Chapter 30: Care of Patients with
Disorders of the Liver, Gallbladder,
and Pancreas
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
MULTIPLE CHOICE
1.The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse’s teaching has been successful?
a.“I should call my doctor if I have any pain.”
b.“I should be able to go back to work tomorrow.”
c.“I should avoid fatty foods for a few weeks.”
d.“I should let these Steri-Strips fall off on their own.”
ANS: D
The nurse should teach the patient to remove the bandages from the puncture site(s) the day after surgery and shower, leaving the Steri- Strips intact. Steri-Strips will fall off in 7 to10 days. The patient should notify the physician in cases of severe abdominal pain that is not relieved by medication or is worsening. Return to work is probable at 1 week post-surgery. The patient should adhere to a low-fat diet for several weeks and slowly introduce fattier foods to determine if they cause unpleasant
symptoms.
PTS:1 DIF: Cognitive Level: Application REF: 696
OBJ:11 TOP: Cholecystectomy: PostOp Teaching
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
2.The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a
temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem?
a.Cholecystitis
b.Hepatitis
c.Pancreatitis
d.Gastroenteritis
ANS: A Nausea and vomiting, fever, and leukocytosis occur with cholecystitis. Pain may be referred to the right clavicle, scapula, or shoulder. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea.
PTS:1DIF:Cognitive Level: Application REF: 696
OBJ:2TOP: Cholecystitis: Signs and Symptoms
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance
3.The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan?
a.To visualize the location of gallstones
b.To assess amounts of inflammation and swelling
c.To diagnose abnormal contraction of the gallbladder
d.To assess composition of gallstones
ANS: C
The HIDA scan can diagnose abnormal contractions of the gallbladder, which occur in the presence of gallstones or a gallbladder that is not functioning properly.
PTS:1DIF: Cognitive Level: Comprehension REF:696
OBJ:1 (theory) TOP: Cholelithiasis: HIDA Scan
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4.The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make?
a.“Is there a reason that you want to have lithotripsy?”
b.“Your doctor decides which procedure will be best.”
c.“Gallstones are usually treated with surgery. Tell me more about your concerns.”
d.“I understand that you are upset. Would you like to speak with a chaplain?”
ANS: C
Lithotripsy, or “shock wave” therapy, is rarely used for gallstones. The treatment of choice is gallbladder removal. By explaining that surgery is the treatment of choice but also asking the patient to elaborate, the nurse provides information and uses an open- ended statement to acknowledge the patient’s feelings. Asking the patient to list
the reasons that he wants lithotripsy is not therapeutic or effective since the patient requires a cholecystectomy. While the physician does choose which procedure is best indicated, the nurse should not dismiss the patient’s concerns or deflect them and suggest that he speak with someone else.
PTS:1DIF:Cognitive Level: Application REF:696
Disorders of the Liver, Gallbladder,
and Pancreas
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
MULTIPLE CHOICE
1.The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse’s teaching has been successful?
a.“I should call my doctor if I have any pain.”
b.“I should be able to go back to work tomorrow.”
c.“I should avoid fatty foods for a few weeks.”
d.“I should let these Steri-Strips fall off on their own.”
ANS: D
The nurse should teach the patient to remove the bandages from the puncture site(s) the day after surgery and shower, leaving the Steri- Strips intact. Steri-Strips will fall off in 7 to10 days. The patient should notify the physician in cases of severe abdominal pain that is not relieved by medication or is worsening. Return to work is probable at 1 week post-surgery. The patient should adhere to a low-fat diet for several weeks and slowly introduce fattier foods to determine if they cause unpleasant
symptoms.
PTS:1 DIF: Cognitive Level: Application REF: 696
OBJ:11 TOP: Cholecystectomy: PostOp Teaching
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
2.The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a
temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem?
a.Cholecystitis
b.Hepatitis
c.Pancreatitis
d.Gastroenteritis
ANS: A Nausea and vomiting, fever, and leukocytosis occur with cholecystitis. Pain may be referred to the right clavicle, scapula, or shoulder. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea.
PTS:1DIF:Cognitive Level: Application REF: 696
OBJ:2TOP: Cholecystitis: Signs and Symptoms
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance
3.The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan?
a.To visualize the location of gallstones
b.To assess amounts of inflammation and swelling
c.To diagnose abnormal contraction of the gallbladder
d.To assess composition of gallstones
ANS: C
The HIDA scan can diagnose abnormal contractions of the gallbladder, which occur in the presence of gallstones or a gallbladder that is not functioning properly.
PTS:1DIF: Cognitive Level: Comprehension REF:696
OBJ:1 (theory) TOP: Cholelithiasis: HIDA Scan
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4.The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make?
a.“Is there a reason that you want to have lithotripsy?”
b.“Your doctor decides which procedure will be best.”
c.“Gallstones are usually treated with surgery. Tell me more about your concerns.”
d.“I understand that you are upset. Would you like to speak with a chaplain?”
ANS: C
Lithotripsy, or “shock wave” therapy, is rarely used for gallstones. The treatment of choice is gallbladder removal. By explaining that surgery is the treatment of choice but also asking the patient to elaborate, the nurse provides information and uses an open- ended statement to acknowledge the patient’s feelings. Asking the patient to list
the reasons that he wants lithotripsy is not therapeutic or effective since the patient requires a cholecystectomy. While the physician does choose which procedure is best indicated, the nurse should not dismiss the patient’s concerns or deflect them and suggest that he speak with someone else.
PTS:1DIF:Cognitive Level: Application REF:696
