1. Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Chapter 44
Nursing Management: Liver, Pancreas, and Biliary Tract Problems

2. 1. initiate oxygen therapy at 2 L/min to increase gas exchange.
1. A patient with advanced cirrhosis with ascites is short of breath and has an increased respiratory rate. The nurse should
1. initiate oxygen therapy at 2 L/min to increase gas exchange.
2. notify the health care provider so a paracentesis can be performed.
3. ask patient to cough and deep breathe to clear respiratory secretions.
4. place the patient in Fowler’s position to relieve pressure on the diaphragm.
Answer: 4
Rationale: Dyspnea is a frequent problem for the patient with ascites, and a semi-Fowler’s or Fowler’s position allows for maximal respiratory efficiency. Oxygen administration is not indicated; SpO2 level less than 90% would be an indication for oxygen. The respiratory distress is caused by ascites (not respiratory secretions); coughing and deep breathing will not alleviate the respiratory distress. A paracentesis may be performed to remove ascitic fluid; however, this procedure is only a temporary measure and is reserved for severe respiratory distress or abdominal pain.

3. 4. H2R blockers or proton pump inhibitors.
2. The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of
1. antibiotics.
2. NPO status.
3. antispasmodics.
4. H2R blockers or proton pump inhibitors.
Answer: 2
Rationale: Pain from acute pancreatitis is aggravated by eating; NPO status will help to alleviate the pain by decreasing pancreatic secretions.

4. 3. cholecystoduodenostomy. 4. laparoscopic cholecystectomy.
3. The surgical treatment of choice for the patient with symptomatic gallbladder disease is a
1. cholecystotomy.
2. choledocholithotomy.
3. cholecystoduodenostomy.
4. laparoscopic cholecystectomy.
Answer: 4
Rationale: Laparoscopic cholecystectomy is the surgical treatment of choice for symptomatic cholelithiasis. The procedure is minimally invasive (puncture sites only); patients experience minimal postoperative pain and are discharged the day of surgery or the day after. Most patients are able to resume normal activities and return to work within 1 week.

5. 1. assess lung sounds every 2 to 4 hours.
4. Postoperatively, a patient with an incisional cholecystectomy has a nursing diagnosis of ineffective breathing pattern related to splinted respirations secondary to a high abdominal incision. The nursing intervention that should be implemented first for this patient is to
1. assess lung sounds every 2 to 4 hours.
2. provide analgesics to relieve incisional pain.
3. assist the patient to cough and deep breathe every hour.
4. position the patient on the operative side to splint the incision.
Answer: 2
Rationale: Postoperative nursing care for incisional cholecystectomy focuses on adequate ventilation and prevention of respiratory complications. The patient will need adequate pain control for optimum coughing and deep breathing to prevent postoperative atelectasis.