Author Question: A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. ... (Read 88 times)

madam-professor · **on:** Jun 25, 2018

A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? (Select all that apply.)

a. Contact the provider immediately.
b. Lower the head of the bed.
c. Decrease intravenous fluids.
d. Ask the client to bear down.
e. Administer prescribed opioids.

Question 2

A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this client's teaching? (Select all that apply.)

a. Take a 20-minute walk at least 5 days each week.
b. Attend local Alcoholics Anonymous (AA) meetings weekly.
c. Choose whole grains rather than foods with simple sugars.
d. Use cooking spray when you cook rather than margarine or butter.
e. Stay away from milk and dairy products that contain lactose.
f.
We can talk to your doctor about a prescription for nicotine patches.

yifu223 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: A, B
Clients who are experiencing biliary colic may present with tachycardia, pallor, diaphoresis, prostration, or other signs of shock. The nurse should stay with the client, lower the client's head, and contact the provider or Rapid Response Team for immediate assistance. Treatment for shock usually includes intravenous fluids; therefore, decreasing fluids would be an incorrect intervention. The client's tachycardia is a result of shock, not pain. Performing the vagal maneuver or administering opioids could knock out the client's compensation mechanism.

Answer to Question 2

ANS: B, D, F
The client should be advised to stay sober, and AA is a great resource. The client requires a low-fat diet, and cooking spray is low in fat compared with butter or margarine. If the client smokes, he or she must stop because nicotine can precipitate an exacerbation. A nicotine patch may help the client quit smoking. The client must rest until his or her strength returns. The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones. Dairy products do not cause a problem.