KDY

NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation
11. A NP assesses a patient who has cholecystitis. Which clinical manifestation indicates
that the condition is chronic rather than acute?
a. Temperature of 100.1 F (37.8 C)
b. Positive Murphys sign
c. Light-colored stools
d. Upper abdominal pain after eating
ANSWER: C
Jaundice, clay-colored stools,&dark urine are more commonly seen with chronic
cholecystitis. The other symptoms are seen equally with both chronic&acute cholecystitis.
DIF: Understanding/Comprehension REF: 1193

KEY: Cholecystitis| assessment/diagnostic
examination MSC: Integrated Process:
Nursing Process: Assessment
NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation
12. A NP cares for a patient who is prescribed patient-controlled analgesia (PCA) after a
cholecystectomy. The patient states, When I wake up I am in pain. Which action
should the NP take?
a. Administer intravenous morphine while the patient sleeps.
b. Encourage the patient to use the PCA pump upon awakening.
c. Contact the provider&request a different analgesic.
d. Ask a family member to initiate the PCA pump for the patient.
ANSWER: B
The NP should encourage the patient to use the PCA pump prior to napping&upon
awakening. Administering additional intravenous morphine while the patient sleeps places
the patient at risk for respiratory depression. The NP should also evaluate dosages received
compared with dosages requested&contact the provider if the dose or frequency is not
adequate. Only the patient should push the pain button on a PCA pump.
DIF: Applying/Application REF:

1196 KEY: Cholecystitis| pain|
postoperative care
MSC: Integrated Process: Nursing Process: Implementation
NOT: Patient Needs Category: Physiological Integrity: Pharmacological&Parenteral
Therapies
13. A NP cares for a patient with acute pancreatitis. The patient states, I am hungry.
How should the NP reply?
a. Is your stomach rumbling or do you have bowel sounds?
b. I need to check your gag reflex before you can eat.
c. Have you passed any flatus or moved your bowels?
d. You will not be able to eat until the pain subsides.
ANSWER: C
Paralytic ileus is a common complication of acute pancreatitis. The patient should not eat
until this has resolved. Bowel sounds&decreased pain are not reliable indicators of
peristalsis. Instead, the NP should assess for passage of flatus or bowel movement.
DIF: Applying/Application REF: 1197
KEY: Pancreatitis| NPO| assessment/diagnostic
examination MSC: Integrated Process: Nursing
Process: Assessment
NOT: Patient Needs Category: Physiological Integrity: Reduction of Risk Potential
14. A NP prepares to discharge a patient with chronic pancreatitis. Which question

should the NP ask to ensure safety upon discharge?
a. Do you have a one- or two-story home?
b. Can you check your own pulse rate?
c. Do you have any alcohol in your home?
d. Can you prepare your own meals?
ANSWER: A
A patient recovering from chronic pancreatitis should be limited to one floor until
strength&activity increase. The patient will need a bathroom on the same floor for
frequent defecation. Assessing pulse rate&preparation of meals is not specific to chronic
pancreatitis. Although the patient should be encouraged to stop drinking alcoholic
beverages, asking about alcohol availability is not adequate to assess this victim safety.

1201 KEY: Pancreatitis| patient
education
MSC: Integrated Process: Nursing Process: Assessment
NOT: Patient Needs Category: Safe&Effective Care Environment: Management of Care
15. A NP assesses victim on the medical-surgical unit. Which patient should the NP
identify as at high risk for pancreatic cancer?
a. A 26-year-old with a body mass index of 21
b. A 33-year-old who frequently eats sushi
c. A 48-year-old who often drinks wine
d. A 66-year-old who smokes cigarettes
ANSWER: D
Risk factors for pancreatic cancer include obesity, older age, high intake of red
meat,&cigarette smoking. Sushi&wine intake are not risk factors for pancreatic cancer.

1205 KEY: Pancreatic cancer|
health screening
16. A NP assesses a patient who is recovering from a Whipple procedure. Which

assessment finding alerts the NP to urgently contact the health care provider?
a. Drainage from a fistula
b. Absent bowel sounds
c. Pain at the incision site
d. Nasogastric (NG) tube drainage
ANSWER: A
Complications of a Whipple procedure include secretions that drain from a
fistula&peritonitis. Absent bowel sounds, pain at the incision site,&NG tube drainage are
normal postoperative findings.
DIF: Applying/Application REF: 1207

KEY: Whipple procedure| postoperative nursing
17. A NP cares for a patient who is recovering from an open Whipple procedure. Which
action should the NP take?
a. Clamp the nasogastric tube.
b. Place the patient in semi-Fowlers position.
c. Assess vital signs once every shift.

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NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation

DIF: Understanding/Comprehension REF: 1193

DIF: Applying/Application REF:

14. A NP prepares to discharge a patient with chronic pancreatitis. Which question

DIF: Applying/Application REF:

DIF: Applying/Application REF:

16. A NP assesses a patient who is recovering from a Whipple procedure. Which

DIF: Applying/Application REF: 1207

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