Pancreatitis

The nurse is caring for a client with severe pancreatitis and ascites. For which assessment finding should the nurse immediately notify the healthcare​ provider? A.Change in mental status B.Urine output of 500 mL in 4 hours C.Heart rate of 104​ beats/min D.Unable to tolerate lying flat

A.Change in mental status ​Rationale: The client with severe pancreatitis can experience a fluid shift and develop ascites and put the client at risk for hypovolemic shock. The nurse should perform frequent assessments and monitor for neurologic​ changes, as well as hypotension with tachycardia and decreased urine output. A heart rate of 104​ beats/min may be due to pain. A urine output of 500 mL in 4 hours is​ adequate, not decreased. The client may not be able to lie flat due to abdominal pain and inability to expand thoracic cavity adequately due to ascites.

A client is newly diagnosed with acute pancreatitis. Which medication should the nurse administer to assist in controlling the​ client's pain? A.Hydromorphone B.Acetaminophen C.Ketorolac tromethamine D.Tramadol hydrochloride

A.Hydromorphone ​Rationale: An opioid analgesic like hydromorphone should be used to control pain in acute pancreatitis.​ Acetaminophen, tramadol​ hydrochloride, and ketorolac tromethamine are not the recommended medications for controlling pain in acute pancreatitis.

The nurse prepares medication teaching for a client with chronic pancreatitis. Which information should the nurse include about the intended action of​ pancrelipase? A.It enhances digestion of​ starches, proteins, and fats. B.It suppresses pancreatic enzyme secretion and helps to relieve pain. C.It is the primary analgesic to manage pain. D.It neutralizes pancreatic secretions.

A.It enhances digestion of​ starches, proteins, and fats. ​Rationale: Pancrelipase is used in the treatment of pancreatitis to enhance digestion of​ starches, proteins, and fats. Octreotide suppresses the secretion of pancreatic​ enzymes, which will also help to relieve pain in the chronic form of the disorder. The medication does not neutralize pancreatic enzymes. Morphine sulfate or hydromorphone is commonly used as the primary analgesic to control the severe pain in pancreatitis.

The nurse is caring for a child with abdominal trauma. For which symptom of acute pancreatitis should the nurse instruct the parents to monitor the​ child? (Select all that​ apply.) A.Jaundice B.Bloating C.Vomiting D.Back pain E.Fever

A.Jaundice B.Bloating C.Vomiting E.Fever ​Rationale: The parents should be instructed to monitor the child for symptoms of acute​ pancreatitis, which include​ fever, vomiting,​ jaundice, and bloating. Back pain is one of the clinical findings for an obstetric client with acute pancreatitis.

The nurse is caring for a client experiencing manifestations of acute pancreatitis. Which diagnostic test should the nurse expect to be prescribed to confirm this​ diagnosis? (Select all that​ apply.) A.Magnetic resonance cholangiopancreatography​ (MRCP) B.​Contrast-enhanced CT scan C.Biopsy D.Ultrasound E.Abdominal​ x-ray

A.Magnetic resonance cholangiopancreatography​ (MRCP) B.​Contrast-enhanced CT scan D.Ultrasound ​Rationale: Diagnostic tests used to diagnose acute pancreatitis include​ ultrasound, contrast-enhanced CT​ scan, and magnetic resonance cholangiopancreatography​ (MRCP). Abdominal​ x-ray is not used to diagnose acute pancreatitis.

The nurse is assessing a client suspected of having pancreatitis. Which finding should the nurse expect when assessing this​ client? (Select all that​ apply.) A.Nausea B.Abdominal pain C.Weight loss D.History of gallstones E.Weight gain

A.Nausea B.Abdominal pain C.Weight loss D.History of gallstones ​Rationale: Assessment findings of pancreatitis include​ nausea, weight​ loss, history of​ gallstones, and abdominal pain. Weight gain is not associated with pancreatitis.

A client with suspected acute pancreatitis experienced severe abdominal pain and vomiting before seeking medical attention. Which laboratory assessment finding should the nurse​ anticipate? A.Serum amylase of 400​ units/dL B.WBC of 9000 mcL C.Serum alkaline phosphatase​ (ALP) of 135​ units/L D.Serum lipase levels of 175​ units/L

A.Serum amylase of 400​ units/dL ​Rationale: The normal levels of serum amylase are 60-160 Somogyi​ units/dL. The levels rise within 2-12 hours of onset of acute pancreatitis to two to three times normal. The serum​ amylase, lipase, and alkaline phosphatase levels will also be elevated in acute pancreatitis. The other results listed are within normal range.

A client is being treated for acute pancreatitis. For which reason should the nurse counsel this client to avoid​ alcohol? A.Alcohol is quickly absorbed into the​ bloodstream, causing toxicity of the pancreatic cells and resulting in decreased production of pancreatic enzymes. B.Alcohol causes edema in the​ duodenum, which raises the pressure within the pancreas and obstructs the outflow of pancreatic enzymes. C.Alcohol in the bloodstream softens and destroys the elastin of the blood​ vessels, allowing for fluid shift into the peritoneal space. D.Alcohol interacts with​ trypsin, causing rapid digestion of pancreatic tissue and resulting in pancreatic necrosis.

B.Alcohol causes edema in the​ duodenum, which raises the pressure within the pancreas and obstructs the outflow of pancreatic enzymes. Rationale: Alcohol causes swelling to occur in the​ duodenum, which results in an increase in pressure in the duodenum and entrance of the common bile duct and pancreatic duct. This increase in pressure reduces the outflow of pancreatic enzymes into the small intestine. Alcohol consumption may result in liver toxicity after prolonged use but does not decrease pancreatic enzyme production. Alcohol is not responsible for activating trypsin and does not cause pancreatic necrosis. Phospholipase​ A, which is activated by​ trypsin, not​ alcohol, is responsible for the destruction of elastin in the walls of the blood vessels.

The nurse is teaching a client about complications associated with chronic pancreatitis. Which potential complication should the nurse include in this​ teaching? (Select all that​ apply.) A.Hepatitis B.Opioid addiction C.Diabetes mellitus D.Peptic ulcer disease E.Malnutrition

B.Opioid addiction C.Diabetes mellitus D.Peptic ulcer disease E.Malnutrition Rationale: As opioids are prescribed for the​ pain, a client with chronic pancreatitis may develop opioid addiction. Other complications to include when teaching the client include​ malnutrition, peptic ulcer​ disease, and diabetes mellitus. Hepatitis is not a potential complication often associated with chronic pancreatitis.

The nurse is caring for a client with​ late-stage chronic pancreatitis. Which client symptom should the nurse expect to​ assess? A.Severe nausea B.Steatorrhea C.Severe vomiting D.Severe epigastric pain

B.Steatorrhea Rationale: Steatorrhea​ (fatty stools) is a symptom that occurs late in the disease process of chronic pancreatitis. Severe epigastric​ pain, severe​ nausea, and severe vomiting are associated more closely with acute pancreatitis than with chronic pancreatitis.

A client with acute pancreatitis has an elevated amylase level. What should the nurse instruct the client about this laboratory​ value? A.Amylase helps break down the fat in your diet. B.Amylase helps break down dietary protein. C.Amylase helps break down the starch in your diet. D.Amylase helps use glucose for energy.

C.Amylase helps break down the starch in your diet. ​Rationale: Amylase breaks down starch. Amylase does not facilitate the use of glucose for energy. Proteolytic enzymes break down dietary proteins. Lipase breaks down fats into glycerol and fatty acids.

The nurse has administered an antiemetic to a client with nausea and vomiting caused by acute pancreatitis. Which additional nursing intervention should the nurse use to help this​ client's nutritional​ status? A.Offer frequent oral hygiene. B.Assess hourly urine output. C.Note the characteristics of stools. D.Maintain nasogastric tube patency.

C.Note the characteristics of stools. ​Rationale: Noting the​ frequency, color,​ odor, and consistency of stools will assist in monitoring output and for steatorrhea. Steatorrhea causes​ fatty, frothy,​ foul-smelling stools due to a decrease in pancreatic enzyme secretion that occurs in the client with chronic pancreatitis. Assessment of hourly urine output assists the nurse in the evaluation of renal function and fluid and electrolyte balance. Offering frequent oral hygiene and maintaining nasogastric tube patency are comfort interventions.

The nurse is caring for a pregnant client who reports epigastric​ pain, back​ pain, anorexia, and their sclera appear jaundiced. The nurse should expect to prepare the client for which diagnostic​ test? A.​Contrast-enhanced computerized tomography​ (CT) scan B.Endoscopic retrograde cholangiopancreatography​ (ERCP) C.Sonography D.Endoscopic ultrasonography

C.Sonography ​Rationale: Sonography is the imaging method of choice in pregnant clients because it is safe for the fetus and has a high sensitivity to gallstones. A CT​ scan, endoscopic​ ultrasonography, and ERCP would not be performed due to the risk to the fetus.

The nurse is obtaining a history on a child to rule out the possibility of acute pancreatitis. Which question should the nurse ask the parent that is specifically associated with acute​ pancreatitis? A.​"Has your child lost​ weight?" B.​"When did your​ child's pain​ begin?" C.​"Does your child take any​ medications?" D.​"Has your child been excessively​ sleepy?"

C.​"Does your child take any​ medications?" ​Rationale: Nearly a quarter of cases of pancreatitis in children are the result of abdominal​ trauma; pancreatic​ anomalies, multisystem​ disease, medications,​ infections, and hereditary disorders are other potential causes of pancreatitis in children. Anorexia is a symptom of acute pancreatitis in pregnancy. Assessing the time that the​ child's pain began is a general question that is specific to the​ pain, not the disease process. Excessive sleepiness is not associated with acute pancreatitis.

The nurse is planning care for a client with acute pancreatitis. Which problem should the nurse make a priority for this​ client? A.Activity intolerance B.Constipation C.Fluid volume excess D.Acute pain

D.Acute pain ​Rationale: Acute pain is the priority problem for the nurse to address because decreasing pain will assist in decreasing pancreatic enzyme secretion. Fluid volume​ excess, constipation, and activity intolerance are not priority problems for the nurse to address when caring for a client with acute pancreatitis.

The nurse is planning teaching for an older adult on the prevention of pancreatitis. Which primary risk factor should the nurse plan to​ discuss? A.Obesity B.Sedentary life style C.Hormonal changes D.Age of the older adult

D.Age of the older adult ​Rationale: The primary risk factor is the age of the older adult. The incidence of pancreatitis increases with​ age, with a​ 200-fold increase occurring after age 65. Hormonal changes in pregnancy increase the risk of acute​ pancreatitis, and hormonal replacement therapy may cause acute pancreatitis. A sedentary lifestyle alone does not contribute to pancreatitis. Obesity and a​ high-fat diet are risk factors for​ gallstones, which are associated with pancreatitis. A diet high in fat is also a contributing factor to pancreatitis.

The nurse prepares health promotion teaching material for an adult client recovering from acute pancreatitis. Which lifestyle modification should the nurse recommend to reduce the risk of chronic​ pancreatitis? A.Avoid spicy foods. B.Decrease caffeine intake. C.Decrease alcohol intake. D.Avoid fatty foods.

D.Avoid fatty foods. Rationale: The nurse should recommend the avoidance of fatty foods. A​ low-fat diet decreases the risk factors for hypertriglyceridemia and​ gallstones, both of which contribute to acute and chronic pancreatitis. The symptoms of chronic pancreatitis are exacerbated with the ingestion of spicy foods and caffeine. The client will be instructed to avoid alcohol because it is a contributing factor to both acute and chronic pancreatitis.

An older client with chronic pancreatitis experiences​ "greasy" stools,​ nausea, vomiting, weight loss and frequent constipation. Which diagnostic test should the nurse anticipate being prescribed to determine the presence of complications related to chronic​ pancreatitis? A.Serum amylase levels B.Serum calcium levels C.Renal function levels D.Blood glucose levels

D.Blood glucose levels ​Rationale: Blood glucose levels are indicated for the client because diabetes mellitus may develop as a complication of chronic pancreatitis. Renal function studies would be appropriate for a client with​ acute, not​ chronic, pancreatitis because acute renal failure may develop within 24 hours after the onset of acute pancreatitis. Serum calcium levels would be decreased in clients with​ acute, not​ chronic, pancreatitis. Serum amylase levels would be increased within 2 to 12 hours after the onset of​ acute, not​ chronic, pancreatitis.

When providing care for a client with​ pancreatitis, which nursing intervention would be implemented to promote​ nutrition? A.Instructing to eat​ gas-forming foods to stimulate peristalsis B.Administering proton pump inhibitors daily C.Providing intravenous fluids while NPO D.Ensuring pancreatic enzymes are taken with meals

D.Ensuring pancreatic enzymes are taken with meals Rationale: Pancreatic enzymes taken with meals will aid in the digestion of food substances and will promote nutrition. Intravenous fluids are given to prevent​ dehydration, not nutrition. Proton pump inhibitors such as omeprazole​ (Prilosec) may be given to neutralize or decrease gastric secretions.​ Gas-forming foods may increase abdominal pain and will not promote nutrition.

A client is receiving care for vomiting and abdominal pain. After administering the prescribed​ analgesic, in which position should the nurse place the client to enhance​ comfort? A.High Fowler B.​Side-lying with legs straight and head elevated 45 degrees C.Supine D.​Side-lying with knees flexed and head elevated 45 degrees

D.​Side-lying with knees flexed and head elevated 45 degrees ​Rationale: The​ side-lying position, with knees flexed and head elevated 45 degrees is best because it reduces stretching of the​ peritoneum, reducing pain. The other choices would not relieve tension in the abdomen.