What elevated blood level indicates inflammation in a patient diagnosed with cholecystitis? Show
1 The white blood cell count is indicative of inflammation. The lactate dehydrogenase, serum alkaline phosphate, and aspartate aminotransferase are significant for abnormalities in the liver. Which of the following factors may be associated with the development of cholelithiasis? Select all that apply. 3, 4, 5 A familial or genetic tendency appears to play a role in the cholelithiasis, but this may be partially related to familial nutrition habits (excessive dietary cholesterol intake) and sedentary lifestyles. The highest frequency of gallstone production lies among the American-Indian and Mexican-American populations. Development of gallstones is not related to smoking or normal weight loss. A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition? 4 Fever, yellowing of the skin and eyes, clay-colored stools, and dark urine are symptoms of chronic cholecystitis. These symptoms occur when repeated episodes of cystic duct obstruction cause chronic inflammation. Peritonitis is an infection of the peritoneal cavity in which the patient presents with a hard, distended abdomen. Patients with malnutrition are underweight for their height and have low albumin. Patients with a vitamin deficiency do not display these symptoms; symptoms are always dependent upon the vitamin in which the patient is deficient. The nurse is preparing a patient for a magnetic resonance cholangiopancreatography (MRCP) scan. Which contrast medium does the nurse tell the patient will be administered prior to the procedure? 4 The oral or IV contrast material gadolinium is given before an MRCP scan. Gadolinium does not contain iodine; therefore, it does not carry the risk for an allergic reaction. Ketorolac, morphine, and meperidine are not helpful in MRI; these drugs are analgesics. A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this
procedure? 2 Surgical removal of the gallbladder in women is most often accomplished via the vagina because it is easily decontaminated with betadine or other antiseptic, and it allows easy access into the peritoneal cavity. The surgeon makes a small internal incision through the cul-de-sac of Douglas, between the rectum and uterine wall, to access the gallbladder. The mouth and rectum do not provide easy access into a woman's peritoneal cavity. The umbilicus is used for removing the gallbladder in laparoscopic cholecystectomy. The nurse is teaching a patient with gallbladder disease about diet modification. Which meal does the nurse suggest to the patient? 3 Turkey is an appropriate low-fat selection for this patient. Steak, french fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a patient with gallbladder disease. Which patients are suitable candidates for extracorporeal shock wave lithotripsy (ESWL) to treat gallstones? Select all that apply. 1, 3, 4 ESWL is used for patients who have small stones and for those who are not good surgical candidates. Patients who are within normal weight range, have cholesterol-based stones, and good gallbladder function are suitable candidates for this procedure. ESWL is not used for patients with severe biliary obstruction or cancer of the gallbladder. The patient is evaluated for use of extracorporeal shockwave lithotripsy for treatment of cholelithiasis. What findings should the nurse notify the health care provider about? 4 A patient scheduled for extracorporeal shockwave lithotripsy should have normal gallbladder function, so poor gallbladder function should be reported. A BMI of 27 indicates normal weight, which is necessary for this procedure. Upper abdominal pain is expected in a patient who has gallstones. A patient with cholesterol-based stones is an appropriate candidate for this procedure. The patient has severe biliary obstruction. What type of surgery does the nurse anticipate this patient requiring in order to explore the ducts for
patency? 1 Patients with severe biliary obstruction whose ducts will need to be explored will need a traditional cholecystectomy. A transhepatic biliary catheter placement is not a surgical procedure to treat cholecystectomy. A laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery will not provide visualization of the ducts. A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis? 2 Patients with chronic cholecystitis are more likely to have jaundice and icterus caused by obstruction of bile flow, causing increased circulating levels of bilirubin. Patients with acute cholecystitis present with abdominal pain. Acalculous cholecystitis and calculous cholecystitis are both types of acute cholecystitis. Which patient characteristics are risk factors for cholelithiasis? Select all that apply. 1, 2, 4 The risk for developing gallstones increases with age. Obesity increases the risk for cholelithias is due to impaired fat metabolism or increased cholesterol. Diabetes mellitus increases the chances of cholelithiasis due to higher levels of fatty acids. Neither depression nor vitamin deficiency cause cholelithiasis; they do not interfere with bile production and storage. Which factor is considered a risk factor in the development of
cholelithiasis? 2 In pregnancy, hormone levels (progesterone and estrogen) are altered, which delays muscular contraction of the gallbladder and decreases the rate of bile emptying, thus increasing the risk for cholelithiasis. Similarly, hormonal changes and hormonal replacement therapy make women over 40 years, not under, more susceptible to the development of cholelithiasis. Obese women, not those with a low BMI, are at a high risk of developing cholelithiasis because of impaired fat metabolism and increased cholesterol. Anemia is not associated with the development of gallstones. Which finding is expected in a patient who has a liver function abnormality? 4 Alkaline phosphatase is an enzyme found in the liver, kidneys, and bones. An increase in serum levels of alkaline phosphatase indicates a liver function abnormality. An increased level of WBCs indicates inflammation or infection. When the liver is not functioning normally, the level of lactate dehydrogenase and aspartate aminotransferase are increased, not decreased. A patient diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? 4 This type of gallbladder inflammation is associated with hypovolemia. Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed. A patient scheduled
for a cholecystectomy because of gallstones causing cholecystitis reports a pain level of 4 on a 0-to-10 pain scale. Which analgesic medication does the nurse anticipate will be prescribed for the patient? 1 Ketorolac (analgesic) Ketorolac may be used for mild to moderate pain. Acute biliary pain requires opioid analgesia, such as morphine or hydromorphone. In the past, meperidine was the drug of choice for acute biliary pain because it was thought to cause fewer spasms of the sphincter of Oddi, which blocks bile flow. However, this drug breaks down into a toxic metabolite and can cause seizures, especially in older adults. All opioids may cause some degree of sphincter spasm. A patient with an external transhepatic biliary catheter has had a reduction in drainage. What does this finding indicate? 1 A reduction in drainage of an external transhepatic biliary catheter indicates that the catheter is not working. A reduction in drainage would not be related to the decrease in biliary secretions. It would not indicate that the patient needs to change positions. The patient does not need to take medication. The nurse understands that which patient is at highest risk for developing gallstones? 2 Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk. A patient is undergoing extracorporeal shockwave lithotripsy. The patient complains of pain in the abdomen. What action by the nurse is appropriate? 4 The patient may experience pain during extracorporeal shockwave lithotripsy when the stones are breaking up and moving. This is not an indication to reposition the patient. The patient will not be placed under conscious sedation. The interventionist would not stop the procedure. A
patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach? 1 Patients who undergo extracorporeal shock wave lithotripsy must be of normal weight and have cholesterol-based, smaller gallstones and good gallbladder function. Iodine is not used in this procedure. The presence of infection and serum cholesterol levels are not factors to consider in candidates for this procedure. Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis, in order to dissolve remaining stone fragments? 4 Ursodeoxycholic acid is administered to dissolve remaining fragments of stones after ESWL. Ketorolac, morphine, and bethanechol are not indicated for dissolution of stones. The nurse is planning discharge teaching for a patient following a cholecystectomy. Which symptoms of post-cholecystectomy syndrome should the patient be taught to report?
Select all that apply. 1, 2, 5 Diarrhea, vomiting, and epigastric pain are signs of post-cholecystectomy syndrome. Dyspepsia and eructation are not symptoms of post-cholecystectomy syndrome. The nurse is providing dietary education to a patient diagnosed with cholecystitis. What foods chosen by the patient
indicate that the teaching has been effective? Select all that apply. 1, 2, 5 Low-fat, high-fiber, low-carbohydrate choices are indicated for patients with cholecystitis. The patient should follow a lower calorie rather than high-calorie diet. Low-protein foods are not indicated. A
patient receiving chenodiol for cholelithiasis has just received teaching about the medication. What statement by the patient indicates the teaching was effective? 3 Chenodiol is a agent that is use for bile acid dissolution. The patient will need to have gallbladder ultrasounds every 6 months for a year. Diarrhea should be reported to the health care provider because it is not a normal finding. Medication should be taken with food or milk, not on an empty stomach. The patient will only be able to take the medication for 2 years. A patient who has undergone a laparoscopic
cholecystectomy is complaining of upper chest and shoulder pain. What action by the nurse is most appropriate? 1 The pain is likely the cause of the carbon dioxide being absorbed. Heat often relieves this pain. Placing the arm in a sling is not indicated. Having a patient rest the arm will not decrease the pain. Encouraging range-of-motion exercises is good but not priority. The nurse is preparing to administer the prescribed dose of pancrelipase to a patient with chronic pancreatitis. What pancreatic enzymes make up this medication? Select all that apply. 1, 4, 5 Pancrelipase provides the enzymes that the body is unable to produce because of chronic pancreatitis. It is a combination of the enzymes lipase, amylase, and protease in different concentrations. It does not contain trypsin and elastase. What medications are administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply. 2, 4 Ranitidine is a histamine receptor antagonist, and omeprazole is a proton pump inhibitor. Both medications help decrease gastric acid secretion. Imipenem and ciprofloxacin are antibiotics. Meperidine is an opiate analgesic. Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas? 1 The lipase enzyme is involved in enzymatic fat necrosis of both the endocrine and exocrine cells of the pancreas. Trypsin activates elastase, which dissolves the elastic fibers of the blood vessels and ducts. Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. A patient is diagnosed with acute pancreatitis. Which test is a sensitive indicator of biliary obstruction in this disorder? 4 Serum alanine aminotransferase is a sensitive indicator of biliary obstruction in acute pancreatitis. A threefold or greater rise in concentration indicates that the diagnosis of acute biliary pancreatitis is valid. Serum bilirubin, alkaline phosphatase, and serum amylase are diagnostic tests prescribed for a patient with acute pancreatitis but do not reflect biliary obstruction. What dietary suggestions are indicated for a patient who is in the healing phase after acute pancreatitis? Select all that apply. 1, 2, 4 Patients in the healing phase after acute pancreatitis should have bland, low-fat foods and small, frequent meals. Patients should have a high, not low, carbohydrate diet and a high, not low, protein diet. Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin? Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. These substances cause vasodilation and increased vascular permeability, compounding the hemorrhagic process. Lipase enzyme is involved in enzymatic fat necrosis. Trypsin activates elastase, which dissolves elastic fibers of the blood vessels and ducts.4 In acute pancreatitis, what does elevated serum lipase indicate? 2 Elevated serum lipase is caused by pancreatic cell injury. An elevated leukocyte count is indicative of the inflammatory response. The hepatobiliary obstructive process causes elevated bilirubin. Hepatobiliary involvement causes elevated alanine aminotransferase (ALT) and elevated aspartate aminotransferase (AST). Which symptoms present in a patient with acute pancreatitis indicate complications? Select all that apply. 2, 4, 5 Acute pancreatitis occurs because of an inflammation of the pancreas. The enzymes released by the pancreas cause autolysis of the pancreatic tissue. Jaundice, darkened urine, and clay-colored stools indicate complications of acute pancreatitis. Jaundice occurs because of an obstruction in the biliary tract, where bile cannot be absorbed into the gastrointestinal tract. Bile salts accumulate in the skin, causing a yellowish discoloration. An increase in serum bilirubin due to the biliary obstruction causes darkened urine. Stools become clay-colored because of an obstruction in the biliary tract. Vertigo and depression are not symptoms of acute pancreatitis. What diet does the health care provider prescribe for a patient during the healing phase of acute pancreatitis? Select all that apply. 2, 3, 5 Acute pancreatitis is an inflammation of the pancreas. When food is introduced, the patient should eat foods that are high in protein, low in fats, and high in carbohydrates. These foods are easy to digest, do not cause irritation of the pancreas, reduce discomfort, and prevent nausea. Alcohol and foods containing caffeine, such as coffee and tea, should be avoided because they may worsen the condition. Which is the primary risk factor for chronic calcifying pancreatitis? 1 Alcoholism is the primary risk factor for chronic calcifying pancreatitis. Cholecystitis is a risk factor for chronic obstructive pancreatitis. Metabolic disturbances and viral infection are risk factors for acute pancreatitis, not chronic calcifying pancreatitis. The nurse is caring for a patient who has been admitted multiple times for pancreatitis. The patient has inflammation and fibrosis of the tissue and diminished pancreatic function. What assessment is priority for this patient? 3 Alcoholism is a common risk factor for pancreatitis. Nicotine use assessment is not necessary. Family support is important but is not priority. Adherence to the prescribed medication regimen is important but not priority. The patient diagnosed with acute pancreatitis has a positive Chvostek's sign. What action by the nurse is priority? 1 Chvostek's sign is an indication of hypocalcemia; therefore, the calcium level should be assessed. Evaluating the sclera for jaundice is not indicated. The priority intervention is not to contact the health care provider. Pain medication is not indicated. A patient is diagnosed with pancreatic cancer. Which is a common complication that the patient can
develop? 4 The patient with pancreatic cancer is at a higher risk for developing venous emboli. This occurs because necrotic products of the pancreatic tumor have thromboplastic properties which, in turn, cause a hypercoagulable state. Decreased mobility and extensive surgical manipulation are also responsible for this infection. Dyspepsia (indigestion) and eructation (belching) are not common complications associated with pancreatic cancer. The nurse is caring for a patient with chronic pancreatitis. What assessment findings are related to this disease process? Select all that apply. 2, 3, 4 Jaundice, polydipsia, and polyphagia are manifestations observed in chronic pancreatitis. Jaundice occurs because of chronic inflammation in the biliary tract; bile cannot drain into the small intestines. Excessive thirst (polydipsia) and an increased appetite (polyphagia) occur because the patient has chronic organ dysfunction and develops diabetes mellitus (of which both symptoms are common). Diarrhea is not a symptom of chronic pancreatitis. Weight loss occurs in chronic pancreatitis. Which symptom of chronic pancreatitis also
occurs with acute pancreatitis? 2 Abdominal pain occurs with both types of pancreatitis, although pain intensity does vary between the two. Ascites, loss of exocrine function, and protein malabsorption occur only with chronic pancreatitis. The nurse is providing teaching about pancreatic enzyme
replacement to a patient diagnosed with chronic pancreatitis. What statement by the patient indicates need for further teaching? 4 Pancreatic enzymes should be taken with meals and snacks, not a half hour before meals. The pill should be swallowed without chewing. The enzyme should not be mixed with protein foods. The pancreatic enzyme should be taken after an antacid. What imaging will provide the most reliable diagnosis of acute pancreatitis? 3 Contrast-enhanced computed tomography provides more reliable images and diagnosis of acute pancreatitis. A chest x-ray will show elevation but is not diagnostic. An abdominal ultrasound is not helpful to view the whole pancreas. An ERCP is better for diagnosing pancreatic stones, not acute pancreatitis. When performing an abdominal assessment on a patient diagnosed with pancreatitis, the nurse notes gray-blue discoloration around the periumbilical area, a dull
sound on percussion, and normal bowel sounds. What action by the nurse is priority? 1 A blue discoloration around the periumbilical area is a normal finding in a patient with acute pancreatitis. A dull sound on percussion may be caused from pancreatic ascites. The findings should be documented. The patient does not need to go to the operating room. The health care provider does not need to be contacted immediately. Checking the hemoglobin and hematocrit level is not indicated. Which factors increase the risk of developing pancreatic cancer? Select all that apply. 2, 3, 5 Pancreatic cancer is an abnormal growth in the pancreas. Cirrhosis, cigarette smoking, and chronic pancreatitis cause chronic irritation of the pancreatic tissue, increasing the risk for pancreatic cancer. Aging and vitamin deficiencies are not risk factors associated with pancreatic cancer. Which enzyme is responsible for the release of vasoactive peptides bradykinin?Angiotensin converting enzyme plays a key role in the hormonal regulation of blood pressure. It is responsible for the production of the vasoconstrictor hormonal peptide angiotensin II as well as the destruction of the vasodilator peptide bradykinin.
Which of the following nutrition guidelines is a priority for a patient prescribed with pancreatic enzymes?Nutritional Adequacy
The fat-soluble vitamins A, D, E, and K are a priority, mainly because pancreatic enzyme insufficiency often results in malabsorption of these nutrients.
Which is the primary risk factor for chronic calcifying pancreatitis?Alcohol abuse is the most common etiology associated with chronic pancreatitis, which accounts for approximately 65% of all cases.
Which factors increase the risk for developing pancreatic cancer quizlet?In general, the following factors may raise a person's risk of developing pancreatic cancer:. Age. The risk of developing pancreatic cancer increases with age. ... . Gender. More men are diagnosed with pancreatic cancer than women (see Statistics).. Race/ethnicity. ... . Smoking. ... . Obesity, diet, and alcohol. ... . Diabetes. ... . Family history.. |
Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin
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