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History
Assessment
Interventions
Teaching
Miscellaneous
100
Which client problem has priority for the client dx with acute pancreatitis? A. Risk for fluid volume deficit B. Alteration in comfort C. Imbalanced nutrition: less than body requirements D. Knowledge deficit
What is: B Alteration in comfort Alteration in comfort: Auto digestion of the pancreas results in severe epigastric pain, accompanied by nausea, vomiting, abdominal tenderness and muscle guarding.
100
Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: A. 45 units/L B. 100 units/L C. 300 units/L D. 500 units/L
What is C. The normal serum amylase level is 25 to 151 units/L. With chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Options A and B are within normal limits. Option D is an extremely elevated level seen in acute pancreatitis.
100
For Rico, who has chronic pancreatitis, which nursing intervention would be most helpful? A. Allowing liberalized fluid intake B. Counseling to stop alcohol consumption C. Encouraging daily exercise D. Modifying dietary protein
What is: B Counseling to stop alcohol consumption because of chronic pancreatitis typically results from repeated episodes of acute pancreatitis. More than half of chronic pancreatitis cases are associated with alcoholism. Counseling to stop alcohol consumption would be the most helpful for the client. Dietary protein modification is not necessary for chronic pancreatitis. Daily exercise and liberalizing fluid intake would be helpful, but not the most beneficial intervention.
100
The client dx with acute pancreatitis is being discharged home, which statement by the client indicates the teaching has been effective? A. I should decrease my intake of coffee, tea, and cola. B. I will eat a low fat diet and avoid spicy foods. C. I will check my amylase and lipase levels daily. D. I will return to work tomorrow by take it easy.
What is B. I will eat a low fat diet and avoid spicy foods. High fat and spicy foods stimulate gastric and pancreatic secretions and may precipitate an acute pancreatic attack.
100
The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart? A. NPO status B. Nasgastric tube inserted C. Morphine sulfate for pain D. an anticholinergic medication
What is C. Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Options A, B, and D are appropriate interventions for the client with acute pancreatitis.
200
You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse
What is A. High cholesterol and alcohol abuse
200
The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? A. Palpates the abdomen for size B. Palpates the liver at the right rib margin C. Listens to bowel sounds in all four quadrants D. Percusses the right lower abdominal quadrant
What is C. The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.
200
The client diagnosis with acute pancreatitis is in pain, which position should the nurse assist the client to assume to help decrease the pain? A. Recommend lying in the prone position with legs extended B. Maintain a tripod position over the bedside table C. Place in side lying position with knees flexed D. Encourage a supine position with a pillow under the knees
What is C. Place in a side lying position with knees flexed: This fetal position decreases pain caused by the stretching of the peritoneum as a result of edema
200
1. A patient who received treatment for pancreatitis is being discharged home. You're providing diet teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions? A "It will be hard but I will eat a diet low in fat and avoid greasy foods.” B "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week.” C "I will concentrate on eating complex carbohydrates rather than refined carbohydrates.” D "I will purchase foods that are high in protein.”
What is B "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week.” Rational: The greatest risk factor in pancreatitis is alcohol consumption
200
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. pancreatitis C. Cholecystitis D. Gastric Ulcer
What is B. Pancreatitis. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
300
A major symptom of pancreatitis that brings the patient to medical care is: A. Abdominal Pain B. Fever C. Jaundice D. Mental Agitation
What is A: Abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care and this result from irritation and edema of the inflamed pancreas. B: Fever is one of the symptoms of pancreatitis. C: Jaundice is one of the symptoms of pancreatitis. D: Mental agitation is one of the symptoms of pancreatitis.
300
When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. Increased intracranial pressure B. decreased urine output C. bradycardia D. Hypertension
What is B. Decreased urine output. Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn’t related to acute pancreatitis.
300
While working with an alcoholic client, the most important approach by the nurse would be to (Psychosocial) a. Explicitly outline expectations of the client. b. Establish strict guidelines of behavior. c. Set up a working nurse-client relationship. d. Maintain a nonjudgmental attitude toward the client.
What is d. Maintain a nonjudgmental attitude toward the client. Rational: The most important nursing attitude which underlies all interactions with this client, including a nurse-client relationship, would be to maintain a nonjudgmental approach. If a nurse carries any judgments about alcoholism, it will negate a working relationship with the client.
300
The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client need further information if the client makes which statement? A. I know I must sign the consent form B. I hope the throat spray keeps me from gagging C. I'm glad I don't have to lie still for this procedure D. I'm glad some intravenous medication will be given to me to relax
What is C. The client does have to lie still for ERCP, which takes about 1 hour to perform. The client also has to sign a consent form. IV sedation is given to relax the client and an anesthetic spray is used to help keep the client from gagging as the endoscope is passed.
300
Pancreatitis is commonly characterized by: A. Edema and inflammation B. Pleural effusion C. Sepsis D. Disseminated intravascular coagulopathy
What is A: Pancreatitis is most often characterized by edema and inflammation of the pancreas. B: Pleural effusion occurs in some patient with pancreatitis yet not too often. C: Sepsis is one of the complications of pancreatitis. D: DIC may occur in patients with pancreatitis yet is uncommon.
400
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: A. Serum Calcium B. Serum Lipase C. Serum Bilirubin D. Serum Amylase
What is B: Serum lipase is elevated within 24 hours of the onset of the symptoms and remains elevated for a longer period than serum amylase. A: Serum calcium may be taken to detect hypocalcemia. C: Serum bilirubin may also be taken to detect elevation in bilirubin levels. D: Serum amylase is not as prolonged as serum lipase.
400
What laboratory finding is the primary diagnostic indicator for pancreatitis? A. Elevated BUN B. Elevated Lipase C. Elevated AST D. Increased lactate dehydrogenase
What is B. Elevated Lipase. Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas. A client’s BUN is typically elevated in relation to renal dysfunction; the AST, in relation to liver dysfunction; and LD, in relation to damaged cardiac muscle.
400
A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: A. Meperidine provides a better, more prolonged analgesic effect B. morphine may cause spasms of Oddi's sphincter C. meperidine is less addictive than morphine D. morphine may cause hepatic dysfunction
What is B. Morphine may cause spasms of Oddi's sphincter. For a client with pancreatitis, the physician will probably avoid prescribing morphine because this drug may trigger spasms of the sphincter of Oddi (a sphincter at the end of the pancreatic duct), causing irritation of the pancreas. Meperidine has a somewhat shorter duration of action than morphine. The two drugs are equally addictive. Morphine isn’t associated with hepatic dysfunction.
400
Nursing measures for pain relief for pancreatitis include: (SELECT ALL THAT APPLY) A. Encourage bed rest to decrease metabolic rate. B. Teaching the patient about correlation between alcohol intake and pain. C. Withholding Oral feedings to limit the release of secretin.
What is A, B, & C. All of the interventions mentioned are appropriate for a patient with pancreatitis. A: The patient is maintained on bed rest to decrease metabolic rate and reduce the secretion of pancreatic and gastric enzymes. B: Alcohol is one of the causes of pain in pancreatitis. C: Oral feedings are withheld to decrease secretion of secretin.
400
The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? A. Maintain NPO status B. Encourage coughing and deep breathing C. Give small, frequent high- calorie feedings D. Maintain the client in a supine and flat position. E. Give hydromorphone IV as prescribed for pain F. Maintain IV fluids at 10 mL/hr to keep vein open
What is A, B, & E. The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is necessary. Because of abdominal pain is prominent symptom of pancreatitis, pain medication are prescribed. Some clients experience lessened pain by assuming positions that flex the trunk with the knees drawn up to the chest. A side lying position with the head of bed elevated 45 degrees decreases tension on the abdomen and may help to ease the pain. The client is susceptible to respiratory infections because of the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow guarded abdominal breaths. Therefore, coughing and deep breathing are instituted.
500
A nurse is assessing a client who has a potential diagnosis of pancreatitis. Which risk factors predispose the client to pancreatitis? Select all that apply. a) Gallstones. b) Hyperlipidemia with excessive triglycerides. c) Hypertension. d) Hypothyroidism. e) Abdominal trauma. f) Excessive alcohol use.
What is: A- Gallstones. B- Hyperlipidemia with excessive triglycerides. E- Abdominal trauma. F- Excessive alcohol use. Explanation: Pancreatitis, a chronic or acute inflammation of the pancreas, is a potentially life-threatening condition. Excessive alcohol intake and gallstones are the greatest risk factors. Abdominal trauma can potentiate inflammation. Hyperlipidemia is a risk factor for recurrent pancreatitis. Hypertension and hypothyroidism are not associated with pancreatitis.
500
A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? A. Diarrhea B. Black, tarry stools C. Hyperactive bowel sounds D. Gray-blue color at the flank E. Abdominal pain guarding and tenderness F. Left upper quadrant pain with radiation to the back
What is D, E, & F. Grayish-blue discoloration at the flank is known as Grey-Turners sign and occurs as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The client may demonstrate abdominal guarding and may complain of tenderness with palpation. The pain associated with acute pancreatitis is often sudden in onset and is located in the epigrastic region or left upper quadrant with radiation to the back.
500
The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions should the nurse expect to note? Select all that apply A. Administer Lasix B. Administer antacids, as prescribed. C. Encourage coughing and deep breathing D. Tell the patient to refrain from coughing E. Administer anticholinergics, as prescribed
What is: Answer B. Administer antacids, as prescribed. C. Encourage coughing and deep breathing E. Administer anticholinergics, as prescribed
500
Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? A. Administration of vasopressin and insertion of a balloon tamponade. B. Preparation for a paracentesis and administration of diuretics C. Maintenance of NPO status and insertion of NG tube with low intermittent suction. D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 mL/day.
What is C. Maintenance of NPO status and insertion of NG tube with low intermittent suction. With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit pancreatic stimulation and secretion of pancreatic enzymes. NG intubation with low intermittent suction is used to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid. Vasopressin would be appropriate for a client diagnosed with bleeding esophageal varices. Paracentesis and diuretics would be appropriate for a client diagnosed with portal hypertension and ascites. A low-fat diet and increased fluid intake would further aggravate the pancreatitis.
500
A client arrives at the emergency department complaining of severe abdominal pain and is placed on NPO status. During a quick assessment, the nurse observes that the client has both Cullen's sign and Grey Turner's sign and pancreatitis is suspected. The nurse should perform the following actions/prescriptions in which priority order? Arrange the actions in the order they should be performed. All options must be used. A. Obtain vital signs and draw blood for laboratory analysis. B. Inquire about when pain occurs and the previous history C. Ensure the client receives intravenous pain medication. D. Hydrate the client with intravenous fluids. E. Place a nasogastric tube. The client is NPO (nothing by mouth).
What is: A. Obtain vital signs and draw blood for laboratory analysis. C. Ensure the client receives intravenous pain medication. D. Hydrate the client with intravenous fluids. E. Place a nasogastric tube. The client is NPO (nothing by mouth). B. Inquire about when pain occurs and the previous history including medications and alcohol.