Nokea
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when it will be possible to resume normal activities. What information should the nurse provide?
- A. Normal activities may be resumed the day after surgery.
- B. Normal activities may be resumed in 1 week.
- C. Normal activities may be resumed in 1 weeks.
- D. Normal activities may be resumed in 1 month.
Correct Answer: B
Rationale: A prolonged recovery period usually is unnecessary. Most clients resume normal activities within 1 week.
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A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?
- A. Hepatitis
- B. Biliary colic
- C. Cholelithiasis
- D. Cholecystitis
Correct Answer: C
Rationale: With cholelithiasis, initially, clients experience belching, nausea, and right upper quadrant discomfort, with pain or cramps after high-fat meal. Symptoms become acute when a stone blocks bile flow from the gallbladder. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain called biliary colic. The symptoms do not correlate with hepatitis.
A client with gallstones tells the nurse, 'The doctor has to do something. Isn't there something he can give me to dissolve them?' What medication does the nurse know may help dissolve the gallstones?
- A. Pancreatin
- B. Chenodiol
- C. Tacrolimus
- D. Cyclosporine
Correct Answer: B
Rationale: Chenodiol suppresses hepatic synthesis of cholesterol and cholic acid to dissolve gallstones. It is administered orally to dissolve gallstones and may require long term therapy for effectiveness. Pancreatin is a pancreatic enzyme and does not have the properties to dissolve gallstones. Tacrolimus is used to prevent transplant rejection as is cyclosporine.
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which intervention should the nurse consider?
- A. Report the condition to the physician immediately.
- B. Measure abdominal girth according to a set routine.
- C. Provide the client with nonprescription laxatives.
- D. Ask the client about food intake.
Correct Answer: B
Rationale: If the abdomen appears enlarged, the nurse measures it according to a set routine. Measuring the abdominal girth is the most accurate method of determining an increase or decrease in abdominal distention. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis. The nurse would report to the physician about abdominal enlargement along with other parameters of the assessment.
A client with cirrhosis is complaining to the nurse of itching. The client asks the nurse if the itching is from taking warm baths. What is the best response by the nurse?
- A. The itching is caused by the accumulation of bile salts.
- B. The itching is related to dry skin from the warm baths.
- C. The itching is most likely a side effect from some of the medications used in treatment.
- D. The itching is related to a psychological response from the illness.
Correct Answer: A
Rationale: Skin may itch (pruritus) from accumulated bile salts related to the diseased liver. It is not related to the baths or a psychological response from the illness. Medication side effect may cause itching, but the most likely cause is the accumulation of bile salts.
The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed?
- A. Thoracentesis
- B. Abdominal paracentesis
- C. Abdominal CT scan
- D. Upper endoscopy
Correct Answer: B
Rationale: Abdominal paracentesis may be performed to remove ascitic fluid. Abdominal fluid is rapidly removed by careful introduction of a needle through the abdominal wall, allowing the fluid to drain. Fluid is removed from the lung via a thoracentesis. Fluid cannot be removed with an abdominal CT scan, but the scan can assist with placement of the needle. Fluid cannot be removed via an upper endoscopy.