Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas

Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

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?
   1. “Bile salts accumulate in the skin and cause the itching.”
   2. “Toxins released from an inflamed gallbladder lead to itching.”
   3. “Itching is caused by the release of calcium into the skin.”
   4. “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:     Understanding/Comprehension         REF: 1214                  KEY: Cholecystitis MSC:             Integrated Process: Teaching/Learning                                  NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

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?
   1. “Drinking at least 2 liters of water each day is suggested.”
   2. “I will decrease the amount of fatty foods in my diet.”
   3. “Drinking fluids with my meals will increase bloating.”
   4. “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 procedure. Restriction of sweets is not required.

DIF:     Applying/Application                         REF: 1218                   KEY: Cholecystitis| postoperative nursing                                                                        MSC:             Integrated Process: Teaching/Learning                                                      NOT:              Client Needs Category: Physiological Integrity: Basic Care and Comfort

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?
   1. “Ambulating in the hallway twice a day will help.”
   2. “I will apply a cold compress to the painful area on your back.”
   3. “Drinking a warm beverage can relieve this referred pain.”
   4. “You should cough and deep breathe every hour.”

ANS:   A

The client who has undergone a laparoscopic cholecystectomy may report free air pain due to retention of carbon dioxide in the abdomen. The nurse assists the client with early ambulation to promote absorption of the carbon dioxide. Cold compresses and drinking a warm beverage would not be helpful. Coughing and deep breathing are important postoperative activities, but they are not related to discomfort from carbon dioxide.

DIF:            Applying/Application                         REF:    1217                 KEY: Cholecystitis| postoperative nursing                                                                    MSC: Integrated Process: Communication and Documentation  NOT:                                           Client Needs Category: Safe and Effective Care Environment: Management of Care

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?
   1. Lasagna, tossed salad with Italian dressing, and low-fat milk
   2. Grilled cheese sandwich, tomato soup, and coffee with cream
   3. Cream of potato soup, Caesar salad with chicken, and a diet cola
   4. Roasted chicken breast, baked potato with chives, and orange juice

ANS:           D

Clients with cholelithiasis should avoid foods high in fat and cholesterol, such as whole milk, butter, and fried foods. Lasagna, low-fat milk, grilled cheese, cream, and cream of potato soup all have high levels of fat. The meal with the least amount of fat is the chicken breast dinner.

DIF:     Applying/Application             REF:    1217     KEY: Cholecystitis| nutritional requirements                         MSC: Integrated Process: Nursing Process: Evaluation        NOT: Client Needs Category: Health Promotion and Maintenance