Acute Pancreatitis
A patient with acute pancreatitis is admitted with severe abdominal pain. The provider places the patient NPO. What is the primary rationale for this intervention?
Reduce pancreatic stimulation and enzyme release
A patient with chronic pancreatitis reports frequent greasy, foul-smelling stools despite eating regularly. What is the primary cause of this symptom?
Fat malabsorption due to lack of pancreatic enzymes
A patient with cirrhosis develops progressive abdominal distention. The provider diagnoses ascites. What is the underlying cause of this fluid accumulation?
Portal hypertension + decreased albumin → fluid shifts into abdomen
A patient with cirrhosis becomes increasingly confused and lethargic. The nurse notes the patient has not had a bowel movement in 2 days and is scheduled to receive lactulose. What is the MOST important nursing action?
A patient with cirrhosis becomes increasingly confused and lethargic. The nurse notes the patient has not had a bowel movement in 2 days and is scheduled to receive lactulose. What is the MOST important nursing action?
A patient with acute pancreatitis is receiving aggressive IV fluids. The nurse notes:
What is the priority nursing action?
Slow fluids and assess for fluid overload
A patient with acute pancreatitis has:
What is the priority intervention?
Aggressive IV fluid resuscitation
A patient is prescribed pancrelipase. The nurse is reviewing administration instructions. Which statement by the patient indicates correct understanding?
“I will take this medication with every meal and snack.”
A patient with cirrhosis is prescribed spironolactone and furosemide together. What is the rationale for using both medications?
Balance potassium levels while promoting fluid removal
A patient receiving lactulose has had 5 large, watery stools in 6 hours and is now weak and dizzy. What is the priority nursing action?
Assess for dehydration and electrolyte imbalance, then notify provider
A patient with cirrhosis and ascites is on spironolactone + furosemide. Labs show:
What is the MOST likely cause of the confusion?
Hyponatremia from diuretic therapy
A patient with pancreatitis develops:
What electrolyte imbalance is occurring and what is the priority action?
Hypocalcemia → administer calcium as ordered
A patient with chronic pancreatitis continues to have weight loss despite taking pancrelipase as prescribed. What is the priority nursing action?
Assess adherence and timing of medication with meals
A patient with cirrhosis undergoes a paracentesis with removal of 4 liters of fluid. What is the priority nursing intervention after the procedure?
Administer albumin as ordered and monitor BP
A patient with hepatic encephalopathy is receiving lactulose and rifaximin. Despite treatment, the patient becomes more confused. Labs show ammonia decreasing. What is the MOST likely explanation?
Another cause of altered mental status (not ammonia-related)
A patient with chronic pancreatitis is admitted with:
The provider focuses treatment on insulin rather than pancreatic enzymes. What is the rationale?
Endocrine failure (insulin deficiency) is now dominant problem
A patient with pancreatitis is not improving and is unable to tolerate oral intake after several days. What is the preferred nutritional support?
Enteral feeding (NG or NJ tube)
A patient with chronic pancreatitis has a history of alcohol use and continues to drink occasionally. What is the priority nursing intervention?
Educate on complete alcohol cessation
A patient with cirrhosis develops:
What is the priority concern and nursing action?
Esophageal variceal bleeding → initiate emergency management (IV access, fluids, notify provider)
A patient with ascites is on spironolactone and furosemide. The nurse notes:
What is the priority nursing action?
Hold spironolactone and notify provider
A patient with cirrhosis develops:
What is the priority concern and nursing action?
Spontaneous bacterial peritonitis (SBP) → notify provider immediately
A patient with acute pancreatitis suddenly develops:
What is the priority concern and nursing action?
Suspected pancreatic necrosis/infection → notify provider immediately
A patient with chronic pancreatitis develops:
What is the underlying complication and priority management focus?
Pancreatic endocrine failure → diabetes mellitus
A patient with cirrhosis develops worsening ascites despite diuretics. The provider is considering a TIPS procedure. What is the major risk associated with this intervention that the nurse must monitor for?
Hepatic encephalopathy
A patient with cirrhosis and ascites undergoes paracentesis with removal of 6 liters of fluid. One hour later, the patient develops:
Albumin has not yet been given. What is the priority nursing action?
Administer albumin immediately as ordered
A patient with cirrhosis, ascites, and hepatic encephalopathy is being treated with:
The nurse notes:
What is the MOST likely cause of deterioration AND priority action?
Over-treatment with lactulose + diuretics → dehydration + hypokalemia
→ HOLD lactulose/diuretics and correct electrolytes