Pancreatitis

Which finding for a patient with pancreatitis is termed Grey Turner's sign? 1. Jaundice of the sclera 2. Bluish discoloration of the flank area 3. Bluish discoloration of the periumbilical area 4. Left abdominal pain that occurs with movement

1. Jaundice of the sclera 2. Bluish discoloration of the flank area 3. Bluish discoloration of the periumbilical area 4. Left abdominal pain that occurs with movement The Grey Turner's sign includes a bluish discoloration, or ecchymosis, on the left or right flank area, the result of internal bleeding caused by pancreatitis.

Which interventions would the nurse implement for a patient with acute pancreatitis who is restless and reports abdominal pain? (SATA) 1. Massage the patient's abdomen 2. Administer IV morphine 3. Encourage the patient to go for a walk 4. Instruct the patient to drink more water 5. Encourage the patient to change positions frequently

2. Administer IV morphine 5. Encourage the patient to change positions frequently Patients with pancreatitis may experience restlessness due to pain in the abdomen. The nurse should administer morphine, which is an analgesic and relieves pain. The nurse should encourage the patient to change positions frequently, which may help relieve the restlessness associated with acute pancreatitis.

The client is diagnosed with acute pancreatitis. Which health-care provider's admitting order should the nurse question? 1. Bedrest with bathroom privileges. 2. Initiate IV therapy of D5W at 125 mL/hr. 3. Weigh client daily. 4. Low-fat, low-carbohydrate diet.

4. Low-fat, low-carbohydrate diet. The client should be NPO

Which intervention would the nurse expect to include in the plan of care for a patient with acute pancreatitis who has recurrent vomiting? 1. Immediately start enteral feeding to prevent malnutrition 2. Initiate early prophylactic antibiotic therapy to prevent infection 3. Administer acetaminophen (Tylenol) every four hours for pain relief 4. Nasogastric (NG) suction and NPO status

4. Nasogastric (NG) suction and NPO status Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis? A. "Does the pain in your stomach radiate to your back?" B. "Does the pain in your lower abdomen radiate to your hip?" C, "Does the pain in your lower abdomen radiate to your groin?" D. "Does the pain in your stomach radiate to your lower middle abdomen?"

A. "Does the pain in your stomach radiate to your back?" The pain that is associated with acute pancreatitis is often severe, is located in the epigastric region, and radiates to the back

The nurse reviews the laboratory results of a client with acute pancreatitis. Which test is significant in determining the client's response to treatment? A. Platelet count B. Amylase level C. RBC count D. Erythrocyte sedimentation level

Amylase level

Which action is likely to reduce the pancreatic and gastric solutions of a client with pancreatitis? A. Encourage clear liquids B. Obtain a prescription for morphine C. Administer prescribed anticholinergic medications D. Assist the client into a semi-fowler position

C. Administer prescribed anticholinergic medications

The nurse is caring for a hospitalized client with pancreatitis. Which findings would the nurse look for and expect to note when reviewing the laboratory results? Select all that apply. A. Elevated lipase level B. Elevated lactase level C. Elevated trypsin level D. Elevated amylase level E. Elevated sucrase level

A. Elevated lipase level B. Elevated lactase level C. Elevated trypsin level D. Elevated amylase level E. Elevated sucrase level

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data would alert the nurse to this occurrence? A. Inability to pass flatus B. Loss of anal sphincter control C. Severe, constant pain with rapid onset D. Firm, nontender mass palpable at the lower right costal margin

A. Inability to pass flatus Inability to pass flatus is a clinical manifestation of paralytic ileus.

The nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "How does my drinking relate to my diagnosis?" Which effect of alcohol would the nurse include when responding? A. It increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas B. It promotes the formation of calculi in the cystic duct C. It stimulates the pancreas to secrete more insulin than it can immediately produce D. It alters the composition of enzymes so they are capable of damaging the pancreas

A. It increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

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? Select all that apply. A. Maintain NPO (nothing by mouth) 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 intravenously as prescribed for pain. F. Maintain intravenous fluids at 10 mL/hour to keep the vein open.

A. Maintain NPO (nothing by mouth) status. B. Encourage coughing and deep breathing. E. Give hydromorphone intravenously as prescribed for pain.

Which medication will the nurse question when it is prescribed for a client with acute pancreatitis? A. Meperidine B. Ranitidine C. Cimetidine D. Promethazine

A. Meperidine

Which term is used for the substance made of cholesterol crystals and calcium salts found in a patient with pancreatitis? 1. Apraxia 2. Biliary sludge 3. Biliary atresia 4. Pancreatic abscess

1. Apraxia 2. Biliary sludge 3. Biliary atresia 4. Pancreatic abscess

Which condition causes the formation of biliary sludge? 1. Ascites 2. Hepatitis 3. Bile stasis 4. Biliary colic

1. Ascites 2. Hepatitis 3. Bile stasis 4. Biliary colic Biliary sludge is a mixture of cholesterol and bile salts and is caused by bile stasis

The nurse discovers a bluish discoloration of the periumbilical area on a patient who has been admitted with severe pancreatitis. How would the nurse document this finding? 1. Asterixis 2. Cullen's sign 3. Spider angioma 4. Grey Turner's sign

1. Asterixis 2. Cullen's sign 3. Spider angioma 4. Grey Turner's sign Bluish discoloration of the periumbilical region is called Cullen's sign and can result from seepage of blood-stained exudate from the pancreas, which may occur in severe pancreatitis.

Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates? 1. Biliary sludge 2. Biliary atresia 3. Pancreatic abscess 4. Pancreatic pseudocyst

1. Biliary sludge 2. Biliary atresia 3. Pancreatic abscess 4. Pancreatic pseudocyst A pancreatic pseudocyst is an accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall

The nurse is caring for a client with pancreatitis. Which finding would the nurse expect to note when reviewing the client's laboratory results? A. Elevated level of pepsin B. Decreased level of lactase C. Elevated level of amylase D. Decreased level of enterokinase

C. Elevated level of amylase The serum level of amylase, an enzyme produced by the pancreas, increases with pancreatitis. Amylase normally is responsible for carbohydrate digestion

Which finding in the patient's history increases the risk for acute pancreatitis? 1. Emphysema 2. Alcohol abuse 3. Diabetes mellitus 4. Congestive heart failure

1. Emphysema 2. Alcohol abuse 3. Diabetes mellitus 4. Congestive heart failure In a majority of the cases of acute pancreatitis, the cause is excessive alcohol intake or biliary tract disease. Alcohol abuse can cause the small pancreatic ducts to become clogged, resulting in pancreatic inflammation.

The nurse is administering a pancreatic enzyme to the client diagnosed with chronic pancreatitis. Which statement best explains the rationale for administering this medication? 1. It is an exogenous source of protease, amylase, and lipase. 2. This enzyme increases the number of bowel movements. 3. This medication breaks down in the stomach to help with digestion. 4. Pancreatic enzymes help break down fat in the small intestine.

1. It is an exogenous source of protease, amylase, and lipase.

The client with an acute exacerbation of chronic pancreatitis has a nasogastric tube. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's bowel sounds. 2. Monitor the client's food intake. 3. Assess the client's intravenous site. 4. Provide oral and nasal care. 5. Monitor the client's blood glucose.

1. Monitor the client's bowel sounds. 3. Assess the client's intravenous site. 4. Provide oral and nasal care. 5. Monitor the client's blood glucose.

A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "What is a pseudocyst?" Which information would the nurse include in a response to this question? A. Malignant growth B. Pocket of undigested food particles C. Walled-off space of pancreatic enzymes and exudate D. Sac filled with pus from necrotic pancreatic tissue

C. Walled-off space of pancreatic enzymes and exudate

The BP of a patient with pancreatitis dropped from 125/80 to 90/60. The nurse administers isotonic fluid without an increase in the patient's BP. Which medication would the nurse anticipate will be prescribed by the HCP? 1. Morphine 2. Dopamine 3. Omeprazole 4. Pancrelipase

1. Morphine 2. Dopamine 3. Omeprazole 4. Pancrelipase Acute pancreatitis is associated with hypotension. Therefore to return the blood pressure to normal, vasoactive drugs such as dopamine are prescribed. These drugs increase the total vascular resistance, thereby increasing blood pressure.

Which type of sample would the nurse collect to determine whether the patient has steatorrhea? 1. Stool 2. Urine 3. Blood 4. Sputum

1. Stool 2. Urine 3. Blood 4. Sputum Steatorrhea is manifested by fatty and foul-smelling stools. Therefore a stool sample is used to diagnose steatorrhea in patients with pancreatitis.

Which body substance would the nurse observe to evaluate the effectiveness of pancreatic enzyme replacement for a patient with chronic pancreatitis? 1. Stool 2. Urine 3. Saliva 4.Nasal mucus

1. Stool 2. Urine 3. Saliva 4. Nasal mucus Patients with pancreatitis have diminished or absent pancreatic lipases, the enzymes that break down fat. This leads to steatorrhea, which is characterized by greasy and foul-smelling stools. Therefore observing the patient's stool for steatorrhea helps to determine the effectiveness of pancreatic enzymes

Which action would the nurse perform immediately for a patient with acute pancreatitis who develops acute respiratory distress syndrome (ARDS)? 1. Infuse normal saline 2. Give chest compressions 3. Provide ventilatory support 4. Schedule a portable chest x-ray

1. Infuse normal saline 2. Give chest compressions 3. Provide ventilatory support 5. Schedule a portable chest x-ray Difficulty in breathing and shortness of breath are characteristics of ARDS. If ARDS develops, the patient would require ventilator support because mechanical ventilation and intubation are required to save the patient from this life-threatening condition

Which description of the Whipple procedure made by a patient demonstrates a need for further education? 1. "Complete removal of the stomach." 2. "Complete removal of the duodenum." 3. "Removal of a portion of the bile duct." 4. "Removal of a portion of the pancreas."

1. "Complete removal of the stomach." 2. "Complete removal of the duodenum." 3. "Removal of a portion of the bile duct." 4. "Removal of a portion of the pancreas." A Whipple procedure involves removing the distal part of the stomach, which is a partial removal of stomach.

Which prescribed treatment would the nurse expect to administer to a patient with pancreatitis who has a BP of 80/70? 1. Albumin 2. Octreotide 3. Cyclosporine 4. Acetazaolamide

1. Albumin Acute pancreatitis may cause shock, which is manifested by decreased volume of body fluids and reduced circulatory volume, which results in decreased blood pressure. Albumin is a plasma volume expander that should be administered to help restore the circulatory volume.

A client is hospitalized with a diagnosis of acute pancreatitis. The plan of care is focused on the goals of maintaining nutrition, promoting rest, maintaining fluids and electrolytes, and decreasing anxiety. Which interventions would the nurse implement? (SATA) A. Provide a low-fat diet B. Administer analgesics C. Teach relaxation exercises D. Encourage walking in the hall E. Monitor cardiac rate and rhythm F. Observe for signs of hypercalcemia

B. Administer analgesics C. Teach relaxation exercises E. Monitor cardiac rate and rhythm

Which action is likely to exacerbate the condition of a patient who has pancreatitis? 1. Checking for fatty stools 2. Eating three large meals a day 3. Taking omeprazole one hour after meals 4. Taking pancreatic enzymes along with meals

2. Eating three large meals a day Patients with pancreatitis should be given small and frequent meals to reduce or prevent pancreatic stimulation. Therefore avoiding small frequent meals is responsible for the patient's condition. Creon is a pancreatic enzyme supplement to be given along with meals or snacks.

The nurse is developing a plan of care for a patient with acute pancreatitis. What nursing actions should be included in the plan of care? (SATA) 1. Observe for skin irritation. 2. Monitor electrolyte levels. 3. Assess respiratory function. 4. Provide psychologic support. 5. Observe for muscular twitching.

2. Monitor electrolyte levels. 3. Assess respiratory function. 4. Provide psychologic support. 5. Observe for muscular twitching. Frequent gastric suctioning is performed in patients with severe acute pancreatitis, which may result in decreased levels of the electrolytes, sodium, potassium, calcium, and chloride; therefore, electrolyte levels should be monitored. The nurse should assess respiratory function by determining the lung sounds and oxygen saturation levels. Hypocalcemia results in muscular twitching and jerking movement, so the nurse should look for muscle twitching in the patient.

The nurse is caring for a patient with pancreatitis. Which action would the nurse encourage the patient to take to reduce the risk for parotitis? 1. Perform hand hygiene 2. Rinse the mouth frequently 3. Moisturize hands before sleeping 4. Practice deep-breathing exercises

2. Rinse the mouth frequently Parotitis is inflammation of the parotid gland, which is located inside the mouth. Therefore to reduce the risk of developing parotitis, the nurse should encourage the patient to perform oral care by rinsing the mouth frequently.

Which statements of the student nurse indicate effective learning about providing care to a patient with acute pancreatitis? (SATA) 1. "I should encourage the patient to tolerate pain." 2. "I should encourage the patient to limit fluid intake." 3. "I should monitor the patient's blood glucose levels." 4. "I should check for spider angioma on the patient's skin." 5. "I should check the patient's body temperature for fever"

3. "I should monitor the patient's blood glucose levels." 5. "I should check the patient's body temperature for fever" Acute pancreatitis is associated with inflammation of the pancreas. Therefore to determine any damage to the beta cells of the islets of Langerhans, the nurse should monitor the patient's blood glucose levels. The nurse should check for fever, which is a manifestation of infection.

A primary health care provider orders nasojejunal tube feeding for a patient with acute pancreatitis. Which rationale supports ordering enteral feeding rather than IV parental nutrition? 1. To ensure fast absorption 2. Because the tube is easier to insert 3. To decrease risk of infection 4. Because the patient will be more compliant

3. To decrease risk of infection Parenteral nutrition is associated with an increased risk of infection, because it must be administered via an intravenous catheter. Therefore the primary health care provider opted for nasojejunal tube feeding instead of parenteral nutrition.

Which statement by a student nurse indicates a need for further teaching about nutritional therapy in patients with acute pancreatitis? 1. "I should feed the patient through a nasojejunal tube." 2. "I should monitor the patient's blood triglyceride levels." 3. "I should give small quantities of food frequently to the patient." 4. "I should include fat-rich food substances in the patient's dietary plan."

4. "I should include fat-rich food substances in the patient's dietary plan." Patients with acute pancreatitis should be provided with food that does not stimulate the pancreas much. Fats are broken down by the enzymes produced by pancreas; therefore, fat-rich food substances should not be given to the patient

A patient is scheduled for a secretin stimulation test and asks the nurse what this will evaluate. What is the best response by the nurse? 1. "It will evaluate if you have Wilson's disease." 2. "It will evaluate if you have diabetes mellitus." 3. "It will determine if you have acute pancreatitis." 4. "It will evaluate the severity of chronic pancreatitis."

4. "It will evaluate the severity of chronic pancreatitis." The secretin stimulation test is performed in patients with chronic pancreatitis to determine the degree of pancreatic function

A patient who has severe abdominal pain is diagnosed with chronic pancreatitis secondary to cholecystitis. Which treatment option would the nurse anticipate will be planned? 1. Cholecystectomy 2. Whipple procedure 3. Chemoembolization 4. Choledochojejunostomy

4. Choledochojejunostomy When a patient with chronic pancreatitis is diagnosed with a biliary tract disease, surgery is required to treat the condition. The surgery involves diversion of bile flow and relieving the duct from obstruction. In patients with chronic pancreatitis, choledochojejunostomy is performed to divert bile flow around the ampulla of Vater. Therefore the nurse anticipates that choledochojejunostomy will be beneficial to the patient

A patient reports severe abdominal pain, nausea, and vomiting. The nurse assesses that the patient has a mass in the upper region of the abdomen. The laboratory reports show the white blood cell (WBC) count as 12,000 cells/µL. What does the nurse anticipate that the patient will be treated for? 1. Pseudocyst 2. Cullen's sign 3. Spider angioma 4. Pancreatic abscess

4. Pancreatic abscess A normal count of WBC is 4,500 to 10,000 cells/µL. The laboratory reports reveal an increased WBC count, which indicates that the patient has leukocytosis. Abdominal mass, abdominal pain, nausea, vomiting, and leukocytosis are manifestations of pancreatic abscess. Therefore the primary health care provider suspects that the patient has pancreatic abscess.

Which nursing intervention would prevent stimulation of the pancreas in a client with acute pancreatitis? A. Maintain the gastric pH at a level of less than 3.5 B. Administer the histamine H 2-receptor antagonist as prescribed C. Encourage the resumption of activities of daily living D. Ensure that the NG tube remains in the fundus of the stomach

B. Administer the histamine H 2-receptor antagonist as prescribed

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a most common causative factor in this client's disorder? A. Weight gain B. Use of alcohol C. Exposure to occupational chemicals D. Abdominal pain relieved with food or antacids

B. Use of alcohol Chronic pancreatitis occurs most often in alcoholics. Abstinence from alcohol is important to prevent the client from developing chronic pancreatitis.

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis? A. "I have epigastric pain radiating to my neck." B. "I have severe abdominal pain that is relieved after vomiting." C. "My temperature has been running between 96° F (35.5° C) and 97° F (36.1° C)." D. "I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

D. "I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

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? Select all that apply. A.Diarrhea B. Black, tarry stools C. Hyperactive bowel sounds D. Gray-blue color at the flank E. Abdominal guarding and tenderness F. Left upper quadrant pain with radiation to the back

D. Gray-blue color at the flank E. Abdominal guarding and tenderness F. Left upper quadrant pain with radiation to the back