Nokea
A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain. The patient states that his family doctor told him he had gallstones. The ED nurse should recognize what possible complication of gallstones?
- A. Acute pancreatitis
- B. Atrophy of the gallbladder
- C. Gallbladder cancer
- D. Gangrene of the gallbladder
Correct Answer: D
Rationale: In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are compressed, compromising its vascular supply. Gangrene of the gallbladder with perforation may result. Pancreatitis, atrophy, and cancer of the gallbladder are not plausible complications.
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A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the patient who has had pancreatic surgery?
- A. Proteinuria and hyperkalemia
- B. Hemorrhage and hypercalcemia
- C. Weight loss and hypoglycemia
- D. Malabsorption and hyperglycemia
Correct Answer: D
Rationale: The nurse arrives at this diagnosis based on the complications of malabsorption and hyperglycemia. These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a low-fat diet, and vitamin supplementation often are also required to meet the patients nutritional needs and restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery, but the electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common complication, but hypoglycemia is less likely.
A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patients health problem?
- A. Toxins have accumulated and inflamed your pancreas.
- B. Bacteria likely migrated from your intestines and became lodged in your pancreas.
- C. A virus that was likely already present in your body has begun to attack your pancreatic cells.
- D. The enzymes that your pancreas produces have damaged the pancreas itself.
Correct Answer: D
Rationale: Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the autodigestion of the pancreas. Less commonly, toxic substances and microorganisms are implicated as the cause of pancreatitis.
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 patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick gallbladder. What rationale would underlie the nurses response?
- A. Surgery is delayed until the patient can eat a regular diet without vomiting.
- B. Surgery is delayed until the acute symptoms subside.
- C. The patient requires aggressive nutritional support prior to surgery.
- D. Time is needed to determine whether a laparoscopic procedure can be used.
Correct Answer: B
Rationale: Unless the patients condition deteriorates, surgical intervention is delayed just until the acute symptoms subside (usually within a few days). There is no need to delay surgery pending an improvement in nutritional status, and deciding on a laparoscopic approach is not a lengthy process.
A patient has been treated in the hospital for an episode of acute pancreatitis. The patient has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes after discharge. What is the nurses most appropriate response?
- A. Educate the patient about the link between alcohol use and pancreatitis.
- B. Ensure that the patient knows the importance of attending follow-up appointments.
- C. Refer the patient to social work or spiritual care.
- D. Encourage the patient to connect with a community-based support group.
Correct Answer: D
Rationale: After the acute attack has subsided, some patients may be inclined to return to their previous drinking habits. The nurse provides specific information about resources and support groups that may be of assistance in avoiding alcohol in the future. Referral to Alcoholics Anonymous as appropriate or other support groups is essential. The patient already has an understanding of the effects of alcohol, and follow-up appointments will not necessarily result in lifestyle changes. Social work and spiritual care may or may not be beneficial.