Critical Thinking
A nurse is caring for a client who reports nausea and severe right upper quadrant pain 1 hour after eating fried chicken. The pain radiates to the right shoulder and the client guards the abdomen during assessment.
What is cholecystitis secondary to gallstones?
A nurse caring for a client with pancreatitis observes a bluish-gray discoloration around the umbilicus.
What is Cullen's sign indicating severe pancreatic inflammation and bleeding?
A nurse is admitting a client with acute pancreatitis. Which prescription should the nurse implement first?
A. Low-fat diet
B. Ambulation three times daily
C. NPO status
D. Incentive spirometer every shift
What is maintaining NPO status?
A nurse is reinforcing discharge teaching for a client following laparoscopic cholecystectomy. The client states, "I plan to stay in bed for several days."
What indicates a need for further teaching because frequent ambulation is encouraged?
A nurse administers lactulose to a client who has cirrhosis. Which outcome indicates the medication is effective?
What is a decrease in ammonia levels?
A nurse is caring for a client who has peptic ulcer disease. The client reports sudden severe abdominal pain and the nurse notes a rigid abdomen, absent bowel sounds, hypotension, and tachycardia.
What is perforation requiring immediate intervention?
A client who has cirrhosis has the following findings:
Which cue is the highest priority?
What is elevated ammonia with neurologic changes?
A client returns from a liver biopsy. Which action should the nurse take first?
What is position the client on the right side?
A client with hepatitis B asks how to prevent transmission to family members at home.
What is avoiding sharing toothbrushes, razors, and practicing proper hand hygiene?
A client prescribed pancrelipase asks when to take the medication.
What is with every meal and snack?
A client admitted for pancreatitis reports pain 9/10 despite prescribed analgesics. The nurse notes the client is lying flat in bed and grimacing.
What is repositioning the client into a fetal position or leaning forward?
A nurse reviews laboratory findings for a client with acute pancreatitis:
The nurse should identify these findings as indicating what complication?
What is pancreatic dysfunction with impaired insulin production?
A nurse is planning care for a client with ascites due to cirrhosis. Which intervention best evaluates the effectiveness of treatment?
What is daily abdominal girth measurements?
A client who has dumping syndrome states, "I drink a large glass of water with every meal."
What indicates a need for further teaching?
A nurse is teaching a client prescribed omeprazole for peptic ulcer disease. Which statement indicates understanding?
What is "I will take this medication before my main meal of the day"?
A client with cirrhosis becomes increasingly confused and attempts to climb out of bed. Family members report the client was alert earlier in the day.
What is hepatic encephalopathy?
A nurse is caring for a client who has esophageal varices. Which finding requires immediate provider notification?
A. Mild fatigue
B. Black stool yesterday
C. Hematemesis
D. Poor appetite
What is hematemesis?
A client with peptic ulcer disease has tachycardia and orthostatic hypotension. What should the nurse suspect?
What is gastrointestinal bleeding?
A client recovering from pancreatitis says, "I can return to eating cheeseburgers once I feel better."
What indicates a need for further teaching because a low-fat diet is recommended?
A client taking bismuth subsalicylate reports black stools and becomes concerned.
What is an expected harmless effect of the medication?
A nurse receives report on four clients. Which client should the nurse assess first?
A. Cholecystitis with nausea
B. Hepatitis with anorexia
C. Cirrhosis with asterixis and confusion
D. Chronic pancreatitis with weight loss
What is the client with asterixis and confusion?
A nurse is caring for a client who has peptic ulcer disease. Which assessment finding requires immediate intervention?
A. Heartburn after eating
B. Coffee-ground emesis
C. Mild nausea
D. Abdominal bloating
What is coffee-ground emesis?
A nurse is caring for a client with acute pancreatitis. Which assessment finding indicates improvement?
A. Increased abdominal distention
B. Lipase continues to increase
C. Pain decreases and oral intake resumes
D. Persistent vomiting
What is decreased pain with return of oral intake?
A client with hepatic encephalopathy asks why protein intake is being limited.
What is to decrease ammonia production?
A nurse is caring for a client prescribed lactulose. Which finding indicates the client is at risk for an adverse effect of therapy?
A. Constipation
B. Hypokalemia
C. Hypercalcemia
D. Bradycardia
What is hypokalemia?
Case:
A 55-year-old with hepatitis C presents with jaundice, pruritus, dark urine, clay-colored stools, epigastric pain post-fatty meal, and elevated bilirubin. Ultrasound: common bile duct obstruction.
Question: In order:
First nursing step (Nursing Process)
Key dietary advice (Patient Education)
Most urgent action (Prioritized Care)
Likely complication (Clinical Judgment)
Reason stools are pale (Critical Thinking)
Correct Sequence:
What is assess severity and symptoms?
What is avoid high-fat meals?
What is notify provider for urgent evaluation?
What is obstructive jaundice due to gallstone?
What is reduced bile pigment reaching intestines?