Biliary Disorders
A nurse is assessing a patient who has been diagnosed with cholecystitis and is experiencing localized abdominal pain.
When assessing the characteristics of the patients pain, the nurse should anticipate that it may radiate to what region?
A) Left upper chest
B) Inguinal region
C) Neck or jaw
D) Right shoulder
Ans: D
Feedback:
The patient may have biliary colic with excruciating upper right abdominal pain that radiates to the back
or right shoulder. Pain from cholecystitis does not typically radiate to the left upper chest, inguinal area,
neck, or jaw.
2. A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical
unit. How should the nurse most likely explain the pathophysiology of this patients health problem?
A) Toxins have accumulated and inflamed your pancreas.
B) Bacteria likely migrated from your intestines and became lodged in your pancreas.
C) A virus that was likely already present in your body has begun to attack your pancreatic cells.
D) The enzymes that your pancreas produces have damaged the pancreas itself.
Ans: D
Feedback:
Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the
autodigestion of the pancreas. Less commonly, toxic substances and microorganisms are implicated as
the cause of pancreatitis.
3. A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is
performing the health interview, what assessment questions address likely etiologic factors? Select all
that apply.
A) How many alcoholic drinks do you typically consume in a week?
B) Have you ever been tested for diabetes?
C) Have you ever been diagnosed with gallstones?
D) Would you say that you eat a particularly high-fat diet?
E) Does anyone in your family have cystic fibrosis?
Ans: A, C
Feedback:
Eighty percent of patients with acute pancreatitis have biliary tract disease such as gallstones or a history
of long-term alcohol abuse. Diabetes, high-fat consumption, and cystic fibrosis are not noted etiologic
factors.
4. A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients
laboratory studies, what finding is most closely associated with this diagnosis?
A) Increased bilirubin
B) Decreased serum cholesterol
C) Increased blood urea nitrogen (BUN)
D) Decreased serum alkaline phosphatase level
Ans: A
Feedback:
If the flow of blood is impeded, bilirubin, a pigment derived from the breakdown of red blood cells, does
not enter the intestines. As a result, bilirubin levels in the blood increase. Cholesterol, BUN, and alkaline
phosphatase levels are not typically affected.
5. A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should
identify which of the following patients as having the highest risk for chronic pancreatitis?
A) A 45-year-old obese woman with a high-fat diet
B) An 18-year-old man who is a weekend binge drinker
C) A 39-year-old man with chronic alcoholism
D) A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day
Ans: C
Feedback:
Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of
chronic pancreatitis.
6. A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and
vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients
flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should
assist in assessing the patient for what health problem?
A) Severe pancreatitis with possible peritonitis
B) Acute cholecystitis
C) Chronic pancreatitis
D) Acute appendicitis with possible perforation
Ans: A
Feedback:
Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care.
Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea.
Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis.
Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain
generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake
makes pancreatitis a more likely possibility than appendicitis or cholecystitis.
7. A patient has been scheduled for an ultrasound of the gallbladder the following morning. What should
the nurse do in preparation for this diagnostic study?
A) Have the patient refrain from food and fluids after midnight.
B) Administer the contrast agent orally 10 to 12 hours before the study.
C) Administer the radioactive agent intravenously the evening before the study.
D) Encourage the intake of 64 ounces of water 8 hours before the study.
Ans: A
Feedback:
An ultrasound of the gallbladder is most accurate if the patient fasts overnight, so that the gallbladder is
distended. Contrast and radioactive agents are not used when performing ultrasonography of the
gallbladder, as an ultrasound is based on reflected sound waves.
8. A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from
postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment
finding to the physician?
A) Decreased breath sounds
B) Drainage of bile-colored fluid onto the abdominal dressing
C) Rigidity of the abdomen
D) Acute pain with movement
Ans: C
Feedback:
The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, which may
result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs
fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be
administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain.
Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal
dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate
bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.
9. A patient with chronic pancreatitis had a pancreatojejunostomy created 3 months ago for relief of pain
and to restore drainage of pancreatic secretions. The patient has come to the office for a routine
postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most
appropriate initial response by the nurse?
A) The majority of patients who have a pancreatojejunostomy have their normal digestion restored
but do not achieve pain relief.
B) Pain relief occurs by 6 months in most patients who undergo this procedure, but some people
experience a recurrence of their pain.
C) Your physician will likely want to discuss the removal of your gallbladder to achieve pain relief.
D) You are probably not appropriately taking the medications for your pancreatitis and pain, so we
will need to discuss your medication regimen in detail.
Ans: B
Feedback:
Pain relief from a pancreatojejunostomy often occurs by 6 months in more than 85% of the patients
who undergo this procedure, but pain returns in a substantial number of patients as the disease
progresses. This patient had surgery 3 months ago; the patient has 3 months before optimal benefits of
the procedure may be experienced. There is no obvious indication for gallbladder removal and
nonadherence is not the most likely factor underlying the pain.
10. A nurse is caring for a patient who has been scheduled for endoscopic retrograde
cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this
patient, the nurse should describe what aspect of this diagnostic procedure?
A) The need to protect the incision post-procedure
B) The use of moderate sedation
C) The need to infuse 50% dextrose during the procedure
D) The use of general anesthesia
Ans: B
Feedback:
Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the
procedure does not involve the creation of an incision.
11. A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home.
When providing health education, the nurse should prioritize which of the following topics?
A) Management of fluid balance in the home setting
B) The need for blood glucose monitoring for the next week
C) Signs and symptoms of intra-abdominal complications
D) Appropriate use of prescribed pancreatic enzymes
Ans: C
Feedback:
Because of the early discharge following laparoscopic cholecystectomy, the patient needs thorough
education in the signs and symptoms of complications. Fluid balance is not typically a problem in the
recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or
pancreatic enzymes.
12. A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage
through the abdominal wall. What nursing diagnosis should the nurse prioritize?
A) Disturbed Body Image
B) Impaired Skin Integrity
C) Nausea
D) Risk for Deficient Fluid Volume
Ans: B
Feedback:
While each of the diagnoses may be applicable to a patient with pancreatic drainage, the priority nursing diagnosis is
Impaired Skin Integrity. The drainage is often perfuse and destructive to tissue because of the enzyme contents. Nursing
measures must focus on steps to protect the skin near the drainage site from excoriation. The application of ointments or
the use of a suction apparatus protects the skin from excoriation.
13. A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse
documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the
care plan based on the potential complications that may occur after surgery. What are the most likely
complications for the patient who has had pancreatic surgery?
A) Proteinuria and hyperkalemia
B) Hemorrhage and hypercalcemia
C) Weight loss and hypoglycemia
D) Malabsorption and hyperglycemia
Ans: D
Feedback:
The nurse arrives at this diagnosis based on the complications of malabsorption and hyperglycemia.
These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a
low-fat diet, and vitamin supplementation often are also required to meet the patients nutritional needs
and restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery, but the
electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to
surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common
complication, but hypoglycemia is less likely.
14. A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder
pain. What should the nurse suggest to relieve the pain?
A) Aspirin every 4 to 6 hours as ordered
B) Application of heat 15 to 20 minutes each hour
C) Application of an ice pack for no more than 15 minutes
D) Application of liniment rub to affected area
Ans: B
Feedback:
If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the
abdominal cavity during the procedure), the nurse may recommend use of a heating pad for 15 to 20
minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding.
15. A patient returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the patient
for signs and symptoms of what serious potential complication of this surgery?
A) Diabetic coma
B) Decubitus ulcer
C) Wound evisceration
D) Bile duct injury
Ans: D
Feedback:
The most serious complication after laparoscopic cholecystectomy is a bile duct injury. Patients do not
face a risk of diabetic coma. A decubitus ulcer is unlikely because immobility is not expected.
Evisceration is highly unlikely, due to the laparoscopic approach.
16. A patient has been treated in the hospital for an episode of acute pancreatitis. The patient has acknowledged the role
that his alcohol use played in the development of his health problem but has not expressed specific plans for lifestyle
changes after discharge. What is the nurses most appropriate response?
A) Educate the patient about the link between alcohol use and pancreatitis.
B) Ensure that the patient knows the importance of attending follow-up appointments.
C) Refer the patient to social work or spiritual care.
D) Encourage the patient to connect with a community-based support group.
Ans: D
Feedback:
After the acute attack has subsided, some patients may be inclined to return to their previous drinking habits. The nurse
provides specific information about resources and support groups that may be of assistance in avoiding alcohol in the
future. Referral to Alcoholics Anonymous as appropriate or other support groups is essential. The patient already has an
understanding of the effects of alcohol, and follow-up appointments will not necessarily result in lifestyle changes. Social
work and spiritual care may or may not be beneficial.
17. A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a
diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform
in order to best address this diagnosis?
A) Position the patient supine to facilitate diaphragm movement.
B) Administer corticosteroids by nebulizer as ordered.
C) Perform oral suctioning as needed to remove secretions.
D) Maintain the patient in a semi-Fowlers position whenever possible.
Ans: D
Feedback:
The nurse maintains the patient in a semi-Fowlers position to decrease pressure on the diaphragm by a
distended abdomen and to increase respiratory expansion. A supine position will result in increased
pressure on the diaphragm and potentially decreased respiratory expansion. Steroids and oral suctioning
are not indicated.
18. A patient with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that
additional teaching is needed regarding this medication when the patient states:
A) It is important that I see my physician for scheduled follow-up appointments while taking this
medication.
B) I will take this medication for 2 weeks and then gradually stop taking it.
C) If I lose weight, the dose of the medication may need to be changed.
D) This medication will help dissolve small gallstones made of cholesterol.
Ans: B
Feedback:
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones composed
primarily of cholesterol. This drug can reduce the size of existing stones, dissolve small stones, and
prevent new stones from forming. Six to 12 months of therapy is required in many patients to dissolve
stones, and monitoring of the patient is required during this time. The effective dose of medication
depends on body weight.
19. A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient
admitted with acute gallbladder inflammation, the nurse will question which of the following foods on
the tray?
A) Fried chicken
B) Mashed potatoes
C) Dinner roll
D) Tapioca pudding
Ans: A
Feedback:
The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked
fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated.
The patient should avoid fried foods such as fried chicken, as fatty foods may bring on an episode of
cholecystitis.
20. A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not
exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may
include what?
A) Fever and pain
B) Chills and jaundice
C) Nausea and vomiting
D) Signs and symptoms of septic shock
Ans: D
Feedback:
The elderly patient may not exhibit the typical symptoms of fever, pain, chills jaundice, and nausea and
vomiting. Symptoms of biliary tract disease in the elderly may be accompanied or preceded by those of
septic shock, which include oliguria, hypotension, change in mental status, tachycardia, and tachypnea.
21. A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced
activity. What rationale for this intervention should be cited in the care plan?
A) Bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis.
B) Reduced activity protects the physical integrity of pancreatic cells.
C) Bed rest lowers the metabolic rate and reduces enzyme production.
D) Inactivity reduces caloric need and gastrointestinal motility.
Ans: C
Feedback:
The acutely ill patient is maintained on bed rest to decrease the metabolic rate and reduce the secretion
of pancreatic and gastric enzymes. Staying in bed does not release energy from the body to fight the
disease.
22. The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse
should monitor the patient for signs of what complications?
A) Pain and peritonitis
B) Bleeding and perforation
C) Acidosis and hypoglycemia
D) Gangrene of the gallbladder and hyperglycemia
Ans: B
Feedback:
Following ERCP removal of gallstones, the patient is observed closely for bleeding, perforation, and the
development of pancreatitis or sepsis. Blood sugar alterations, gangrene, peritonitis, and acidosis are less
likely complications.
23. A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple
procedure). During health education, the patient should be informed that this procedure will involve the
removal of which of the following? Select all that apply.
A) Gallbladder
B) Part of the stomach
C) Duodenum
D) Part of the common bile duct
E) Part of the rectum
Ans: A, B, C, D
Feedback:
A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer
of the head of the pancreas (Fig. 50-7). This procedure involves removal of the gallbladder, a portion of
the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The
rectum is not affected.
24. An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What
nursing action should be included in this patients plan of care?
A) Measure the patients abdominal girth daily.
B) Limit the use of opioid analgesics.
C) Monitor the patient for signs of dysphagia.
D) Encourage activity as tolerated.
Ans: A
Feedback:
Due to the risk of ascites, the nurse should monitor the patients abdominal girth. There is no specific
need to avoid the use of opioids or to monitor for dysphagia, and activity is usually limited.
25. A community health nurse is caring for a patient whose multiple health problems include chronic
pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe
abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate
action?
A) Administer a PRN dose of pancreatic enzymes as ordered.
B) Teach the patient about the importance of abstaining from alcohol.
C) Arrange for the patient to be transported to the hospital.
D) Insert an NG tube, if available, and stay with the patient.
Ans: C
Feedback:
Chronic pancreatitis is characterized by recurring attacks of severe upper abdominal and back pain,
accompanied by vomiting. The onset of these acute symptoms warrants hospital treatment. Pancreatic
enzymes are not indicated and an NG tube would not be inserted in the home setting. Patient education is
a later priority that may or may not be relevant.
26. A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving
parenteral nutrition. The student should prioritize which of the following assessments?
A) Fluid output
B) Oral intake
C) Blood glucose levels
D) BUN and creatinine levels
Ans: C
Feedback:
In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels
every 4 to 6 hours. Output should be monitored but in most cases it is not more important than serum
glucose levels. A patient on parenteral nutrition would have no oral intake to monitor. Blood sugar levels
are more likely to be unstable than indicators of renal function.
27. A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine
pancreatic islet cell function. The nurse should anticipate what diagnostic test?
A) Glucose tolerance test
B) ERCP
C) Pancreatic biopsy
D) Abdominal ultrasonography
Ans: A
Feedback:
A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for
making decisions about surgical resection of the pancreas. This specific clinical information is not
provided by ERCP, biopsy, or ultrasound.
28. A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been
stabilized and the nurse is now planning health promotion and educational interventions. Which of the
following should the nurse prioritize?
A) Educating the patient about expectations and care following surgery
B) Educating the patient about the management of blood glucose after discharge
C) Educating the patient about postdischarge lifestyle modifications
D) Educating the patient about the potential benefits of pancreatic transplantation
Ans: C
Feedback:
The patients lifestyle (especially regarding alcohol use) is a major determinant of the course of chronic
pancreatitis. The disease is not often managed by surgery and blood sugar monitoring is not necessarily
indicated for every patient after hospital treatment. Transplantation is not an option.
29. The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has
been moved to an air bed. What would be the nurses best response?
A) Air beds allow the care team to reposition her more easily while shes on bed rest.
B) Air beds are far more comfortable than regular beds and shell likely have to be on bed rest a long time.
C) The bed automatically moves, so shes less likely to develop pressure sores while shes in bed.
D) The bed automatically moves, so she is likely to have less pain.
Ans: C
Feedback:
It is important to turn the patient every 2 hours; use of specialty beds may be indicated to prevent skin
breakdown. The rationale for a specialty bed is not related to repositioning, comfort, or ease of
movement.
30. A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that
pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis.
Consequently, the nurse should assess for what signs or symptoms of this complication?
A) Sudden increase in random blood glucose readings
B) Increased abdominal girth accompanied by decreased level of consciousness
C) Fever, increased heart rate and decreased blood pressure
D) Abdominal pain unresponsive to analgesics
Ans: C
Feedback:
Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis
because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS).
Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in
status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis.
31. A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute
Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this
patient?
A) Oral oxycodone
B) IV hydromorphone (Dilaudid)
C) IM meperidine (Demerol)
D) Oral naproxen (Aleve)
Ans: B
Feedback:
The pain of acute pancreatitis is often very severe and pain relief may require parenteral opioids such as
morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). There is no clinical evidence to support
the use of meperidine for pain relief in pancreatitis. Opioids are preferred over NSAIDs.
32. A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe
pain and diagnostic testing indicates that over 80% of the patients pancreas has been destroyed. The
patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the
nurses best response?
A) The symptoms of pancreatitis mimic those of much less serious illnesses.
B) Your body doesnt require pancreatic function until it is under great stress, so it is easy to go unnoticed.
C) Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.
D) Its likely that your other organs were compensating for your decreased pancreatic function.
Ans: C
Feedback:
By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function
(exocrine function) has been lost. Late detection is not usually attributable to the vagueness of
symptoms. The pancreas contributes continually to homeostasis and other organs are unable to perform
its physiologic functions.
33. A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial
treatment, the nurse should be aware that the patient is most likely to require which of the following?
A) Inpatient rehabilitation
B) Rehabilitation in the home setting
C) Intensive physical therapy
D) Hospice care
Ans: D
Feedback:
Pancreatic carcinoma has only a 5% survival rate at 5 years regardless of the stage of disease at
diagnosis or treatment. As a result, there is a higher likelihood that the patient will require hospice care
than physical therapy and rehabilitation.
34. A patient is admitted to the ICU with acute pancreatitis. The patients family asks what causes acute
pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what?
A) Type 1 diabetes
B) An impaired immune system
C) Undiagnosed chronic pancreatitis
D) An amylase deficiency
Ans: C
Feedback:
Eighty percent of patients with acute pancreatitis have biliary tract disease or a history of long-term
alcohol abuse. These patients usually have had undiagnosed chronic pancreatitis before their first
episode of acute pancreatitis. Diabetes, an impaired immune function, and amylase deficiency are not
specific precursors to acute pancreatitis.
35. A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be
scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick
gallbladder. What rationale would underlie the nurses response?
A) Surgery is delayed until the patient can eat a regular diet without vomiting.
B) Surgery is delayed until the acute symptoms subside.
C) The patient requires aggressive nutritional support prior to surgery.
D) Time is needed to determine whether a laparoscopic procedure can be used.
Ans: B
Feedback:
Unless the patients condition deteriorates, surgical intervention is delayed just until the acute symptoms
subside (usually within a few days). There is no need to delay surgery pending an improvement in
nutritional status, and deciding on a laparoscopic approach is not a lengthy process.
36. A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is
laparoscopic cholecystectomy preferred by surgeons over an open procedure?
A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
B) Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR.
C) A laparoscopic approach allows for the removal of the entire gallbladder.
D) A laparoscopic approach can be performed under conscious sedation.
Ans: A
Feedback:
Open surgery has largely been replaced by laparoscopic cholecystectomy (removal of the gallbladder
through a small incision through the umbilicus). As a result, surgical risks have decreased, along with
the length of hospital stay and the long recovery period required after standard surgical cholecystectomy.
Both approaches allow for removal of the entire gallbladder and must be performed under general
anesthetic in an operating theater.
37. A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis
secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?
A) Laparoscopic cholecystectomy
B) Methyl tertiary butyl ether (MTBE) infusion
C) Intracorporeal lithotripsy
D) Extracorporeal shock wave therapy (ESWL)
Ans: A
Feedback:
Most of the nonsurgical approaches, including lithotripsy and dissolution of gallstones, provide only
temporary solutions to gallstone problems and are infrequently used in the United States.
Cholecystectomy is the preferred treatment.
38. A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA).
The patient askshow this medicine is going to help his symptoms. The nurse should be aware of what
aspect of this drugs pharmacodynamics?
A) It inhibits the synthesis of bile.
B) It inhibits the synthesis and secretion of cholesterol.
C) It inhibits the secretion of bile.
D) It inhibits the synthesis and secretion of amylase.
Ans: B
Feedback:
UDCA acts by inhibiting the synthesis and secretion of cholesterol, thereby desaturating bile. UDCA
does not directly inhibit either the synthesis or secretion of bile or amylase.
39. A nurse is providing discharge education to a patient who has undergone a laparoscopic
cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?
A) High-fiber foods
B) Low-purine, nutrient-dense foods
C) Low-fat foods high in proteins and carbohydrates
D) Foods that are low-residue and low in fat
Ans: C
Feedback:
The nurse encourages the patient to eat a diet that is low in fats and high in carbohydrates and proteins
immediately after surgery. There is no specific need to increase fiber or avoid purines. A low-residue
diet is not indicated.
40. A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain.
The patient states that his family doctor told him he had gallstones. The ED nurse should recognize what
possible complication of gallstones?
A) Acute pancreatitis
B) Atrophy of the gallbladder
C) Gallbladder cancer
D) Gangrene of the gallbladder
Ans: D
Feedback:
In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder
initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are
compressed, compromising its vascular supply. Gangrene of the gallbladder with perforation may result.
Pancreatitis, atrophy, and cancer of the gallbladder are not plausible complications.