Mastery EAQ Chapter 54

The nurse is reviewing the laboratory results of a
patient diagnosed with cholecystitis. Elevations in
which result would prompt the nurse to suspect
abnormal liver function in this patient? Select all
that apply. One, some, or all responses may be
correct.
Some correct answers were not selected
Rationale
Elevated lactate dehydrogenase, serum alkaline phosphate,
and aspartate aminotransferase are all laboratory results that
would indicate abnormalities in liver function. Elevated serum
Serum amylase
White blood cell count
Lactate dehydrogenase
Serum alkaline phosphate
Aspartate aminotransferase
amylase would indicate pancreatic involvement. An elevated
white blood cell count indicates inflammation.
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A nurse is assessing a patient who presents with
severe abdominal pain radiating at times to the
shoulder. The nurse notes the patient’s skin and
sclera are yellow in appearance. The patient reports
a sedentary lifestyle and experiences rebound
tenderness when tested for the Blumberg sign.
Which finding does the nurse suspect?
The patient has chronic cholecystitis because the
Blumberg sign is present in this form of the disease.
The patient has acute cholecystitis because the
Blumberg sign is present in this form of the disease.
The patient has acute cholecystitis because jaundice
and icterus are common in this form of the disease.
The patient has chronic cholecystitis because jaundice
and icterus are common in this form of the disease.
Rationale
Based on the provided information, it is most likely that the
patient has chronic cholecystitis. The Blumberg sign is present
in both forms of the disease, so this information cannot help
the nurse determine whether the patient has acute or chronic
cholecystitis. The yellow discoloration of the skin (jaundice)
and sclera (icterus) are most commonly seen in patients with
chronic cholecystitis than in patients with the acute form of
the disease.
Test-Taking Tip: Reread the question if the answers do not
seem to make sense because you may have missed words such
as not or except in the statement.
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Correct (47)
Which laboratory result would the nurse review for a
patient suspected of having cholecystitis? Select all
that apply. One, some, or all responses may be
correct.
Platelets
Hematocrit
Rationale
Liver function, white blood cells, and alkaline phosphate are
often elevated in patients with cholecystitis. Hematocrit and
platelets are not often abnormal and therefore are not
diagnostic.
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A patient diagnosed with chronic cholecystitis
develops jaundice and clay-colored stools. For which
other sign or symptom would the patient be
assessed? Select all that apply. One, some, or all
responses may be correct.
Liver function
White blood cells
Alkaline phosphate
Icterus
Ascites
Asterixis
Steatorrhea
Rationale
Icterus and steatorrhea are common findings in late chronic
cholecystitis. Ascites, asterixis, and peripheral edema are not
common findings in patients with chronic cholecystitis.
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A patient with cholecystitis has jaundice and icterus.
These signs are typical of which type of
cholecystitis?
Rationale
Patients with chronic cholecystitis are more likely to have
jaundice and icterus caused by obstruction of bile flow,
Peripheral edema
Acute
Chronic
Calculous
Acalculous
causing increased circulating levels of bilirubin. Patients with
acute cholecystitis present with abdominal pain. Acalculous
cholecystitis and calculous cholecystitis are both types of acute
cholecystitis.
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Which finding is expected in a patient who has a
liver function abnormality?
Rationale
Alkaline phosphatase is an enzyme found in the liver, kidneys,
and bones. An increase in serum levels of alkaline phosphatase
indicates a liver function abnormality. An increased level of
WBCs indicates inflammation or infection. When the liver is
not functioning normally, the level of lactate dehydrogenase
and aspartate aminotransferase are increased, not decreased.
Increased white blood cell (WBC) count
Decreased level of lactate dehydrogenase
Decreased level of aspartate aminotransferase
Increase in serum levels of alkaline phosphatase
p. 1179
The nurse is preparing a patient for a magnetic
resonance cholangiopancreatography (MRCP) scan.
Which contrast medium does the nurse tell the
patient will be administered before the procedure?
Rationale
The oral or IV contrast material gadolinium is given before an
MRCP scan. Gadolinium does not contain iodine; therefore it
does not carry the risk for an allergic reaction. Ketorolac,
morphine, and meperidine are not helpful in MRI; these drugs
are analgesics.
p. 1179
Ketorolac
Morphine
Meperidine
Gadolinium
A patient who has cholesterol-based gallstones and
good gallbladder function is interested in
nonsurgical management options for this
condition. Which other factor must be present for
this patient to be a candidate for a nonsurgical
approach?
Rationale
Patients who undergo extracorporeal shock wave lithotripsy
must be of normal weight and have cholesterol-based, smaller
gallstones and good gallbladder function. Iodine is not used in
this procedure. The presence of infection and serum
cholesterol levels are not factors to consider in candidates for
this procedure.
p. 1180
Normal weight
Absence of infection
Low serum cholesterol
Ability to tolerate iodine
A female patient is scheduled for a cholecystectomy
by natural orifice transluminal endoscopic surgery.
Which area is most commonly used for inserting
the endoscope during this procedure?
Rationale
Surgical removal of the gallbladder in women is most often
accomplished via the vagina because it is easily
decontaminated with betadine or other antiseptic, and it
allows easy access into the peritoneal cavity. The surgeon
makes a small internal incision through the cul-de-sac of
Douglas, between the rectum and uterine wall, to access the
gallbladder. The mouth and rectum do not provide easy access
into a woman
‘
s peritoneal cavity. The umbilicus is used for
removing the gallbladder in laparoscopic cholecystectomy.
p. 1181
Mouth
Vagina
Rectum
Umbilicus
A patient reports fever, yellowing of the skin and
eyes, clay-colored stools, and dark urine. The nurse
suspects further testing will reveal which condition?
Rationale
Fever, yellowing of the skin and eyes, clay-colored stools, and
dark urine are symptoms of chronic cholecystitis. These
symptoms occur when repeated episodes of cystic duct
obstruction cause chronic inflammation. Peritonitis is an
infection of the peritoneal cavity in which the patient presents
with a hard, distended abdomen. Patients with malnutrition
are underweight for their height and have low albumin.
Patients with a vitamin deficiency do not display these
symptoms; symptoms are always dependent upon the vitamin
in which the patient is deficient.
p. 1179
Peritonitis
Malnutrition
Vitamin deficiency
Chronic cholecystitis
Which medication would be administered after
extracorporeal shock wave lithotripsy (ESWL) for
treatment of cholelithiasis to dissolve remaining
stone fragments?
Rationale
Ursodeoxycholic acid is administered to dissolve remaining
fragments of stones after ESWL. Ketorolac, morphine, and
bethanechol are not indicated for dissolution of stones.
Test-Taking Tip: Start by reading each of the answer options
carefully. Usually at least one of them will be clearly wrong.
Eliminate this one from consideration. Now you have reduced
the number of response choices by one and improved the
odds. Continue to analyze the options. If you can eliminate
one more choice in a four-option question, you have reduced
Ketorolac
Morphine sulfate
Bethanechol
Ursodeoxycholic acid
the odds to 50/50. While you are eliminating the wrong
choices, recall often occurs. One of the options may serve as a
trigger that causes you to remember what a few seconds ago
had seemed completely forgotten.
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