Nokea
A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the patient should be informed that this procedure will involve the removal of which of the following? Select all that apply.
- A. Gallbladder
- B. Part of the stomach
- C. Duodenum
- D. Part of the common bile duct
- E. Part of the rectum
Correct Answer: A,B,C,D
Rationale: A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The rectum is not affected.
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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.
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 just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that over 80% of the patients pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurses best response?
- A. The symptoms of pancreatitis mimic those of much less serious illnesses.
- B. Your body doesnt require pancreatic function until it is under great stress, so it is easy to go unnoticed.
- C. Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.
- D. Your other organs were compensating for your decreased pancreatic function.
Correct Answer: C
Rationale: By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been lost. Late detection is not usually attributable to the vagueness of symptoms. The pancreas contributes continually to homeostasis and other organs are unable to perform its physiologic functions.
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.
A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The patient asks how this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drugs pharmacodynamics?
- A. It inhibits the synthesis of bile.
- B. It inhibits the synthesis and secretion of cholesterol.
- C. It inhibits the secretion of bile.
- D. It inhibits the synthesis and secretion of amylase.
Correct Answer: B
Rationale: UDCA acts by inhibiting the synthesis and secretion of cholesterol, thereby desaturating bile. UDCA does not directly inhibit either the synthesis or secretion of bile or amylase.