Acute Pancreatitis

21. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of a. alcohol use. b. diabetes mellitus. c. high-protein diet. d. cigarette smoking.

ANS: A Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.

22. When educating a patient with chronic pancreatitis about the prescribed pancrelipase (Viokase), the nurse will teach the patient to take the medication a. at bedtime. b. with every meal. c. upon arising in the morning. d. as soon as abdominal pain occurs.

ANS: B Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

19. Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis? a. Calcium b. Bilirubin c. Amylase d. Potassium

ANS: C Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be as useful in evaluating whether the prescribed therapies have been effective.

35. In planning care for a patient with acute severe pancreatitis, the nurse assigns the highest priority to the patient outcome of a. expressing satisfaction with pain control. b. developing no ongoing pancreatic problems. c. maintenance of normal respiratory function. d. having adequate fluid and electrolyte balance.

ANS: C Respiratory failure can occur as a complication of acute pancreatitis, and maintenance of adequate respiratory function is the priority goal. The other outcomes also would be appropriate for the patient.

27. When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patients hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patients blood pressure. c. Check the calcium level on the chart. d. Notify the health care provider immediately.

ANS: C The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseaus sign. The health care provider should be notified after the nurse checks the patients calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

29. When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

ANS: D A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

20. Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

ANS: D Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings also should be reported to the health care provider, they do not indicate complications that require rapid action.

28. A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

ANS: D NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this occur to determine whether treatment was effective.