N4 test Gallbladder and Pancreas

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition
Chapter 60: Interventions for Clients with Problems of the Gallbladder and Pancreas

1. A client presents with symptoms of acute cholecystitis. What data in the client’s history may account for this inflammation of the gallbladder?

A. History of abdominal trauma one month ago
B. Use of oral contraceptives
C. History of smoking
D. Sedentary lifestyle

2. Which of the following alterations in laboratory data should you expect in a client admitted with cholecystitis secondary to bile duct obstruction? Elevated:

A. serum alkaline phosphatase; decreased serum aspartate aminotransferase
B. serum indirect bilirubin; decreased lactate dehydrogenase
C. WBC; decreased serum alkaline phosphatase
D. direct and indirect serum bilirubin levels

3. A client with acute cholecystitis requires an analgesic for pain. Which of the following medications would be contraindicated for this client?

A. Morphine sulfate
B. Meperidine hydrochloride
C. Dicyclomine hydrochloride
D. Trimethobenzamide hydrochloride

4. A client has undergone a traditional cholecystectomy with T-tube drain placement. The drainage from the T-tube has abruptly ceased. What should be your first action?

A. Notify the physician.
B. Assess the drainage system for kinks.
C. Clamp the tube for two hours, then release it.
D. Irrigate the tube with 50 cc of normal saline.

5. Which of the following pathophysiologic changes can the nurse expect to find in a client with chronic pancreatitis?

A. Decreased trypsinogen factor
B. Loss of pancreatic endocrine function
C. Pericardial effusion and decreased LV function
D. Increased output of pancreatic secretion and bicarbonate

6. Which of the following nursing interventions is aimed at detecting a serious complication of pancreatitis?

A. Monitoring serum ALT and AST levels
B. Auscultating for the presence of an S3
C. Recording daily weights
D. Monitoring vital signs

7. You are caring for a client admitted with acute pancreatitis. What is the priority nursing intervention for this client?

A. Pain relief
B. Decreasing oral intake
C. Resumption of activity
D. Normalization of body temperature

8. The physician has ordered fasting blood glucose levels and a sliding insulin coverage scale on a client admitted with acute pancreatitis. The client tells you he is not a diabetic, and therefore does not require insulin. What is your best response?

A. “Giving insulin by injection rests the pancreas during the acute phase of the illness.”
B. “Your blood sugar became elevated because of injury to the cells of the pancreas, and you may need some insulin at this time.”
C. “We will check your blood sugars routinely, but you will probably not require insulin.”
D. “The insulin will help remove autodigestive enzymes from the gut, preventing further damage to the pancreas.”

9. You are assessing a client who has undergone a Whipple procedure for the treatment of pancreatic carcinoma. You note that the Salem Sump tube drainage has changed from serosanguineous to a bile-tinged color. What would be your best action?

A. Irrigate the Salem Sump tube with 50 cc of normal saline.
B. Remove the Salem Sump tube from suction, and clamp for two hours before releasing.
C. Document the finding.
D. Notify the physician.

10. A client admitted with a diagnosis of carcinoma of the pancreas is being readied for discharge. Which of the following complications should you teach this client and family members to be alert for?

A. Ascites
B. Jaundice
C. Anorexia
D. Thrombophlebitis

11. A client recently diagnosed with advanced pancreatic cancer expresses anger directed toward family members and the nursing staff. What conclusion can you draw from the actions of this client? The client:

A. has not yet effectively adjusted to the diagnosis.
B. is in need of a psychiatric consultation.
C. would benefit from a private-duty nurse.
D. wishes to be left alone during this time.