreatic enzymes must be administered with meals to enhance the digestion of starches and fats in the gastrointestinal tract the client is dx with acute pancreatitis. which health care providers admitting order should the nurse question?

• bedrest with bathroom privleges.
• initiate iv therapy of D5W at 125 mL/hr
• weigh client daily
• low fat, low carb diet

low fat, low carb diet: the client will be NPO, which will decrease stimulation of the pancreatic enzymes, resulting in decreased autodigestion of the pancreas, therefore decreasing pain

the nurse is completing discharge teaching to the client dx with acute pancreatitis. which instruction should the nurse discuss with the client?

• instruct client to decrease alcohol intake
• explain the need to avoid all stress
• discuss the importance of stopping smoking
• teach the correct way to take pancreatic enzymes

discuss the importance of stopping smoking: smoking stimulates the pancreas to release pancreatic enaymes and should be stopped the male client dx with chronic pancreatitis calls and reports to the clinic nurse he has been having a lot of gas along with frothy and very foul smelling stools. which intervention should the nurse implement?

• explain this is common for chronic pancreatitis
• ask the client to bring in a stool specimen to the clinic
• arrange an appointment with the hcp for today
• discuss the need to decrease fat in the diet so this wont happen

arrange an appointment with the hcp for today: steatorrhea (fatty, frothy, foul smelling stool) is caused by a decrease in pancreatic enzyme secretion and indicates impaired digestion and possibly an increase in the severity of the pancreatitis. the client should see the hcp the nurse is discussing complications of chronic pancreatitis with a client dx with the disease. which complication should the nurse discuss with the client?

• diabetes insipudus
• crohns disease
• narcotic addiction
• peritonitis

narcotic addiction: its related to the frequent, severe pain episodes often occurring with chronic pancreatitis which require narcotics for relief the client is immediate postprocedure endoscopic retrograde cholangiopancreatogram (ERCP). which intervention should the nurse implement?

• assess for rectal bleeding,

2, increase fluid intake

• assess gag reflex
• keep in supine position

assess gag reflex: the gag reflex will be suppressed as a result of the local anesthesia applied to the throat to insert the endoscope into the esophagus; therefore, the gag reflex must be assessed prior to allowing the client to resume eating or drinking the client dx with acute pancreatitis is in pain. which position should the nurse assist the client to assume to help decrease the pain?

• recommend lying in the prone position with legs extended
• maintain a tripod position over the bedside table
• place in side lying position with knees flexed
• encourage a supine position with a pillow under the knees

place in side lying position with knees flexed: this fetal lposition decreases pain caused by the stretching of the peritoneum as a result of edema

the client with an acute exacerbation of chronic pancreatitis has a nasogastric tube. which interventions should the nurse implement? select all that apply

• monitor the clients bowel sounds
• monitor the clients food intake
• assess the clients intravenous site
• provide oral and nasal care
• monitor the clients blood glucose

monitor the clients bowel sounds, assess the clients intravenous site, provide oral and nasal care, provide oral and nasal care, monitor the clients blood glucose: the return of bowel sounds indicates the return of peristalsis, and the nasogastric suction is usually discontinued within 24 to 48 hrs thereafter. the nurse should assess for signs of infection or infiltration. fasting and the ng tube increase the clients risk for mucous membrane irritation and brk dwn. blood glucose levels are monitored because clients with chronic pancreatitis can develop diabetes mellitus the nurse is administering a pancreatic enzyme to the client dx with chronic pancreatitis. which statement best explains the rationale for administering this med?

• it is an exogenous source of protease, amylase, and lipase
• this enzyme increases the number of bowel movements
• this medication breaks down in the stomach to help with digestion
• pancreatic enzymes help break down fat in the small intestine

it is an exogenous source of protease, amylase, and lipase: pancreatic enzymes enhance the digestion of starches (carbohydrates) in the gastrointestinal tract by supplying an exogenous (outside) source of the pancreatic enzymes protease, amylase and lipase the client dx with acute pancreatitis is being discharged home. which statement by the client indicates the teaching has been effective?

• i should decrease my intake of coffee, tea, and cola
• i will eat a low fat diet and avoid spicy foods
• i will check my amylase and lipase levels daily
• i will return to work tomorrow but take it easy

i will eat a low fat diet and avoid spicy foods: high fat and spicy foods stimulate gastric and pancreatic secretions and may precipitate an acute pancreatic attack the nurse is caring for a pt with chronic pancreatitis, the nurse would expect an elevation in which of the following lab tests?

• serum bilirubin
• serum calcium
• serum albumin
• serum amylase

d: the serum amylase level is elevated in chronic pancreatitis

a pt with acute pacreatitis is NPO and has been receiving on IV hydration. which laboratory result indicates the need to consult the dietitian for nutritional support?

• potassium 4.2 mEq/L
• sodium 130 mEq/L
• fasting glucose 82 mg/dL
• serum albumin 2.9g/dL

d: low serum albumin level indicates malnutrition (normal albumin levels are 3.5-5.