Wk. 10 - Caring for People with Biliary and Pancreatic Disorders Foreign Language

A 52-year-old woman with intermittent RUQ pain after fatty meals has a positive ultrasound showing gallstones. Which statement best explains how ursodeoxycholic acid (ursodiol) treats her condition? A. It increases gallbladder contractility to expel stones. B. It dissolves cholesterol stones by decreasing hepatic cholesterol secretion into bile. C. It dissolves pigment stones by chelating bilirubin. D. It inhibits hepatic bile acid synthesis, causing cholesterol precipitation.

B

A patient with suspected choledocholithiasis presents with RUQ pain, dark urine, and clay stools. Which lab pattern most supports obstruction of the common bile duct? A. ↑ AST, ↑ ALT, ↑ bilirubin (direct), ↑ alkaline phosphatase B. ↑ amylase only with normal bilirubin and LFTs C. ↓ alkaline phosphatase with ↑ unconjugated bilirubin D. Isolated ↑ lipase with normal liver enzymes

A

Which clinical findings are most consistent with acute cholecystitis? (Select all that apply.) A. RUQ pain > 6 hours with rebound tenderness B. Fever and leukocytosis C. Pain improved by vomiting and position change D. Positive Murphy’s sign

A,B,D

True or False: Laparoscopic cholecystectomy typically requires a hospital stay of 2–4 days and prolonged lifting restrictions compared with open cholecystectomy.

False

A patient scheduled for laparoscopic cholecystectomy asks why they must be NPO. The nurse’s best explanation: A. NPO prevents postoperative ileus B. NPO reduces bile production so the gallbladder is smaller. C. NPO reduces risk of aspiration during general anesthesia. D. NPO is primarily to decrease postoperative nausea.

C

A 68-year-old man with cholelithiasis is not a surgical candidate. Which treatment option would be appropriate to dissolve cholesterol stones? A. Intravenous antibiotics only B. Oral ursodiol therapy over months C. Immediate open cholecystectomy D. High-fat diet to pass stones

B

Important nursing considerations for administering pancrelipase (Creon) include: A. Give with every meal and snack; sprinkle on acidic foods if capsules can’t be swallowed. B. Do not crush or chew enteric-coated microspheres. C. Monitor for steatorrhea to assess effectiveness. D. Hold enzymes if the patient is NPO and on bowel rest.

B,C,D

A 30-year-old with heavy alcohol use presents with sudden severe epigastric pain radiating to the back, tachycardia, and elevated lipase. Which mechanism best describes acute pancreatitis? A. Autoimmune destruction of islet cells causing insulin deficiency B. Premature activation of pancreatic enzymes within the pancreas causing autodigestion C. Bacterial infection of pancreatic ducts leading to abscess formation D. Obstruction of the hepatic ducts causing biliary hypertension

B

Which diagnostic study is first-line to detect gallstones? A. Abdominal x-ray B. Transabdominal ultrasound C. CT abdomen/pelvis with contrast D. MRCP

B

A patient with gallstone pancreatitis is NPO and receiving IV fluids. Which nursing goal is highest priority in the first 24 hours? A. Preventing malnutrition by starting TPN immediately B. Controlling pain while maintaining adequate perfusion and urine output C. Starting oral low-fat diet as soon as pain decreases D. Placing an NG tube for continuous suction in all cases

B

                        Select all that apply — Which complications can occur from untreated choledocholithiasis? (Select all that apply.) A. Acute cholangitis B. Obstructive jaundice C. Acute pancreatitis D. Renal tubular acidosis                          

                        A,B,C                          

                        True or False: A markedly elevated serum amylase is more specific than elevated lipase for diagnosing acute pancreatitis.                          

                        False                          

                        A patient with acute pancreatitis exhibits tetany and muscle cramps. Which lab abnormality should the nurse suspect? A. Hyperkalemia B. Hypocalcemia C. Hypermagnesemia D. Metabolic alkalosis                          

                        B                          

                        Which statement about a T-tube placed after open cholecystectomy is correct? A. The T-tube is placed into the gallbladder for drainage. B. The T-tube bag should be kept above the patient’s waist to facilitate drainage. C. The tube is in the common bile duct and drainage is usually green-yellow. D. The T-tube is routinely clamped permanently after 24 hours.                          

                        C                          

                        A patient taking ursodiol should be instructed that: A. It acts rapidly — stones dissolve within 24–48 hours. B. It is effective for all stone types, including calcified stones. C. Therapy can require months and is only effective for cholesterol stones with a functioning gallbladder. D. It is always first-line for acute cholecystitis.                          

                        C                          

                        Select all that apply — Initial medical management for mild acute pancreatitis includes: A. NPO and bowel rest B. Aggressive IV fluid resuscitation (crystalloid) C. Early oral high-fat diet to stimulate enzymes D. Pain management with opioids as needed                          

                        A,B,C                          

                        A patient with chronic pancreatitis has steatorrhea and weight loss. The nurse anticipates which treatment? A. Long-term high-dose antacids only B. Pancreatic enzyme replacement (pancrelipase) with meals C. Lifelong TPN D. Immediate total pancreatectomy                          

                        B                          

                        A 45-year-old woman with suspected ascending cholangitis demonstrates the classic Charcot triad. Which set is Charcot’s triad? A. RUQ pain, fever, jaundice B. Fever, hypotension, altered mental status C. RUQ pain, clay stools, steatorrhea D. Epigastric pain, nausea, vomiting                          

                        A                          

                        Which findings in the patient chart would support a diagnosis of gallstone pancreatitis? (Select all that apply.) A. Recent ultrasound showing common bile duct stone B. Elevated ALT > 3× normal on admission C. Markedly elevated triglycerides > 2000 mg/dL with normal LFTs D. Elevated lipase and amylase                          

                        A,B,D                          

                        True or False: MRCP is noninvasive and useful to visualize biliary and pancreatic ducts, but ERCP allows both visualization and therapeutic removal of stones.                          

                        True                          

                        A patient with pancreatitis has persistent vomiting with NG output of 900 mL/day and worsening abdominal distention. The most appropriate next nursing action is:  A. Start oral clear liquids immediately. B. Increase opioid dose to slow GI motility. C. Notify provider for possible nasojejunal feeding or continued NG decompression. D. Discontinue IV fluids to reduce edema.                          

                        C                          

                        Which lab trend is expected during severe necrotizing pancreatitis with large areas of fat necrosis?  A. Rising serum calcium due to bone resorption B. Falling serum calcium due to binding in fat necrosis C. Rising bicarbonate levels causing alkalosis D. Rapid decrease in serum lipase to normal                          

                        B                          

                        Priority nursing interventions for a patient with acute cholangitis include:  A. Obtain blood cultures and start broad-spectrum IV antibiotics. B. Prepare the patient for emergent ERCP for biliary decompression. C. Keep patient NPO and begin aggressive IV fluids. D. Immediately administer high-dose pancreatic enzymes.                          

                        A,B,C                          

                        A common reason for persistent diarrhea following cholecystectomy is: A. Complete inability of the liver to make bile. B. Continuous, less concentrated bile flow into the intestine causing fat malabsorption. C. Pancreatic enzyme overproduction. D. Chronic infection at the incision site.                          

                        B                          

                        Which description best differentiates chronic pancreatitis from acute pancreatitis? A. Chronic pancreatitis has sudden onset and resolves in 48 hours; acute is progressive with fibrosis. B. Chronic pancreatitis often causes permanent exocrine and endocrine insufficiency and steatorrhea; acute is inflammatory with potential necrosis. C. Acute pancreatitis always leads to diabetes; chronic never does. D. Chronic pancreatitis is always caused by gallstones.                          

                        B                          

                        Nursing education for patients starting pancrelipase should include: A. Take with meals and snacks to aid digestion. B. Avoid giving enzymes with highly acidic fruit juices (e.g., orange) if capsules are opened. C. If stool becomes less fatty, the dose may be effective. D. Double the dose if you forget to take one with a meal.                          

                        A,B,C                          

                        A patient is admitted with suspected biliary colic. Which pain description is most characteristic? A. Dull, midline lower abdominal cramping lasting weeks B. Severe RUQ or epigastric pain radiating to the right scapula, often postprandial and lasting less than 6 hours C. Colicky periumbilical pain relieved by defecation D. Left lower quadrant sharp pain with blood in stool                          

                        B                          

                        Which medication side effect is most important to monitor in a patient receiving ursodiol long-term? A. Nephrotoxicity with rising creatinine B. Diarrhea and potential hepatotoxicity (monitor LFTs) C. QT prolongation on ECG D. Hyperglycemia                          

                        B                          

                        A 55-year-old with severe acute pancreatitis requires large volumes of IV fluid. What parameter best indicates adequate perfusion from fluids A. Urine output ≥ 0.5 mL/kg/hr and stable MAP B. Serum lipase returning to normal within 2 hours C. Immediate resolution of pain after fluids D. Development of ankle edema                          

                        A                          

                        Which interventions are part of discharge teaching after an uncomplicated laparoscopic cholecystectomy? (Select all that apply.) A. Start a strict high-fat diet to prevent future stones. B. Expect small incisional pain; gradually resume activity and avoid heavy lifting for ~1 week. C. Adopt a low-fat diet for at least the first week postoperatively and advance as tolerated. D. Seek care for fever, increasing abdominal pain, jaundice, or bile-colored drainage.                          

                        B,C,D                          

                        True or False: A patient with chronic pancreatitis who develops diabetes should be treated exactly the same as a person with Type 2 diabetes regarding oral hypoglycemics                          

                        False                          

                        Which clinical sign suggests hemorrhagic pancreatitis with retroperitoneal bleeding? A. Cullen sign (periumbilical ecchymosis) and Grey-Turner sign (flank ecchymosis) B. Murphy’s sign on inspiration C. Positive psoas sign D. Rovsing sign                          

                        A                          

                        A patient with suspected biliary obstruction has an elevated alkaline phosphatase (ALP) and mildly elevated AST/ALT. Which imaging should the nurse anticipate as next step for ductal visualization and possible therapeutic intervention? A. MRCP only B. ERCP — diagnostic and therapeutic C. Plain abdominal x-ray D. DEXA scan                          

                        B                          

                        Select all that apply — Which factors increase the risk of gallstone formation? (Select all that apply.) A. Female sex and estrogen therapy B. Rapid weight loss and prolonged fasting (e.g., TPN) C. High-fiber diet and regular exercise D. Pregnancy and family history                          

                        A,B,D                          

                        A patient with chronic pancreatitis is prescribed pancrelipase. Which assessment finding would suggest poor effectiveness of the medication? A. Decreased stool frequency and softer stools B. Continued bulky, foul-smelling, oily stools (steatorrhea) and weight loss C. Decrease in postprandial abdominal cramping D. Improved appetite and weight gain                          

                        B                          

                        True or False: ERCP should be avoided in acute cholangitis because instrumentation increases the risk of sepsis.                          

                        False                          

                        The nurse is preparing to teach a patient about ursodiol. Which patient is least likely to be a candidate for ursodiol therapy? A. A patient with small, radiolucent cholesterol stones and functioning gallbladder B. A patient who must avoid surgery and has cholesterol stones < 1.5 cm C. A patient with radiopaque calcified stones and non-functioning gallbladder D. A patient with symptomatic gallstones who refuses surgery                          

                        C                          

                        Which findings are expected with prolonged or severe pancreatitis? (Select all that apply.) A. Pseudocyst formation on CT scan after several weeks B. Hypocalcemia due to fat necrosis C. Development of chronic steatorrhea and malnutrition D. Immediate normalization of pancreatic enzymes                          

                        A,B,C                          

                        A patient with pancreatitis asks why the nurse is monitoring triglyceride levels. The nurse’s best explanation: A. Increased triglycerides are unrelated to pancreatitis. B. Hypertriglyceridemia is a possible cause of pancreatitis and extremely high levels (>1000–2000 mg/dL) can trigger pancreatitis. C. Low triglycerides are diagnostic of chronic pancreatitis. D. Triglycerides rise only as a result of pancreatic enzyme replacement therapy.                          

                        B                          

                        A patient with obstructive jaundice and fever is being prepared for ERCP. Which preprocedure nursing tasks are appropriate? A. Verify NPO status, obtain informed consent, assess for iodine/shellfish allergy, and obtain baseline coagulation studies. B. Give full solid breakfast, hold consent, and proceed immediately. C. Discontinue all IV access and restrict fluids. D. Administer pancrelipase immediately before the procedure.                          

                        A