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) Amylase of 400 units/dL B) Alk Phos (ALP) of 135 units/L C) WBC of 9000 D) Lipase level of 175 units/L

A) 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.

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 fatty foods B) Decrease alcohol intake C) Avoid spicy foods D) Decrease caffeine intake

A) 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.

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

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.

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) Note the characteristics of stools B) Maintain NG tube patency C) Assess hourly urine output D) Offer frequent oral hygiene

A) 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 client with late-stage chronic pancreatitis. Which client symptom should the nurse expect to assess? A) Steatorrhea B) Severe nausea C) Severe vomiting D) Sever epigastric pain

A) 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.

*Possible exam question* What is most characteristic of acute pancreatitis? A) The pancreas attacks its own tissue. B) The pancreas becomes distended with fluid. C) The pancreas ceases to produce enzymes. D) The pancreas needs to be removed.

A) The pancreas attacks its own tissue Rationale: Regardless of the precipitating factor, the pathophysiologic process of acute pancreatitis begins with the release of activated pancreatic enzymes into pancreatic tissue. Activated proteolytic enzymes, trypsin in particular, digest pancreatic tissue and activate other enzymes such as phospholipase A, which digests cell membrane phospholipids, and elastase, which digests the elastic tissue of blood vessel walls. The problem is not distension of the pancreas with fluid, the cessation of enzyme production, or the pancreas needing to be removed.

A 28-year-old pregnant client presents with epigastric pain, back pain, anorexia, nausea, vomiting, and jaundice. What diagnostic test should the nurse expect to be performed on this client to determine the presence of gallstones? A) Ultrasonography B) Endoscopic retrograde cholangiopancreatography (ERCP) C) Contrast-enhanced CT scan D) Percutaneous fine-needle aspiration biopsy

A) Ultrasonography Rationale: Acute pancreatitis in pregnancy is relatively rare, occurring in roughly 3 of every 10,000 pregnancies. The majority of cases are the result of gallstones that obstruct pancreatic outflow. Pregnant clients may present with epigastric pain, back pain, anorexia, and jaundice. Nausea and vomiting are also common. Although the other tests are used in the diagnosis of pancreatitis, sonography is the imaging method of choice in pregnant clients because it is safe for the fetus and has a high sensitivity to gallstones.

*Possible exam question* 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 be prescribed? SATA A) Administer antacids as prescribed B) Encourage coughing and deep breathing C) Administer anticholinergics, as prescribed D) Maintain the client in a supine and flat position E) Encourage small, frequent, high-calorie feedings

A, B, C Rationale: The client with acute pancreatitis is normally placed on an NPO status to rest the pancreas and suppress GI secretions. Because abdominal pain is a prominent symptom of pancreatitis, pain medication will be prescribed. Some clients experience lessened pain by assuming positions that flex the trunk and draw the knees up to the chest. A side lying position with the head elevated 45 degrees decreases tension on the abdomen and may also help ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted. Antacids and anticholinergics may be prescribed to suppress GI secretion.

The nurse is providing care to a client admitted with acute pancreatitis. Which data support the client's diagnosis? SATA A) Severe epigastric pain B) Nausea and vomiting C) Elevated temperature D) Hypotension E) Steatorrhea

A, B, C, D Rationale: Acute pancreatitis presents with severe epigastric pain, nausea, vomiting, elevated temperature, and hypotension. Steatorrhea is a clinical manifestation that is associated with chronic pancreatitis.

*Possible exam question* The nurse is assessing a client suspected of having pancreatitis. Which finding should the nurse expect when assessing this client? SATA A) Hx of gallstones B) Abdominal pain C) Weight loss D) Nausea E) Weight gain

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

A client was discharged after hospitalization for acute pancreatitis with instructions on the use of analgesics, cautions on the importance of avoiding alcohol and smoking, and recommendations for a low-fat diet. Which outcomes would indicate that the client has implemented the recommendations? SATA A) The client experiences reduction or elimination of pain. B) The client is free from alterations in nutritional status. C) The client remains free from alterations in fluid balance. D) The client returns to work. E) The client is free from nausea.

A, B, C, E Rationale: Indications that would suggest that the client has implemented the recommendations include a reduction or elimination of pain; freedom from alterations in nutritional status; freedom from alterations in fluid balance; and freedom from nausea. Employment is not an evaluative measure for managing acute pancreatitis.

The nurse is providing care to an older adult client with a history of alcohol abuse who is admitted to the hospital with acute pancreatitis. Which treatment options should the nurse plan for when caring for this client? SATA A) Opioid analgesics B) High-fat diet C) Total parenteral nutrition D) Nasogastric tube to suction E) Pancrelipase administration

A, C, D Rationale: A client admitted with acute pancreatitis will be NPO until serum amylase levels have returned to normal, bowel sounds are present, and pain disappears. Opioid analgesics are often necessary for the acute pain experienced by the client. Total parenteral nutrition is initiated and a nasogastric tube is inserted and connected to suction. A low-fat, not a high-fat, diet will be implemented once the client is able to eat by mouth. Pancrelipase is prescribed for clients with chronic pancreatitis, not acute pancreatitis.

An adult client is admitted to the emergency department with symptoms of acute pancreatitis. Which nursing diagnoses are appropriate for this client? Select all that apply. A) Acute Pain B) Impaired Swallowing C) Deficient Fluid Volume D) Nausea E) Imbalanced Nutrition: Less than Body Requirement

A, C, D, E Rationale: Acute pancreatitis develops suddenly, typically with an abrupt onset of continuous severe epigastric and abdominal pain. Systemic complications of acute pancreatitis include intravascular volume depletion. Other manifestations of acute pancreatitis include nausea and vomiting, which result in imbalanced nutrition. Impaired swallowing is not associated with pancreatitis.

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

A, C, D, E 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 providing care to a client who is being admitted to rule out acute pancreatitis. Which item found in the client's history increases the client's risk for this disease process? A) Systemic lupus B) Alcoholism C) Cystic fibrosis D) Hypertriglyceridemia

B) Alcoholism Rationale: Risk factors for acute pancreatitis include alcoholism and gallstones. Autoimmune disorders, such as systemic lupus, cystic fibrosis, and hypertriglyceridemia, are all risk factors for chronic pancreatitis.

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

B) 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.

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 calcium levels B) Blood glucose levels C) Renal function levels D) Serum amylase levels

B) 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.

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

B) 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. Next Question

A 63-year-old client is diagnosed with chronic pancreatitis. In planning care for this patient, which of the following treatments should the nurse expect to increase the patient's risk for edema? A) Pancrelipase administration B) IV fluid administration C) Nasogastric tube insertion D) Total parenteral nutrition

B) IV fluid administration Rationale: Treatment for older adults is similar to that for other populations, so pancreatic enzyme replacement with administration of pancrelipase, insertion of a nasogastric tube, and total parenteral nutrition are all indicated, but aggressive use of IV fluids to maintain vascular volume is more likely to lead to edema in older adults and may not have the desired effect on renal function.

The nurse is providing care to an older adult client admitted to the medical unit for acute gastric and left upper abdominal pain radiating to the back. The healthcare provider has diagnosed the client with chronic pancreatitis. Which items are appropriate to include in the discharge teaching for this client? SATA A) Encouraging a high-fat diet B) Eliminating alcoholic beverages C) Properly administering pancrelipase D) Reporting symptoms of infection E) Taking antacids

B, C, D, E Rationale: Appropriate teaching for a client diagnosed with chronic pancreatitis includes eliminating alcoholic beverages, proper administration of pancrelipase, and the importance of taking antacids to prevent the destruction of the enzymes by hydrochloric acid. The client should be taught to follow a low-fat diet. The client should report any symptoms of infection (high fever, pain, rapid pulse, malaise).

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? SATA A) Back pain B) Bloating C) Jaundice D) Vomiting E) Fever

B, C, D, E Bloating, Jaundice, Vomiting, 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? SATA A) Biopsy B) Ultrasound C) Magnetic resonance cholangiopancreatography (MRCP) D) Abdominal X-ray E) CT scan w/contrast

B, C, E 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 obtaining a hx 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 been excessively sleepy?" B) "When did your child's pain begin?" C) "Does your child take any medications?" D) "Has your child lost weight?"

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. Next Question

*Possible exam question* 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) Acute pain D) Fluid volume excess

C) 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.

*Possible exam question* 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) Sedentary life style B) Hormonal changes C) Age of the older adult D) Obesity

C) 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.

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

C) 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.

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

C) 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.

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 is primary analgesic to manage pain B) It suppresses pancreatic enzyme secretion and helps to relieve pain C) It enhances digestion of starches, proteins, and fats D) It neutralizes pancreatic secretions

C) It enhances the 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.

*Possible exam question* The nurse is reviewing the HCP's prescriptions written for a client admitted with acute pancreatitis. Which prescription should the nurse verify if noted in the client's chart? A) NPO status B) An anticholinergic C) Position the client supine and flat D) Prepare to insert an NG tube

C) Position the client supine and flat Rationale: The pain associated with acute pancreatitis is aggravated when the client lies in a supine and flat position. therefore, the nurse would verify this prescription. The other options are appropriate interventions for the client with acute pancreatitis.

*Possible exam question* 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) Side-lying with legs straight and head elevated 45 degrees B) High Fowler C) Side-lying with knees flexed and head elevated 45 degrees D) Supine

C) 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. Next Question

The nurse is caring for a pregnant client who reports epigastric pain, back pain, anorexia, and her sclera appear jaundiced. The nurse should expect to prepare the client for which diagnostic test? A) 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.