The nurse is caring for a client who had a laparoscopic cholecystectomy 3 days ago

This is a quiz that contains NCLEX review questions for cholecystitis. As a nurse providing care to a patient with cholecystits, it is important to know the classic signs and symptoms of this conditions, diagnostic tests, and nursing care.

In the previous NCLEX review series, I explained about other GI disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.

Don’t forget to watch the lecture on cholecystitis before you take the quiz.

Cholecystitis NCLEX Questions

This quiz will test your nursing knowledge on cholecystitis in preparation for the NCLEX exam.

• 1. The gallbladder is found on the __________ side of the body and is located under the ____________. It stores __________.*
  • A. right; pancreas; bilirubin
  • B. left; liver; bile
  • C. right; thymus' bilirubin
  • D. right; liver; bile

• 2. Which statements below are CORRECT regarding the role of bile? Select all that apply:*
  • A. Bile is created and stored in the gallbladder.
  • B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K.
  • C. Bile is released from the gallbladder into the duodenum.
  • D. Bile contains bilirubin.

• 3. You’re providing a community in-service about gastrointestinal disorders. During your teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for cholelithiasis that you will include in your teaching to the participants? Select all that apply:*
  • A. Being male
  • B. Underweight
  • C. Being female
  • D. Older age
  • E. Native American
  • F. Caucasian
  • G. Pregnant
  • H. Family History
  • I. Obesity

• 4. A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you that the patient has a positive Murphy’s Sign. You know that this means:*
  • A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line.
  • B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line.
  • C. The patient verbalizes pain when the lower right quadrant is palpated.
  • D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase in pain intensity when the pressure is released.

• 5. Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-Tube. Which finding during your assessment of the T-Tube requires immediate nursing intervention?*
  • A. The drainage from the T-Tube is yellowish/green in color.
  • B. There is approximately 750 cc of drainage within the past 24 hours.
  • C. The drainage bag and tubing is at the patient's waist.
  • D. The patient is in the Semi-Fowler's position.

• 6. The physician orders a patient’s T-Tube to be clamped 1 hour before and 1 hour after meals. You clamp the T-Tube as prescribed. While the tube is clamped which finding requires you to notify the physician?*
  • A. The T-Tube is not draining.
  • B. The T-Tube tubing is below the patient’s waist.
  • C. The patient reports nausea and abdominal pain.
  • D. The patient’s stool is brown and formed.

• 7. Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply:*
  • A. Right lower quadrant pain with rebound tenderness
  • B. Negative Murphy’s Sign
  • C. Epigastric pain that radiates to the right scapula
  • D. Pain and fullness that increases after a greasy or spicy meal
  • E. Fever
  • F. Tachycardia
  • G. Nausea

• 8. A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you anticipate the physician will order to help diagnose cholecystitis? Select all that apply:*
  • A. Lower GI series
  • B. Abdominal ultrasound
  • C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan)
  • D. Colonoscopy

• 9. You’re precepting a nursing student who is helping you provide T-Tube drain care. You explain to the nursing student that the t-shaped part of the drain is located in what part of the biliary tract?*
  • A. Cystic duct
  • B. Common hepatic duct
  • C. Common bile duct
  • D. Pancreatic duct

• 10. Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube) is TRUE?*
  • A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the gallbladder.
  • B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to ensure patency.
  • C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder.
  • D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the tube is draining properly.

• 11. A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient?*
  • A. Baked chicken with steamed carrots and rice
  • B. Broccoli and cheese casserole with gravy and mashed potatoes
  • C. Cheeseburger with fries
  • D. Fried chicken with a baked potato

• 12. Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the appropriate nursing interventions for the patient:*
  • A. Encourage the patient to consume clear liquids.
  • B. Administered IV fluids per MD order.
  • C. Provide mouth care routinely.
  • D. Keep the patient NPO.
  • E. Administer analgesic as ordered.
  • F. Maintain low intermittent suction to NG tube.

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Cholecystits NCLEX Questions

1. The gallbladder is found on the __________ side of the body and is located under the ____________. It stores __________.

A. right; pancreas; bilirubin

B. left; liver; bile

C. right; thymus’ bilirubin

D. right; liver; bile

The answer is D. The gallbladder is found in the RIGHT side of the body and is located under the LIVER. It stores BILE.

2. Which statements below are CORRECT regarding the role of bile? Select all that apply:

A. Bile is created and stored in the gallbladder.

B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K.

C. Bile is released from the gallbladder into the duodenum.

D. Bile contains bilirubin.

The answer are B, C, and D. Option A is INCORRECT because bile is created in the LIVER (not gallbladder), but bile is stored in the gallbladder.

3. You’re providing a community in-service about gastrointestinal disorders. During your teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for cholelithiasis that you will include in your teaching to the participants? Select all that apply:

A. Being male

B. Underweight

C. Being female

D. Older age

E. Native American

F. Caucasian

G. Pregnant

H. Family History

I. Obesity

The answers are C, D, E, G, H and I. Cholelithiasis is the formation of gallstones. Risk factors include: being female, older age (over 40), Native American or Mexican American descent, pregnant, obesity, and family history.

4. A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you that the patient has a positive Murphy’s Sign. You know that this means:

A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line.

B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line.

C. The patient verbalizes pain when the lower right quadrant is palpated.

D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase in pain intensity when the pressure is released.

The answer is A. Murphy’s Sign can occur with cholecystitis. This occurs when the patient is placed in the supine position and the examiner palpates under the ribs on the right upper side of the abdomen. The examiner will have the patient breathe out and then take a deep breath in. The examiner will simultaneously (while the patient is breathing in) palpate on this area under the ribs at the midclavicular line (hence the location of the gallbladder). It is a POSITIVE Murphy’s Sign when the patient stops breathing in during palpation due to pain.

5. Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-Tube. Which finding during your assessment of the T-Tube requires immediate nursing intervention?

A. The drainage from the T-Tube is yellowish/green in color.

B. There is approximately 750 cc of drainage within the past 24 hours.

C. The drainage bag and tubing is at the patient’s waist.

D. The patient is in the Semi-Fowler’s position.

The answer is B. A T-Tube should not drain more than about 500 cc of drainage per day (within 24 hours). A T-Tube’s drainage will go from bloody tinged (fresh post-op) to yellowish/green within 2-3 days. The drainage bag and tubing should be below the site of insertion (at or below the patient’s waist so gravity can help drainage the bile), and the patient should be in Semi-Fowler’s to Fowler’s position to help with draining the bile.

6. The physician orders a patient’s T-Tube to be clamped 1 hour before and 1 hour after meals. You clamp the T-Tube as prescribed. While the tube is clamped which finding requires you to notify the physician?

A. The T-Tube is not draining.

B. The T-Tube tubing is below the patient’s waist.

C. The patient reports nausea and abdominal pain.

D. The patient’s stool is brown and formed.

The answer is C. A nurse should ONLY clamp a T-Tube with a physician’s order. Most physicians will prescribe to clamp the T-tube 1 hour before and 1 hour after meals. WHY? So, bile will flow down into the small intestine (instead out of the body) during times when food is in the small intestine to help with the digestion of fats. This is to help the small intestine adjust to flow of bile (remember normally it received bile when the gallbladder contracted but now it will flow from the liver to the small intestine continuously). Option C is an abnormal finding. The patient should not report nausea or abdominal pain when the tube is blocked. This could indicate a serious problem. Option A is correct because the T-tube should not be draining because it’s clamped. Option B is correct because the T-tube tubing should be below or at the patient’s waist level. Option D is correct because this shows the body is digesting fats and bilirubin is exiting the body through the stool (remember bilirubin is found in the bile and gives stool its brown color…it would be light colored if the bilirubin was not present). You would NOT want to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn’t being delivered to help digest the fats.

7. Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply:

A. Right lower quadrant pain with rebound tenderness

B. Negative Murphy’s Sign

C. Epigastric pain that radiates to the right scapula

D. Pain and fullness that increases after a greasy or spicy meal

E. Fever

F. Tachycardia

G. Nausea

The answers are C, D, E, F, and G. Option A and B are not associated with cholecystitis, but a POSITIVE Murphy’s Sign is.

8. A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you anticipate the physician will order to help diagnose cholecystitis? Select all that apply:

A. Lower GI series

B.  Abdominal ultrasound

C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan)

D. Colonoscopy

The answers are B and C. These two tests can assess for cholecystitis. A lower GI series would not assess the gallbladder but the lower portions of the GI system like the rectum and large intestine. Option D is wrong because it would also assess the lower portions of the GI system.

9. You’re precepting a nursing student who is helping you provide T-Tube drain care. You explain to the nursing student that the t-shaped part of the drain is located in what part of the biliary tract?

A. Cystic duct

B. Common hepatic duct

C. Common bile duct

D. Pancreatic duct

The answer is C. The “T-shaped” part of the drain is located in the common bile duct and helps deliver bile to the duodenum (small intestine).

10. Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube) is TRUE?

A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the gallbladder.

B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to ensure patency.

C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder.

D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the tube is draining properly.

The answer is C. This is the only correct statement about a cholecystostomy. A cholecystostomy, also sometimes called a C-Tube, is placed when a patient can’t immediately have the gallbladder removed (cholecystectomy) due to cholecystitis. It is placed through the abdominal wall and into the gallbladder. It will drain infected bile (NOT gallstones). The tubing and drainage bag should be at or below waist level so it drains properly.

11. A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient?

A. Baked chicken with steamed carrots and rice

B. Broccoli and cheese casserole with gravy and mashed potatoes

C. Cheeseburger with fries

D. Fried chicken with a baked potato

The answer is A. The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods. Option B is wrong because this contains dairy/animal fat like the cheese and gravy, and broccoli is known to cause gas. Option C and D are greasy food options.

12. Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade.  Select all the appropriate nursing interventions for the patient:

A. Encourage the patient to consume clear liquids.

B. Administered IV fluids per MD order.

C. Provide mouth care routinely.

D. Keep the patient NPO.

E. Administer analgesic as ordered.

F. Maintain low intermittent suction to NG tube.

The answers are B, C, D, E, and F. The treatment for cholecystitis includes managing pain, managing nausea/vomiting (a NG tube with GI decompression (removal of stomach contents) to low intermittent suction may be ordered to help severe cases), keep patient NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube, and administer IV fluids to keep the patient hydrated.

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