Complex Ch 50: Metabolic

What is a major concern for the nurse when caring for a patient with chronic pancreatitis? a) Mental status changes b) Weight loss c) Nausea d) Pain

A patient with acute pancreatitis has been started on total parenteral nutrition (TPN). Following the administration of the TPN, which of the following should the nurse plan to monitor? a) Blood glucose levels every 4 to 6 hours b) Auscultate the abdomen for bowel sounds every 4 hours c) Complaints of nausea and vomiting d) Measure the abdominal girth every shift

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? a) 30 mg/dL b) 50 mg/dL c) 70 mg/dL d) 90 mg/dL

Which of the following is clinical manifestation of cholelithiasis? a) Epigastric distress prior to a meal b) Nonpalpable abdominal mass c) Upper left quadrant abdominal pain d) Clay-colored stools

This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States? a) 15% b) 60% c) 25% d) 75%

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a) Hot roast beef sandwich with gravy b) Vanilla pudding c) White rice d) Mashed potatoes

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a) Encouraging frequent visits from family and friends b) Administering frequent oral feedings c) Positioning the client on the side with the knees flexed d) Administering an analgesic once per shift, as ordered, to prevent drug addiction

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Monitor pulse oximetry every hour. b) Withhold analgesics unless necessary. c) Instruct the client to cough only when necessary. d) Use incentive spirometry every hour.

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: a) Edema and inflammation b) Disseminated intravascular coagulopathy c) Pleural effusion d) Sepsis

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Maintaining adequate nutritional status b) Preventing fluid volume overload c) Relieving abdominal pain d) Teaching about the disease and its treatment

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? a) Disturbed body image b) Anxiety c) Nausea d) Impaired nutrition: less than body requirements

The digestion of carbohydrates is aided by a) secretin. b) lipase. c) amylase. d) trypsin.

Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels? a) Dry mouth, which makes the patient thirsty b) Frequent vomiting leading to loss of fluid volume c) Acetone in the urine d) High glucose levels in the blood

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a) Dysfunction of the pancreatic islet cells b) Inability for the liver to reabsorb serum glucose c) Ingestion of foods high in sugar d) Renal failure

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Providing mouth care b) Maintaining nothing-by-mouth (NPO) status c) Administering morphine I.V. as ordered d) Placing the client in a semi-Fowler's position

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a) Reserving an antecubital site for a peripherally inserted central catheter (PICC) b) Providing generous servings at mealtime c) Providing the client with plenty of P.O. fluids d) Limiting I.V. fluid intake according to the physician's order

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a) Sepsis b) Edema and inflammation c) Disseminated intravascular coagulopathy d) Pleural effusion

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Acute pain related to biliary spasms c) Deficient knowledge related to prevention of disease recurrence d) Anxiety related to unknown outcome of hospitalization

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased liver enzyme levels b) Increased serum calcium levels c) Elevated urine amylase levels d) Decreased white blood cell count

The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? a) Jaundice b) Fever c) Mental agitation d) Severe abdominal pain

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a) To depress the central nervous system and increase the pain threshold b) To decrease metabolism c) To reduce gastric and pancreatic secretions d) To relieve nausea and vomiting

The nurse is planning care for a patient following an incisional cholecystectomy for cholelithiasis. Which of the following interventions is the highest nursing priority for this patient? a) Performing range-of-motion (ROM) leg exercises hourly while the patient is awake b) Assisting the patient to ambulate the evening of the operative day c) Assisting the patient to turn, cough, and deep breathe every 2 hours d) Teaching the patient to choose low-fat foods from the menu

Total parental nutrition (TPN) should be used cautiously in patients with pancreatitis due to which of the following? a) They can digest high-fat foods. b) They are at risk for hepatic encephalopathy. c) They are at risk for gallbladder contraction. d) They cannot tolerate high-glucose concentration.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) light amber urine. b) circumoral pallor. c) black, tarry stools. d) yellow sclerae.

The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: a) Serum bilirubin b) Serum calcium c) Serum lipase d) Serum amylase

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient? a) The patient has developed renal failure. b) The patient requires more pain medication. c) The patient is developing a paralytic ileus. d) The patient has developed peritonitis.

The physician has written the following orders: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) for a new patient admitted with pancreatitis. The nurse attributes which of the following as the cause for NPO status? a) To avoid inflammation of the pancreas b) To aid opening up of pancreatic duct c) To drain the pancreatic bed d) To prevent the occurrence of fibrosis

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? a) Pancreatitis b) Peptic ulcer c) Appendicitis d) Cholecystitis

A 70-year-old patient is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which of the following gerontologic considerations associated with the pancreas? a) Increases in the bicarbonate output by the kidneys b) Decreases in the physiologic function of major organs c) Development of local complications d) Increases in the rate of pancreatic secretion

A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.) a) Amber-colored urine b) Clay-colored feces c) Jaundice d) Pain in the left upper abdominal quadrant e) Pruritus

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Elevated urine amylase levels c) Decreased liver enzyme levels d) Increased serum calcium levels

Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis? a) Shock b) Tetany c) Pancreatic necrosis d) Multiple organ dysfunction syndrome (MODS)

A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to a) Presence of diabetes mellitus b) Cigarette smoking c) Age d) Dietary intake of fat

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a) 4 months b) Over 1 year c) 7 months d) 1 month

A patient discharged following a laparoscopic cholecystectomy calls the surgeon's office complaining of severe right shoulder pain 24 hours after surgery. Which of the following statements is the correct information for the nurse to provide to this patient? a) This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated. b) This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort. c) This pain is caused from your incision. Take analgesics as needed and as prescribed and report to surgeon if pain is unrelieved even with analgesic use. d) This may be the beginning symptoms of an infection. You need to come to see the surgeon today for an evaluation.

When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) a) Assisting the patient into the prone position b) Encouraging bed rest to decrease the metabolic rate c) Administering parenteral opioid analgesics as ordered d) Administering prophylactic antibiotics e) Withholding oral feedings to limit the release of secretin

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? a) One-time exposure to petrochemicals b) History of pancreatitis c) Ingestion of a low-fat diet d) Ingestion of caffeinated coffee

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Maintaining nothing-by-mouth (NPO) status b) Placing the client in a semi-Fowler's position c) Providing mouth care d) Administering morphine I.V. as ordered

Several clinical manifestations are associated with a tumor of the head of the pancreas. Choose all that apply. a) Amber-colored urine b) Dark urine c) Dark-colored stools d) Clay-colored stools e) Jaundice

A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply.) a) Hyperglycemia b) An abnormal glucose tolerance c) Hypoglycemia d) Glucosuria e) Elevated lipase level

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Teaching about the disease and its treatment b) Maintaining adequate nutritional status c) Preventing fluid volume overload d) Relieving abdominal pain

A patient is admitted to the health care center with severe abdominal pain rated at 10 on a 1-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP) as ordered. The nurse plans for which of the following goals following the administration of this mediation? a) To control BP b) To diagnose the cause of abdominal pain c) To control muscle spasms d) To increase the patient's pain threshold

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a) To decrease metabolism b) To reduce gastric and pancreatic secretions c) To depress the central nervous system and increase the pain threshold d) To relieve nausea and vomiting

A patient has a nasogastric (NG) tube for suction and is NPO following a pancreaticoduodenectomy. Which of the following explanations made by the nurse is the major purpose of this treatment? a) The tube will allow the gastrointestinal (GI) tract to rest. b) The tube will allow the removal of toxins. c) The tube will provide relief from nausea and vomiting. d) The tube will help control fluid and electrolyte imbalance.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Elevated urine amylase levels b) Increased serum calcium levels c) Decreased white blood cell count d) Decreased liver enzyme levels

Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy? a) Semi-Fowler's position b) Low-carbohydrate, low-protein diet immediately after surgery c) Observe color of sclera d) NPO status postop for 2 days

A nurse is caring for a client in the emergency department who is complaining of severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value requires immediate intervention? a) Calcium level of 7.8 mg/dl b) Serum glucose level of 240 mg/dl c) White blood cell (WBC) count of 18,000 mm3 d) Troponin of 2.3 mcg/L

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? a) Low-sodium, high-potassium, low-fat diet b) Low-carbohydrate, high-potassium diet c) High-carbohydrate, high-protein, low-fat diet d) High-carbohydrate, low-protein, low-fat diet

A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? a) Serum bilirubin level greater than 1.0 mg/dL b) Serum albumin concentration of 4.0 g/dL c) Serum ammonia concentration of 90 mg/dL d) Serum globulin concentration of 2.0 g/dL

Which of the following terms most precisely refers to the incision of the common bile duct for removal of stones? a) Choledochotomy b) Choledochoduodenostomy c) Cholecystostomy d) Choledocholithotomy

The nurse identifies a potential collaborative problem of electrolyte imbalance for a patient with severe acute pancreatitis. Which of the following assessment findings would alert the nurse to an electrolyte imbalance associated with acute pancreatitis? a) Paralytic ileus and abdominal distention b) Muscle twitching and finger numbness c) Elevated blood glucose levels d) Hypotension

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Maintaining nothing-by-mouth (NPO) status b) Providing mouth care c) Administering morphine I.V. as ordered d) Placing the client in a semi-Fowler's position

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a) Over 1 year b) 1 to 4 months c) 4 to 6 months d) 6 to 12 months

Which dietary modification is utilized for a patient diagnosed with acute pancreatitis? a) High-protein diet b) Elimination of coffee c) High-fat diet d) Low-carbohydrate diet

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a) Potassium b) Vitamin K c) Vitamin B d) Oral bile acids