Chapter 62: Care of Patients with Problems of the Biliary System and Pancreas

Chapter 62: Care of Patients with Problems of the Biliary System and Pancreas

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The client with obstructive jaundice asks the nurse why his skin is so itchy. Which is the nurse’s best response?

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.”

 

 

ANS:  A

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.

 

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 1316

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Teaching/Learning

 

2. The nurse is caring for a client with cholecystitis. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?

a.	Abdomen that is hyperresonant to percussion
b.	Hyperactive bowel sounds and diarrhea
c.	Clay-colored stools and dark amber urine
d.	Rebound tenderness in the right upper quadrant

 

 

ANS:  C

In chronic cholecystitis, bile duct obstruction results in the absence of urobilinogen to color the stool. Excess circulating bilirubin turns the urine dark and foamy. The other assessment findings do not correlate with chronic cholecystitis.

 

DIF:    Cognitive Level: Knowledge/Remembering                       REF:   Chart 62-1, p. 1317

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

3. A client is admitted for suspected cholecystitis. On reviewing laboratory results, the nurse notes that the client’s amylase is elevated. Which action by the nurse is best?

a.	Document the finding in the chart.
b.	Ask the client about drinking habits.
c.	Notify the health care provider.
d.	Place the client on clear liquids.

 

 

ANS:  B

Serum and urine amylase levels are elevated when the pancreas becomes inflamed. One cause of pancreatitis is gallbladder disease; another causative factor is alcohol intake. The nurse should tactfully explore this subject with the client before documenting the findings and notifying the provider. The client may need to be NPO or on clear liquids, but the nurse does not have enough information yet to determine this.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC:           Integrated Process: Nursing Process (Assessment)

 

4. The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery. Which statement by the client indicates understanding of the instructions?

a.	“I will drink at least 2 liters of fluid a day.”
b.	“I need a diet without a lot of fatty foods.”
c.	“I should drink fluids between meals rather than with meals.”
d.	“I will avoid concentrated sweets and simple carbohydrates.”

 

 

ANS:  B

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 operation. Restriction of sweets is not required.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:    Client Needs Category: Physiological Integrity (Basic Care and Comfort—Nutrition and Oral Hydration) MSC:            Integrated Process: Teaching/Learning