Pancreas
Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation? A) "It empties the stomach of fluids and gas." B) "It prevents spasms at the sphincter of Oddi." C) "It prevents air from forming in the small intestine and large intestine." D) "It removes bile from the gallbladder."
A) "It empties the stomach of fluids and gas." An NG tube is inserted into the patients stomach to drain fluid and gas.
Which of the following laboratory values would be the most important to monitor for a patient with pancreatic cancer? A) Serum glucose B) Radioimmunoassay (RIA) C) Creatine phosphokinase (CPK) D) Carcinoembryo antigen (CEA)
A) Serum glucose In pancreatitis, hypersecretion of the insulin from a tumor may affect the islets of Langerhans, resulting in hyperinsulinemia, a complication of pancreatic cancer.
A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate relief of pain would place the patient in a: A) knee-chest position B) semi-Fowler's position C) recumbent position D) low-Fowler's position
A) knee-chest position Flexion of the trunk lessens the pain and decreases restlessness.
When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? A) Transports fatty acids into the brush border B) Breaks down fat into fatty acids and glycerol C) Triggers cholecystokinin to contract the gallbladder D) Breaks down protein into dipeptides and amino acids
B) Breaks down fat into fatty acids and glycerol Lipase hydrolyses or breaks down fat into fatty acids and glycerol.
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
B) Counseling to stop alcohol consumption 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.
What laboratory finding is the primary diagnostic indicator for pancreatitis? A) Elevated blood urea nitrogen (BUN) B) Elevated serum lipase C) Elevated aspartate aminotransferase (AST) D) Increased lactate dehydrogenase (LD)
B) Elevated serum lipase Elevation of serum lipase is the most reliable indicator of pancreatitis because this enzyme is produced solely by the pancreas.
Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? A) Calcium B) Glucose C) Magnesium D) Potassium
B) Glucose Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of langerhans
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A) Appendicitis B) Pancreatitis C) Cholecystitis D) Gastric ulcer
B) Pancreatitis Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis.
To inhibit pancreatic secretions, which pharmacologic agent would you anticipate administering to a patient with acute pancreatitis? A) Nitroglycerin B) Somatostatin C) Pancrelipase D) Pepcid
B) Somatostatin Somatostatin, a treatment for acute pancreatitis, inhibits the release of pancreatic enzymes.
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
B) decreased urine output Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition.
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.
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.
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
C) 300 units/L 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.
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 nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction D) Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day
C) Maintenance of nothing-by-mouth status and insertion of nasogastric (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.
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) Nasogastric tube inserted C) Morphine sulfate for pain D) An anticholinergic medication
C) Morphine sulfate for pain 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.
Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: A) Continuous peritoneal lavage B) Regular diet with increased fat C) Nutritional support with TPN D) Insertion of a T tube to drain the pancreas
C) Nutritional support with TPN With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.
Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? A) Serum creatinine and BUN B) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) C) Serum amylase and lipase D) Cardiac enzymes
C) Serum amylase and lipase Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.
What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus? A) Grey-Turner's sign B) Homan's sign C) Rovsing's sign D) Cullen's sign
D) Cullen's sign Cullen's sign is associated with pancreatitis when a hemorrhage is suspected.
Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? A) There is no skin breakdown B) Her appetite improves C) She loses more than 10 lbs D) Stools are less fatty and decreased in frequency
D) Stools are less fatty and decreased in frequency Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance
