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A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and the patient underwent an open cholecystectomy with a T tube inserted into the common bile duct. Which is the purpose of the T tube?
- A. To decompress the duct and relieve pain caused by stimulation of the sphincter of Oddi.
- B. To improve diaphragmatic expansion and prevention of atelectasis.
- C. To shorten postoperative recovery and hasten the healing process.
- D. To keep the duct open and allow drainage of the bile until edema resolves.
Correct Answer: D
Rationale: If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves.
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What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy?
- A. High placement of incision
- B. Excessive nausea
- C. Weakened abdominal muscles
- D. Poor oxygenation
Correct Answer: A
Rationale: The high placement of the incision of the cholecystectomy makes the patient reluctant to cough. Splinting the incision is beneficial.
Which action will the nurse take to prepare a patient for an endoscopic retrograde cholangiopancreatography (ERCP)?
- A. Confirm that a recent chest x-ray is on file.
- B. Confirm the presence of a consent form.
- C. Warn patient that the procedure will take about 3 hours.
- D. Confirm the presence of a prothrombin time/INR.
- E. Withhold food and drink for 4 hours.
Correct Answer: B,D
Rationale: Before the ERCP, the patient will be held NPO for 8 hours. It is necessary that a consent form be signed as well as evidence of a prothrombin time INR.
Why is it advantageous for a live person to be a liver donor?
- A. Because the donor is not at risk for any complication.
- B. Because the recipient is more likely to avoid rejection.
- C. Because the donor donates only a part of the liver.
- D. Because the blood supply is more dependable in the donated liver.
Correct Answer: C
Rationale: A live donor may donate only a portion of their liver and within weeks the donor's liver has grown to the size to meet the body's needs. The same is true for the recipient.
Why is morphine contraindicated in the patient with pancreatitis?
- A. Meperidine is less expensive.
- B. Tylenol is more effective at managing this type of pain.
- C. Morphine may cause spasms of the sphincter of Oddi.
- D. These patients do not experience pain.
Correct Answer: C
Rationale: A common complaint is constant, severe pain; in such cases, meperidine is often administered. Morphine may cause spasms of the sphincter of Oddi.
Viral hepatitis may be treated at home. Which should be taught to the patient's family?
- A. Clothes should be laundered separately with hot water.
- B. Personal items and drinking glasses should not be shared.
- C. Articles soiled with feces do not require extra care.
- D. Hands need to be thoroughly washed after toileting.
- E. Contaminated items may be disposed of with regular trash.
Correct Answer: A,B,D
Rationale: For the patient with viral hepatitis being cared for in the home, the family needs to be taught necessary precautions. Clothes should be laundered separately with hot water. Personal items used by the patient should not be shared. Articles soiled with feces must be disinfected. Any contaminated items should be disposed of properly.