NUR3219C Adult Acute Final Exam 2
Questions and Already Passed
Solutions 2025 -2026 Graded A+.
cholelithiasis - Answer most common disorder of biliary system
-stones in gallbladder
cholecystitis - Answer -inflammation of the gallbladder
-usually associated with gallstones
cholecystitis risk factors - Answer "fair, fat, forty, female"
female
older than 40
estrogen therapy
sedentary life
family history
obesity
cholecystitis etiology - Answer -gallstones cause unknown
-develops when balance that keeps cholesterol, bile salts, and calcium is changed
-bile is supersaturated with cholesterol
-stasis of bile leads to biliary sludge
-stones can lodge in ducts and cause obstruction
cholecystitis manifestations - Answer -severe pain when stones move or obstruct (residual
tenderness in RUQ referring to right shoulder occurring 3-6 hours after high fat meal or when
lying down)
-with total obstruction: dark urine, clay color stools, pruritus, intolerance to fatty foods,
steatorrhea
-leukocytosis
Stones moving/ lodged = spasms = pain - Answer Steady, excruciating
,When total obstruction occurs: - Answer Dark amber urine (bile into urine)
Clay-colored stools ( due to lack of bile)
Pruritus - bile salts >> itchy skin (jaundice in eyes)
Intolerance to fatty foods
Bleeding tendencies
r/t clotting factors bc < K abs = <prothrombin
Steatorrhea- fat in poop bc not digested
In addition to pain - Answer Indigestion
Fever, chills
Jaundice
Pain, tenderness RUQ
Referred to right shoulder, scapula
Nausea/vomiting
Restlessness
Diaphoresis
Inflammation - Answer Leukocytosis
Fever
Physical examination findings - Answer RUQ or epigastrium tenderness
Abdominal rigidity
cholecystitis diagnostics - Answer -ultrasound, ERCP, percutaneous transhepatic
cholangiography
-lab tests: increased WBC, serum and urinary bilirubin, liver enzymes, serum amylase
cholecystitis complications - Answer Gangrenous cholecystitis & bile peritonitis (most common
complication for older adults/ pts w/ diabetes)
Subphrenic abscess (accumulation of infected fluid between the diaphragm, liver, and spleen. )
Pancreatitis
,Gallbladder rupture leads to peritonitis
Choledocholithiasis
cholecystitis treatment - Answer Oral dissolution therapy
Ursodeozycholic acid (Ursodiol)- softens the stone so it passes thru easier
Chenodeozycholic acid (Chenodiol)
ERCP with sphincterotomy (wire basket snags stone) Extracorporeal shock-wave lithotripsy
(ESWL)
SURGERY:Cholecystotomy (Laporscopic* or Open)
DRUGS: analgesics, anticholinergics, biles Salts, fat soluble Vitamins (A, D,E & K)
Cholestyramine may be given for pruritus
cholecystitis interventions - Answer -consult with nutritionist, have small frequent meals with
some fat, low in sat fat, high in fiber and calcium
- (diet < sat fat/calories, > fiber/Ca)
-treat severe pain
-fluid and electrolyte balance
- observe for complications
-manage nausea and vomitting (gastric decompression, oral hygiene, accurate intake and
output, antiemetics)
cholecystitis education - Answer Low-fat for 4-6 weeks following removal
Weight reduction if needed
Fat-soluble vitamin supplements
Teach what to report for T tubes if going home
Drainage tubes (dark green bile)
Follow-up care for open procedures: no heavy lifting for 4-6 weeks
Follow-up care for laparascopic procedures (see table 43.25)
Remove bandages day after surgery
NOTIFY: redness, sweliing, bile-color drainage/ pus | Severe abd pain, N&V, fever, chills
Return to work < 1 week
, liver cancer patho - Answer most common cause of death with patients diagnosed with
cirrhosis due to hep c
-single or multiple nodular lesions
-may infiltrate other organs
liver cancer manifestations - Answer -early symptoms are absent
-hepatomegaly, fatigue, peripheral edema, ascites
-late stage: fever, jaundice, anorexia, weight loss, palpable mass
liver cancer complications - Answer -mostly associated with treatment such as post op
complications
-portal hypertension can cause: bleeding, ascites, spleenamegaly
liver cancer diagnostics - Answer -US, CT, MRTI
-lab values: serum alpha-feto protein levels, liver enzyme assays
liver cancer treatment - Answer -prevention: diagnosis of Hep B and C and alcohol disease
-nonsurgical: ablation, chemoembolization, radioembolization, oral therapy
-surgical: liver resection/partial hepatectomy
liver cancer interventions - Answer -patient comfort and bedrest
-assess for bleeding caused by low platelets
-skin care for edema/jaundice
-oral care r/t vomiting
-promote nutrition
-monitor fluid
-assess LOC due to increased ammonia levels
-coping skills for poor prognosis
liver cancer education - Answer -educate about disease process
-educate about palliative care
Questions and Already Passed
Solutions 2025 -2026 Graded A+.
cholelithiasis - Answer most common disorder of biliary system
-stones in gallbladder
cholecystitis - Answer -inflammation of the gallbladder
-usually associated with gallstones
cholecystitis risk factors - Answer "fair, fat, forty, female"
female
older than 40
estrogen therapy
sedentary life
family history
obesity
cholecystitis etiology - Answer -gallstones cause unknown
-develops when balance that keeps cholesterol, bile salts, and calcium is changed
-bile is supersaturated with cholesterol
-stasis of bile leads to biliary sludge
-stones can lodge in ducts and cause obstruction
cholecystitis manifestations - Answer -severe pain when stones move or obstruct (residual
tenderness in RUQ referring to right shoulder occurring 3-6 hours after high fat meal or when
lying down)
-with total obstruction: dark urine, clay color stools, pruritus, intolerance to fatty foods,
steatorrhea
-leukocytosis
Stones moving/ lodged = spasms = pain - Answer Steady, excruciating
,When total obstruction occurs: - Answer Dark amber urine (bile into urine)
Clay-colored stools ( due to lack of bile)
Pruritus - bile salts >> itchy skin (jaundice in eyes)
Intolerance to fatty foods
Bleeding tendencies
r/t clotting factors bc < K abs = <prothrombin
Steatorrhea- fat in poop bc not digested
In addition to pain - Answer Indigestion
Fever, chills
Jaundice
Pain, tenderness RUQ
Referred to right shoulder, scapula
Nausea/vomiting
Restlessness
Diaphoresis
Inflammation - Answer Leukocytosis
Fever
Physical examination findings - Answer RUQ or epigastrium tenderness
Abdominal rigidity
cholecystitis diagnostics - Answer -ultrasound, ERCP, percutaneous transhepatic
cholangiography
-lab tests: increased WBC, serum and urinary bilirubin, liver enzymes, serum amylase
cholecystitis complications - Answer Gangrenous cholecystitis & bile peritonitis (most common
complication for older adults/ pts w/ diabetes)
Subphrenic abscess (accumulation of infected fluid between the diaphragm, liver, and spleen. )
Pancreatitis
,Gallbladder rupture leads to peritonitis
Choledocholithiasis
cholecystitis treatment - Answer Oral dissolution therapy
Ursodeozycholic acid (Ursodiol)- softens the stone so it passes thru easier
Chenodeozycholic acid (Chenodiol)
ERCP with sphincterotomy (wire basket snags stone) Extracorporeal shock-wave lithotripsy
(ESWL)
SURGERY:Cholecystotomy (Laporscopic* or Open)
DRUGS: analgesics, anticholinergics, biles Salts, fat soluble Vitamins (A, D,E & K)
Cholestyramine may be given for pruritus
cholecystitis interventions - Answer -consult with nutritionist, have small frequent meals with
some fat, low in sat fat, high in fiber and calcium
- (diet < sat fat/calories, > fiber/Ca)
-treat severe pain
-fluid and electrolyte balance
- observe for complications
-manage nausea and vomitting (gastric decompression, oral hygiene, accurate intake and
output, antiemetics)
cholecystitis education - Answer Low-fat for 4-6 weeks following removal
Weight reduction if needed
Fat-soluble vitamin supplements
Teach what to report for T tubes if going home
Drainage tubes (dark green bile)
Follow-up care for open procedures: no heavy lifting for 4-6 weeks
Follow-up care for laparascopic procedures (see table 43.25)
Remove bandages day after surgery
NOTIFY: redness, sweliing, bile-color drainage/ pus | Severe abd pain, N&V, fever, chills
Return to work < 1 week
, liver cancer patho - Answer most common cause of death with patients diagnosed with
cirrhosis due to hep c
-single or multiple nodular lesions
-may infiltrate other organs
liver cancer manifestations - Answer -early symptoms are absent
-hepatomegaly, fatigue, peripheral edema, ascites
-late stage: fever, jaundice, anorexia, weight loss, palpable mass
liver cancer complications - Answer -mostly associated with treatment such as post op
complications
-portal hypertension can cause: bleeding, ascites, spleenamegaly
liver cancer diagnostics - Answer -US, CT, MRTI
-lab values: serum alpha-feto protein levels, liver enzyme assays
liver cancer treatment - Answer -prevention: diagnosis of Hep B and C and alcohol disease
-nonsurgical: ablation, chemoembolization, radioembolization, oral therapy
-surgical: liver resection/partial hepatectomy
liver cancer interventions - Answer -patient comfort and bedrest
-assess for bleeding caused by low platelets
-skin care for edema/jaundice
-oral care r/t vomiting
-promote nutrition
-monitor fluid
-assess LOC due to increased ammonia levels
-coping skills for poor prognosis
liver cancer education - Answer -educate about disease process
-educate about palliative care
