The Client with Cholecystitis nursing exam for your nursing review.
A cholecystectomy was performed in laparoscopic surgery. In the discharge teaching, which of the following instructions should the nurse include?
A. Empty the bile bag on a daily basis.
B. Breathe deeply into a paper bag if you become sick.
C. Leave the adhesive dressings on for 6 weeks.
D. Any incision with bile-colored drainage should be reported.
The correct answer is D. After surgery, there should be no bile-colored drainage coming from any of the incisions. A bile bag is not used in laparoscopic cholecystectomy. Breathing deeply into a paper bag can save you from passing out from hyperventilation, but it will not help you feel better. The surgeon removes the adhesive dressings after 7 to 10 days, not 6 weeks if they haven’t already fallen off.
Results
#1. A 40-year-old client has acute cholecystitis and is admitted to the hospital. Which of the following directions should the nurse question the physician?
Because morphine sulfate is thought to produce biliary spasms, a nurse should question the order. As a result, meperidine is the preferred opioid analgesic for treating cholecystitis (Demerol). Because of the danger of sudden disorientation and seizures in the elderly, meperidine should not be given to them. Alternative pain relievers will be required. I.V. fluid treatment is used to restore fluid and electrolyte balance caused by NPO status and stomach suctioning. Gallbladder stimulation is prevented by NPO state and stomach decompression.
#2. A patient is admitted to the hospital with cholecystitis as a result of cholelithiasis. The patient is experiencing significant abdominal discomfort, and nausea, and has vomited on multiple occasions. Which nursing diagnosis would have the highest priority for intervention at this moment, based on these data?
The client’s acute stomach pain is the priority for nursing care at this time. The biliary spasm causes pain, which is often accompanied by nausea and vomiting. The extreme pain and spasms of cholecystitis are treated with opioid medications. Pain relief may reduce nausea and vomiting, lowering the client’s risk of developing subsequent issues such as insufficient fluid volume and nutritional imbalances. There is no evidence that the client is worried.
#3. The stools of a client are light gray in hue. Which of the following should the nurse assess the client for? All that apply should be selected.
The liver produces bile, which is then held in the gallbladder before being discharged into the duodenum, giving stool its brown hue. Pale-colored feces can be caused by a bile duct occlusion. Right upper quadrant tenderness, fever from inflammation or infection, jaundice from raised serum bilirubin levels, and nausea or right upper quadrant pain after a fatty meal are all indications of cholelithiasis. Appendicitis is related to pain at McBurney’s point, which is located between the umbilicus and the right iliac crest. Black, tarry stools are the result of a bleeding ulcer. Cholelithiasis does not cause respiratory discomfort.
#4. A customer who is scheduled for a choledocholithotomy shows concern about the procedure. Which nurse intervention would be most effective in achieving the desired result of anxiety reduction?
Providing knowledge can assist in answering inquiries and reducing fear in clients. Anxiety can be exacerbated by a fear of the unknown. Telling the client not to be fearful, that the treatment is usual, or that she should follow her doctor’s recommendations won’t necessarily make her feel better.
#5. An open cholecystectomy with bile duct exploration is performed on a patient. The client has a T-tube after surgery. To assess the T-effectiveness, the tube's the nurse should:
A T-tube is put into the common bile duct to keep it open until the edema caused by the duct exploration goes away. To ensure tube patency, the bile color should range from gold to dark green, and the amount of drainage should be continuously monitored. Irrigation is not done on a regular basis unless a smaller volume of fluid is ordered. To allow for continuous drainage, the T-tube is not clamped in the early postoperative period. A right subcostal incision is used in an open cholecystectomy, whereas numerous tiny incisions are used in laparoscopic cholecystectomy.
#6. The nurse checks the amount of T-tube drainage for a client who had an open cholecystectomy the day before at 8 a.m. Following a review of the output record (as shown in the diagram), the nurse should: 12 pm 50 mL, 4 pm 60 mL, 8 pm 60 mL, 12 am 70 mL, 4 am 70 mL, 8 am 10 mL
During the first 24 hours, the T-tube should drain roughly 300 to 500 mL, and after 3 to 4 days, the amount should be less than 200 mL in 24 hours. The nurse should examine the tube for obstruction of flow, which can be caused by kinks in the tube or the client sleeping on the tube when drainage suddenly drops at 8 a.m. The color of the drainage must also be checked for evidence of bleeding. Without permission, the tube should not be irrigated or clamped.
#7. Which of the following procedures does the nurse use to record the amount of bile drainage from a T-tube?
Bile drainage through the T-tube is recorded separately on the output record. It’s difficult to precisely estimate the amounts of bile, urine, or drainage when the T-tube drainage is mixed in with the urine output or wound drainage. If drainage is removed from the client’s total intake, the total intake will be erroneous.
#8. The client must have a low-fat diet after a cholecystectomy. Which of the following foods should you eat if you're trying to eat a low-fat diet?
Lean meats are low in fat, such as beef, lamb, veal, and well-trimmed lean ham and swine. When served without butter, cream, or sauces, rice, pasta, and vegetables are low in fat. Fruits have a low-fat content. After cholecystectomy, the amount of fat allowed in a client’s diet will be determined by the client’s ability to tolerate fat. The customer is usually not on a specific diet but is advised to avoid eating too much fat. The fat level of a cheese omelet and peanut butter is substantial. Salad dressing fat contributes to the high-fat content of ham salad.
#9. A cholecystitis patient continues to experience significant right upper quadrant pain. The following vital signs are obtained by the nurse: The temperature was 38.4°C, the pulse was 114, the respirations were 22, and the blood pressure was 142/90. The nurse suggests to the primary care provider, using the SBAR (Situation-Background-Assessment-Recommendation) communication strategy, that the client receives:
Dilaudid is a pain reliever that should be explored. It should be given intravenously for immediate relief of the client’s severe discomfort. Intramuscular injections are uncomfortable and take a long time to work. Meperidine is no longer used to alleviate pain since its poisonous metabolite can cause seizures. The calcium channel blocker diltiazem is not recommended. Pain and fever are likely to cause an increase in heart rate and blood pressure. Phenergan is an anti-nausea medication.
#10. The nurse prepares to give a client with cholecystitis who is experiencing nausea promethazine (Phenergan) 35 mg I.M. as instructed by the p.r.n. The medicine is available at 25 mg/mL, according to the ampule label. How many milliliters should the nurse provide to the patient?
35 mg/X mL = 25 mg/1 mL X = 1.4 mL
