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A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?
- A. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
- B. Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR.
- C. A laparoscopic approach allows for the removal of the entire gallbladder.
- D. A laparoscopic approach can be performed under conscious sedation.
Correct Answer: A
Rationale: Open surgery has largely been replaced by laparoscopic cholecystectomy (removal of the gallbladder through a small incision through the umbilicus). As a result, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. Both approaches allow for removal of the entire gallbladder and must be performed under general anesthetic in an operating theater.
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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 patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize?
- A. Educating the patient about expectations and care following surgery
- B. Educating the patient about the management of blood glucose after discharge
- C. Educating the patient about postdischarge lifestyle modifications
- D. Educating the patient about the potential benefits of pancreatic transplantation
Correct Answer: C
Rationale: The patients lifestyle (especially regarding alcohol use) is a major determinant of the course of chronic pancreatitis. The disease is not often managed by surgery and blood sugar monitoring is not necessarily indicated for every patient after hospital treatment. Transplantation is not an option.
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.
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.
A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments?
- A. Fluid output
- B. Oral intake
- C. Blood glucose levels
- D. BUN and creatinine levels
Correct Answer: C
Rationale: In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels every 4 to 6 hours. Output should be monitored but in most cases it is not more important than serum glucose levels. A patient on parenteral nutrition would have no oral intake to monitor. Blood sugar levels are more likely to be unstable than indicators of renal function.