Complex Ch 50: Metabolic
A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Elevated urine amylase levels c) Decreased liver enzyme levels d) Increased serum calcium levels
Answer: B Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low (page 1402)
The digestion of carbohydrates is aided by a) secretin. b) lipase. c) amylase. d) trypsin.
Answer: C Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas. (page 1390)
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) a) Assisting the patient into the prone position b) Encouraging bed rest to decrease the metabolic rate c) Administering parenteral opioid analgesics as ordered d) Administering prophylactic antibiotics e) Withholding oral feedings to limit the release of secretin
Answer: B, C, E The current recommendation for pain management is the use of opioids, with assessment for their effectiveness and altering therapy if pain is not controlled or increased (Marx, 2009). Nonpharmacologic interventions such as proper positioning (not prone), music, distraction, and imagery may be effective in reducing pain when used along with medications. In addition, oral feedings are withheld to decrease the secretion of secretin (page 1404)
A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to a) Presence of diabetes mellitus b) Cigarette smoking c) Age d) Dietary intake of fat
Answer: C Incidence of pancreatic cancer increases with age, peaking in the seventh and eighth decades for both men and women. It is very rare before 45 years, and most patients present in or beyond the sixth decade of life. Cigarette smoking, exposure to industrial chemicals or toxins in the environment, and a diet high in fat, meat, or both are associated with pancreatic cancer, although their roles are not completely clear. Diabetes mellitus, chronic pancreatitis, and hereditary pancreatitis are also associated with pancreatic cancer. (page 1410)
A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Maintaining nothing-by-mouth (NPO) status b) Providing mouth care c) Administering morphine I.V. as ordered d) Placing the client in a semi-Fowler's position
Answer: C The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues. (page 1403)
A patient is admitted to the health care center with severe abdominal pain rated at 10 on a 1-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP) as ordered. The nurse plans for which of the following goals following the administration of this mediation? a) To control BP b) To diagnose the cause of abdominal pain c) To control muscle spasms d) To increase the patient's pain threshold
Answer: D Morphine, fentanyl, and hydromorphone act by depressing the central nervous system and thereby increasing the patient's pain threshold. (page 1406)
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a) Over 1 year b) 1 to 4 months c) 4 to 6 months d) 6 to 12 months
Answer: D Six to 12 months of therapy with UDCA is recommended in patients to dissolve the stones. (page 1395)
The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? a) Low-sodium, high-potassium, low-fat diet b) Low-carbohydrate, high-potassium diet c) High-carbohydrate, high-protein, low-fat diet d) High-carbohydrate, low-protein, low-fat diet
Answer: D The nurse should provide a high-carbohydrate, low-protein, low-fat diet when tolerated. These foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond. (page 1407)
A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Elevated urine amylase levels b) Increased serum calcium levels c) Decreased white blood cell count d) Decreased liver enzyme levels
Answer: A Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low. (page 1402)
A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Teaching about the disease and its treatment b) Maintaining adequate nutritional status c) Preventing fluid volume overload d) Relieving abdominal pain
Answer: D The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain. (page 1402)
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? a) 30 mg/dL b) 50 mg/dL c) 70 mg/dL d) 90 mg/dL
Answer: A Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulinlike material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function (i.e., lower than 30 mg/dL [1.6 mmol/L]). (page 1413)
A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply.) a) Hyperglycemia b) An abnormal glucose tolerance c) Hypoglycemia d) Glucosuria e) Elevated lipase level
Answer: A, B, D An important sign, if present, is the onset of symptoms of insulin deficiency: glucosuria, hyperglycemia, and abnormal glucose tolerance. Therefore, diabetes may be an early sign of carcinoma of the pancreas. (page 1410)
The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a) To decrease metabolism b) To reduce gastric and pancreatic secretions c) To depress the central nervous system and increase the pain threshold d) To relieve nausea and vomiting
Answer: B Anticholinergic medications reduce gastric and pancreatic secretion. (page 1406)
Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis? a) Shock b) Tetany c) Pancreatic necrosis d) Multiple organ dysfunction syndrome (MODS)
Answer: C Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Shock and MODS may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in patients with acute pancreatitis (page 1404)
A nurse is caring for a client in the emergency department who is complaining of severe abdominal pain. The client is diagnosed with acute pancreatitis. Which laboratory value requires immediate intervention? a) Calcium level of 7.8 mg/dl b) Serum glucose level of 240 mg/dl c) White blood cell (WBC) count of 18,000 mm3 d) Troponin of 2.3 mcg/L
Answer: D An elevated troponin level indicates myocardial damage and needs immediate further investigation. Hyperglycemia (evidenced by a serum glucose of 240 mg/dl), an elevated WBC count, and hypocalcemia (evidenced by a calcium level of 7.8 mg/dl), although commonly seen in pancreatitis, don't require immediate action. (page 1182)