# Situation: A 55-year-old woman has jaundice, itching, dark urine, and pale stools from a common bile duct stone that could not be removed endoscopically. She is scheduled for open cholecystectomy with common bile duct exploration. After surgery a T-tube drains bile into a bag kept below the insertion site. The nurse reviews the record: Postoperative day 1: 420 mL of green-brown bile; no stool yet Postoperative day 2: 360 mL of bile; light brown stool; urine lighter Postoperative day 3 (08:00–14:00): 5 mL of bile; new right upper quadrant pain; temperature 38.0 °C Which conclusion is BEST supported by these data?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630493  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 55-year-old woman has jaundice, itching, dark urine, and pale stools from a common bile duct stone that could not be removed endoscopically. She is scheduled for open cholecystectomy with common bile duct exploration.

After surgery a T-tube drains bile into a bag kept below the insertion site. The nurse reviews the record:
Postoperative day 1: 420 mL of green-brown bile; no stool yet
Postoperative day 2: 360 mL of bile; light brown stool; urine lighter
Postoperative day 3 (08:00–14:00): 5 mL of bile; new right upper quadrant pain; temperature 38.0 °C
Which conclusion is BEST supported by these data?

## 보기

1. The tube is likely blocked or dislodged; report it now **✔ 정답**
2. Bile now flows to the duodenum, so low output is expected
3. The day 1 output was excessive and points to a bile leak
4. The fever reflects atelectasis, so deep breathing is needed

**정답: 1**

## 해설

Output of about 300–500 mL in the first 24 hours is expected and should fall gradually as bile begins to flow into the duodenum, shown by brown stool and lighter urine. An abrupt fall to almost nothing, together with new right upper quadrant pain and fever, suggests the T-tube is obstructed or dislodged. The nurse reports it at once rather than flushing without an order.

## 심화 해설

Reading the drainage trend
After common bile duct exploration, a T-tube keeps the duct open and drains bile while swelling settles. Drainage of about 300–500 mL in the first 24 hours is expected; her 420 mL on day 1 is within that range. Output should then fall gradually as bile begins to flow into the duodenum. Day 2 shows exactly that: 360 mL of bile, light brown stool, and lighter urine, all signs that bile is reaching the intestine. On day 3, however, only 5 mL drained in 6 hours, and she has new right upper quadrant pain and a temperature of 38.0 °C. An abrupt stop in drainage with new pain and fever suggests the T-tube is blocked or dislodged.

Why it must be reported now
If the tube is obstructed or displaced, bile can no longer drain externally, and if the duct is not yet fully patent, bile backs up or leaks into the peritoneum. That can lead to bile peritonitis or cholangitis, both serious complications. The nurse checks the tubing for kinks and clamps, confirms the bag is below the insertion site, inspects the dressing for bile leakage, and reports the findings immediately. The tube is not flushed or irrigated without an order, because forcing fluid can push debris or bile into the tissues.

| Day | Bile output | Other findings | Interpretation |
| --- | --- | --- | --- |
| 1 | 420 mL | No stool | Expected (300–500 mL) |
| 2 | 360 mL | Light brown stool, lighter urine | Expected gradual fall; bile reaching gut |
| 3 (6 hours) | 5 mL | New RUQ pain, 38.0 °C | Abrupt stop: obstruction or dislodgement |

Why the other conclusions are wrong
Low output is expected only when it falls gradually with signs of bile reaching the gut and no new symptoms; an abrupt stop with pain and fever is different. The day 1 volume was not excessive, so it does not suggest a leak. Atelectasis can cause low-grade fever after abdominal surgery, but it does not explain the sudden loss of drainage or new right upper quadrant pain. Watch out! Distractors that explain only one finding are wrong when another option accounts for all the data together.

Exam takeaway
T-tube care includes keeping the bag below the insertion site, recording output every shift, protecting the skin from bile, and watching for sudden changes. Key point! A gradual fall in bile drainage is expected; a sudden stop with pain or fever is reported immediately.

## 임상 시나리오

T-Tube Drainage After Bile Duct SurgeryExpected trend versus warning signs
Expected: about 300–500 mL of bile in the first 24 hours, then a gradual fall as bile flows into the duodenum, shown by brown stool and lighter urine.

Warning: an abrupt fall to 5 mL with new right upper quadrant pain and fever 38.0 °C suggests the tube is obstructed or dislodged.

Check for kinks, keep the bag below the insertion site, inspect the dressing, and report at once.

CautionDo not flush or irrigate a T-tube without an order; bile leakage can cause peritonitis.

## 핵심 개념

- **T-tube** — A T-shaped drain placed in the common bile duct after exploration to keep it open and drain bile.
- **Common bile duct exploration** — Surgical opening of the common bile duct to remove stones that could not be cleared endoscopically.
- **Bile peritonitis** — Inflammation of the peritoneum caused by bile leaking into the abdominal cavity.
- **Cholangitis** — Infection of the bile ducts, typically with fever, right upper quadrant pain, and jaundice.

## 같은 주제 문제

- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630291)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630292)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630293)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630294)
- [Situation: A 58-year-old man with alcohol-associated cirrhosis is admitted with tense asci…](https://mymerci.kr/pages/nclex_q.php?qn_id=630295)
- [Situation: A 46-year-old woman with obesity is admitted with acute cholangitis caused by a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630296)
- [Situation: A 46-year-old woman with obesity is admitted with acute cholangitis caused by a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630297)
- [Situation: A 46-year-old woman with obesity is admitted with acute cholangitis caused by a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630298)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._