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A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain?
- A. Aspirin every 4 to 6 hours as ordered
- B. Application of heat 15 to 20 minutes each hour
- C. Application of an ice pack for no more than 15 minutes
- D. Application of liniment rub to affected area
Correct Answer: B
Rationale: If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the abdominal cavity during the procedure), the nurse may recommend use of a heating pad for 15 to 20 minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding.
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A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?
- A. Laparoscopic cholecystectomy
- B. Methyl tertiary butyl ether (MTBE) infusion
- C. Intracorporeal lithotripsy
- D. Extracorporeal shock wave therapy (ESWL)
Correct Answer: A
Rationale: Most of the nonsurgical approaches, including lithotripsy and dissolution of gallstones, provide only temporary solutions to gallstone problems and are infrequently used in the United States. Cholecystectomy is the preferred treatment.
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem?
- A. Severe pancreatitis with possible peritonitis
- B. Acute cholecystitis
- C. Chronic pancreatitis
- D. Acute appendicitis with possible perforation
Correct Answer: A
Rationale: Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis.
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform in order to best address this diagnosis?
- A. Position the patient supine to facilitate diaphragm movement.
- B. Administer corticosteroids by nebulizer as ordered.
- C. Perform oral suctioning as needed to remove secretions.
- D. Maintain the patient in a semi-Fowlers position whenever possible.
Correct Answer: D
Rationale: The nurse maintains the patient in a semi-Fowlers position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. A supine position will result in increased pressure on the diaphragm and potentially decreased respiratory expansion. Steroids and oral suctioning are not indicated.
A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?
- A. The need to protect the incision postprocedure
- B. The use of moderate sedation
- C. The need to infuse 50% dextrose during the procedure
- D. The use of general anesthesia
Correct Answer: B
Rationale: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the procedure does not involve the creation of an incision.
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.