Nokea
The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse should monitor the patient for signs of what complications?
- A. Pain and peritonitis
- B. Bleeding and perforation
- C. Acidosis and hypoglycemia
- D. Gangrene of the gallbladder and hyperglycemia
Correct Answer: B
Rationale: Following ERCP removal of gallstones, the patient is observed closely for bleeding, perforation, and the development of pancreatitis or sepsis. Blood sugar alterations, gangrene, peritonitis, and acidosis are less likely complications.
You may also like to solve these questions
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.
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.
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician?
- A. Decreased breath sounds
- B. Drainage of bile-colored fluid onto the abdominal dressing
- C. Rigidity of the abdomen
- D. Acute pain with movement
Correct Answer: C
Rationale: The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, which may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.
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 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.