Nokea
A nurse is providing the client with biliary obstruction a simple overview of the anatomy of the liver and gallbladder. The nurse tells the client that normally the liver stores bile in the gallbladder, which is connected to the liver by the?
- A. Liver canaliculi
- B. Common bile duct
- C. Cystic duct
- D. Right hepatic duct.
Correct Answer: C
Rationale: The correct answer is C: Cystic duct. The cystic duct connects the gallbladder to the common bile duct, through which bile flows from the liver to the gallbladder for storage. The liver canaliculi are tiny channels within the liver where bile is produced. The common bile duct is the main duct through which bile flows from the liver to the small intestine. The right hepatic duct is one of the ducts that collect bile from the liver but does not directly connect to the gallbladder. Therefore, the cystic duct is the correct choice as it specifically links the gallbladder to the common bile duct for bile transportation.
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Lactulose (Chronulac) is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse would determine that this medication has had a therapeutic effect if which of the following is noted?
- A. Increased red blood cell count
- B. Decreased serum ammonia level
- C. Increased protein level
- D. Decreased white blood cell level
Correct Answer: B
Rationale: The correct answer is B: Decreased serum ammonia level. Lactulose is used to treat hepatic encephalopathy by reducing serum ammonia levels through its laxative effect, promoting the excretion of ammonia in the feces. Decreased ammonia levels indicate that the medication is effectively managing the condition. Increased red blood cell count (A), increased protein level (C), and decreased white blood cell level (D) are not directly related to the therapeutic effect of lactulose in hepatic encephalopathy.
The home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that because the stomach lining produces a decreased amount of intrinsic factor in this disorder, the client will need
- A. Vitamin B12 injections
- B. Vitamin B6 injections
- C. An antibiotic
- D. An antacid
Correct Answer: A
Rationale: The correct answer is A: Vitamin B12 injections. Pernicious anemia results from a lack of intrinsic factor, which is needed for Vitamin B12 absorption. Since the stomach lining produces less intrinsic factor after gastric surgery, the client cannot absorb B12 orally. Therefore, B12 injections are necessary to bypass the need for intrinsic factor. Vitamin B6 injections (B) are not indicated for pernicious anemia. Antibiotics (C) and antacids (D) are not relevant to the treatment of pernicious anemia.
The nurse is doing preoperative teaching with the client who is about to undergo creation of a Kock pouch. The nurse interprets that the client has the best understanding of the nature of the surgery if the client makes which of the following statements?
- A. I will need to drain the pouch regularly with a catheter.
- B. I will need to wear a drainage bag for the rest of my life.
- C. The drainage from this type of ostomy will be formed.
- D. I will be able to pass stool from the rectum eventually.
Correct Answer: A
Rationale: The correct answer is A: "I will need to drain the pouch regularly with a catheter." This answer demonstrates an accurate understanding of the Kock pouch procedure, which involves the creation of a reservoir that needs to be drained periodically to prevent complications like overflow or infection.
Rationale:
1. A Kock pouch is a continent ileostomy that requires regular catheterization for drainage.
2. Choice B is incorrect because wearing a drainage bag for life is not necessary with a Kock pouch.
3. Choice C is incorrect as a Kock pouch does not produce formed drainage.
4. Choice D is incorrect because passing stool from the rectum is not possible after a Kock pouch surgery.
In summary, choice A is the correct answer as it aligns with the specific care requirements of a Kock pouch surgery, while the other options misrepresent the nature of the procedure.
Which of the following expected outcomes would be appropriate for the client who has ulcerative colitis?
- A. The client maintains a daily record of intake and output.
- B. The client verbalizes the importance of small, frequent feedings.
- C. The client uses a heating pad to decrease abdominal cramping.
- D. The client accepts that a colostomy is inevitable at some time in his life.
Correct Answer: B
Rationale: The correct answer is B: The client verbalizes the importance of small, frequent feedings. This is appropriate for a client with ulcerative colitis because small, frequent feedings help reduce gastrointestinal distress and maintain proper nutrition. Clients with ulcerative colitis often have difficulty tolerating large meals, so small, frequent feedings can help prevent exacerbation of symptoms.
A: Recording intake and output is important for certain conditions but not specifically for ulcerative colitis.
C: Using a heating pad may provide temporary relief for abdominal cramping but does not address the underlying issue of ulcerative colitis.
D: Accepting a colostomy is not an expected outcome for ulcerative colitis treatment unless all other options have failed.
The nurse is caring for a client following a Billroth II procedure. On review of the postoperative orders, which of the following if prescribed, should the nurse question and verify?
- A. Irrigating the nasogastric tube
- B. Coughing and deep breathing exercises
- C. Leg exercises
- D. Early ambulation
Correct Answer: A
Rationale: The correct answer is A: Irrigating the nasogastric tube. After a Billroth II procedure, the client's stomach has been partially removed, making them prone to dumping syndrome. Irrigating the nasogastric tube can disrupt the natural digestive process and may exacerbate dumping syndrome. Instead, the focus should be on promoting slow, gradual feeding to prevent complications.
Summary:
B: Coughing and deep breathing exercises - Important for preventing respiratory complications postoperatively.
C: Leg exercises - Essential for preventing blood clots and promoting circulation.
D: Early ambulation - Encourages mobility and prevents complications such as pneumonia and blood clots.