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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.
Correct Answer: A
Rationale: 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.
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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
Correct Answer: D
Rationale: 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.
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
Correct Answer: D
Rationale: 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.
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
Correct Answer: B
Rationale: 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.
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.
Correct Answer: C
Rationale: 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.
A patient with chronic pancreatitis had a pancreaticojejunostomy 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 pancreaticojejunostomy 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.
Correct Answer: B
Rationale: Pain relief from a pancreaticojejunostomy 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.