FALL RNSG 2539
My Exam 2 BP
1. Metabolism/Liver Failure/Nutrition- Application (Ch 49, p 1406)
Chart 49-5
Nutritional Management of Hepatic Encephalopathy
Minimize the formation and absorption of toxins, principally ammonia, from the intestine.
Keep daily protein intake between 1.2 and 1.5 g/kg body weight per day.
Avoid protein restriction if possible, even in those with encephalopathy.
For patients who are truly protein intolerant, provide additional nitrogen in the form of an amino acid
supplement. The use of branched-chain amino acids should be a consideration in patients with cirrhosis. It has improved
outcomes in varied populations with the disease.
Provide small, frequent meals and 3 small snacks per day in addition to a late-night snack before bed.
Nutritional Therapy for Ascites
The goal of treatment for the patient with ascites is a negative sodium balance to reduce fluid retention. Table
salt, salty foods, salted butter and margarine, and all canned and frozen foods that are not specifically prepared for
low-sodium (2-g sodium) diets should be avoided. It may take 2 to 3 months for the patient’s taste buds to adjust to
unsalted foods. In the meantime, the taste of unsalted foods can be improved by using salt substitutes such as lemon
juice, oregano, and thyme. Commercial salt substitutes need to be approved by the patient’s primary provider,
because those that contain ammonia could precipitate hepatic encephalopathy and coma. Most salt substitutes
contain potassium and should be avoided if the patient has impaired renal function. The patient should make liberal
use of powdered, low-sodium milk and milk products. If fluid accumulation is not controlled with this regimen, the
daily sodium allowance may be reduced further to 500 mg, and diuretic agents may be given. However, most
patients will not accept such a severe sodium restriction as 500 mg, so clinicians often will not recommend it.
Dietary control of ascites via strict sodium restriction is difficult to achieve at home. The likelihood that the
patient will follow a 2-g sodium diet increases if the patient and the person preparing meals understand the rationale
for the diet and receive periodic guidance about selecting and preparing appropriate foods. Approximately 10% of
patients with ascites respond to these measures alone. Patients who do not respond and those who find sodium
restriction difficult require diuretic therapy.
Improving Nutritional Status for Cirrhosis of the Liver
Nursing interventions are directed toward promoting patient’s rest, improving nutritional status, providing skin care,
reducing risk of injury, and monitoring and managing potential complications. The patient with cirrhosis without
ascites, edema, or signs of impending hepatic coma should receive a nutritious, high-protein diet, if tolerated,
supplemented by vitamins of the B complex, as well as A, C, and K. The nurse encourages the patient to eat. If
ascites is present, small, frequent meals may be better tolerated than three large meals because of the
abdominal pressure exerted by ascites.
The use of probiotics for the management of hepatic encephalopathy is currently the topic of ongoing research.
Imbalance of the intestinal flora is not uncommon. Some research suggests that the oral ingestion of 1 cup of
probiotic yogurt three times a day reduces intestinal flora imbalance by decreasing Escherichia coli counts and
promoting the growth of non–urease-producing bacteria. This strategy is thought to then reduce ammonia levels and
improve mental status.
Patients with fatty stools (steatorrhea) should receive water-soluble forms of fat-soluble vitamins A, D, and E
(Aquasol A, D, and E). Folic acid and iron are prescribed to prevent anemia. Sodium restriction is also indicated to
prevent ascites. Patients with prolonged or severe anorexia and those who are vomiting or eating poorly for any
reason may receive nutrients by the enteral or parenteral route.
A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse
should prioritize which of the following in the patient’s plan?
A) Increased potassium intake
B) Fluid restriction to 2 L per day
C) Reduction in sodium intake
D) High-protein, low-fat diet
Ans: C
Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no
need for fluid restriction or increased protein intake.
1
, FALL RNSG 2539
My Exam 2 BP
A nurse is amending a patient’s plan of care in light of the fact that the patient has recently developed ascites. What should the nurse
include in this patient’s care plan?
A) Mobilization with assistance at least 4 times daily
B) Administration of beta-adrenergic blockers as ordered
C) Vitamin B12 injections as ordered
D) Administration of diuretics as ordered
Ans: D
Feedback: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites
and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.
A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient’s increased risk of
bleeding. The nurse recognizes that this risk is related to the patient’s inability to synthesize prothrombin in the liver. What factor most
likely contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: D
Feedback: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This
probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile
salts, or albumin.
A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate
the patient's liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly.
Ans: C
Feedback: To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the
other hand
A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse
should prioritize which of the following in the patient's plan?
A) Increased potassium intake
B) Fluid restriction to 2 L per day
C) Reduction in sodium intake
D) High-protein, low-fat diet
Ans: C
Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased.
2. Metabolism/ Pancreatitis/Diagnostic Findings- Applying (Ch 50)
Assessment and Diagnostic Findings of ACUTE Pancreatitis
The diagnosis of acute pancreatitis is based on a history of abdominal pain, the presence of known risk factors,
physical examination findings, and diagnostic findings. Serum amylase and lipase levels are used in making the
diagnosis of acute pancreatitis, although their elevation can be attributed to many other causes. In most cases,
serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms. Serum amylase usually
returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days
longer than amylase. Urinary amylase levels also become elevated and remain elevated longer than serum amylase
levels. The white blood cell count is usually elevated; hypocalcemia is present in many patients and correlates well
with the severity of pancreatitis. Transient hyperglycemia and glucosuria and elevated serum bilirubin levels occur
in some patients with acute pancreatitis.
X-ray studies of the abdomen and chest may be obtained to differentiate pancreatitis from other disorders that
can cause similar symptoms and to detect pleural effusions. Ultrasound studies, contrast-enhanced CT scans, and
magnetic resonance imaging (MRI) scans are used to identify an increase in the diameter of the pancreas and to
detect pancreatic cysts, abscesses, or pseudocysts.
Hematocrit and hemoglobin levels are used to monitor the patient for bleeding. Peritoneal fluid, obtained
through paracentesis or peritoneal lavage, may contain increased levels of pancreatic enzymes. ERCP is rarely used
in the diagnostic evaluation of acute pancreatitis, because the patient is acutely ill; however, it may be valuable in
the treatment of gallstone pancreatitis.
Assessment and Diagnostic Findings of CHRONIC Pancreatitis
ERCP (endoscopic retrograde cholangiopancreatography) is the most useful study in the diagnosis of chronic
pancreatitis. It provides details about the anatomy of the pancreas and the pancreatic and biliary ducts. It is also
helpful in obtaining tissue for analysis and differentiating pancreatitis from other conditions, such as carcinoma.
Various imaging procedures, including MRI, CT scans, and ultrasound, are used in the diagnostic evaluation of
patients with suspected pancreatic disorders. A CT scan or ultrasound study is also helpful to detect pancreatic cysts.
2
, FALL RNSG 2539
My Exam 2 BP
A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making
decisions about surgical resection of the pancreas. An abnormal glucose tolerance test may indicate the presence of
diabetes associated with pancreatitis. Acute exacerbations of chronic pancreatitis may result in increased serum
amylase levels. Steatorrhea is best confirmed by laboratory analysis of fecal fat content.
Chart 49-10 ASSESSMENT
Assessing for Cirrhosis
Be alert to the following signs and symptoms:
Compensated
Abdominal pain
Ankle edema
Firm, enlarged liver
Flatulent dyspepsia
Intermittent mild fever
Palmar erythema (reddened palms)
Splenomegaly
Unexplained epistaxis
Vague morning indigestion
Vascular spiders
Decompensated
Ascites
Clubbing of fingers
Continuous mild fever
Epistaxis
Gonadal atrophy
Hypotension
Jaundice
Muscle wasting
Purpura (due to decreased platelet count)
Sparse body hair
Spontaneous bruising
Weakness
Weight loss
White nails
3
, FALL RNSG 2539
My Exam 2 BP
A nurse is assessing a patient who has been diagnosed with cholecystitis and is experiencing localized abdominal pain. When assessing the
characteristics of the patient’s pain, the nurse should anticipate that it may radiate to what region?
A) Left upper chest
B) Inguinal region
C) Neck or jaw
D) Right shoulder
Ans: D
Feedback: The patient may have biliary colic with excruciating upper right abdominal pain that radiates to the back or right shoulder. Pain from
cholecystitis does not typically radiate to the left upper chest, inguinal area, neck, or jaw.
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain.
The patient’s abdomen is rigid, and there is bruising to the patient’s flank. The patient’s wife states that he was on a drinking binge for
the past 2 days. The ED nurse should assist in assessing the patient for what health problem?
A) Severe pancreatitis with possible peritonitis
B) Acute cholecystitis
C) Chronic pancreatitis
D) Acute appendicitis with possible perforation
Ans: A
Feedback: Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Pain in pancreatitis is
accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen
may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24
to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or
cholecystitis.
A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When
providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?
A) The need to protect the incision post-procedure
B) The use of moderate sedation
C) The need to infuse 50% dextrose during the procedure
D) The use of general anesthesia
Ans: B
Feedback: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the procedure does not involve the creation of an
incision.
A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that
over 80% of the patient’s pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process.
What would be the nurse’s best response?
A) “The symptoms of pancreatitis mimic those of much less serious illnesses.”
B) “Your body doesn’t require pancreatic function until it is under great stress, so it is easy to go unnoticed.”
C) “Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.”
D) “It’s likely that your other organs were compensating for your decreased pancreatic function.”
Ans: C
Feedback: By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been
lost. Late detection is not usually attributable to the vagueness of symptoms. The pancreas contributes continually to homeostasis and other
organs are unable to perform its physiologic functions.
A patient is admitted to the ICU with acute pancreatitis. The patient’s family asks what causes acute pancreatitis. The critical care nurse
knows that a majority of patients with acute pancreatitis have what?
A) Type 1 diabetes
B) An impaired immune system
C) Undiagnosed chronic pancreatitis
D) An amylase deficiency
Ans: C
Feedback: Eighty percent of patients with acute pancreatitis have biliary tract disease or a history of long-term alcohol abuse. These patients
usually have had undiagnosed chronic pancreatitis before their first episode of acute pancreatitis. Diabetes, an impaired immune function, and
amylase deficiency are not specific precursors to acute pancreatitis.
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing
Pattern Related to Pain. What intervention should the nurse perform in order to address this diagnosis?
A) Position the patient supine to facilitate diaphragm movement.
B) Administer corticosteroids by nebulizer as ordered.
C) Perform oral suctioning as needed to remove secretions.
D) Maintain the patient in a semi-Fowler's position whenever possible.
Ans: D
Feedback: The nurse maintains the patient in a semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to
increase respiratory expansion.
A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent
visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is
the nurse's most appropriate action?
A) Administer a PRN dose of pancreatic enzymes as ordered.
B) Teach the patient about the importance of abstaining from alcohol.
C) Arrange for the patient to be transported to the hospital.
D) Insert an NG tube, if available, and stay with the patient.
Ans: C
4
My Exam 2 BP
1. Metabolism/Liver Failure/Nutrition- Application (Ch 49, p 1406)
Chart 49-5
Nutritional Management of Hepatic Encephalopathy
Minimize the formation and absorption of toxins, principally ammonia, from the intestine.
Keep daily protein intake between 1.2 and 1.5 g/kg body weight per day.
Avoid protein restriction if possible, even in those with encephalopathy.
For patients who are truly protein intolerant, provide additional nitrogen in the form of an amino acid
supplement. The use of branched-chain amino acids should be a consideration in patients with cirrhosis. It has improved
outcomes in varied populations with the disease.
Provide small, frequent meals and 3 small snacks per day in addition to a late-night snack before bed.
Nutritional Therapy for Ascites
The goal of treatment for the patient with ascites is a negative sodium balance to reduce fluid retention. Table
salt, salty foods, salted butter and margarine, and all canned and frozen foods that are not specifically prepared for
low-sodium (2-g sodium) diets should be avoided. It may take 2 to 3 months for the patient’s taste buds to adjust to
unsalted foods. In the meantime, the taste of unsalted foods can be improved by using salt substitutes such as lemon
juice, oregano, and thyme. Commercial salt substitutes need to be approved by the patient’s primary provider,
because those that contain ammonia could precipitate hepatic encephalopathy and coma. Most salt substitutes
contain potassium and should be avoided if the patient has impaired renal function. The patient should make liberal
use of powdered, low-sodium milk and milk products. If fluid accumulation is not controlled with this regimen, the
daily sodium allowance may be reduced further to 500 mg, and diuretic agents may be given. However, most
patients will not accept such a severe sodium restriction as 500 mg, so clinicians often will not recommend it.
Dietary control of ascites via strict sodium restriction is difficult to achieve at home. The likelihood that the
patient will follow a 2-g sodium diet increases if the patient and the person preparing meals understand the rationale
for the diet and receive periodic guidance about selecting and preparing appropriate foods. Approximately 10% of
patients with ascites respond to these measures alone. Patients who do not respond and those who find sodium
restriction difficult require diuretic therapy.
Improving Nutritional Status for Cirrhosis of the Liver
Nursing interventions are directed toward promoting patient’s rest, improving nutritional status, providing skin care,
reducing risk of injury, and monitoring and managing potential complications. The patient with cirrhosis without
ascites, edema, or signs of impending hepatic coma should receive a nutritious, high-protein diet, if tolerated,
supplemented by vitamins of the B complex, as well as A, C, and K. The nurse encourages the patient to eat. If
ascites is present, small, frequent meals may be better tolerated than three large meals because of the
abdominal pressure exerted by ascites.
The use of probiotics for the management of hepatic encephalopathy is currently the topic of ongoing research.
Imbalance of the intestinal flora is not uncommon. Some research suggests that the oral ingestion of 1 cup of
probiotic yogurt three times a day reduces intestinal flora imbalance by decreasing Escherichia coli counts and
promoting the growth of non–urease-producing bacteria. This strategy is thought to then reduce ammonia levels and
improve mental status.
Patients with fatty stools (steatorrhea) should receive water-soluble forms of fat-soluble vitamins A, D, and E
(Aquasol A, D, and E). Folic acid and iron are prescribed to prevent anemia. Sodium restriction is also indicated to
prevent ascites. Patients with prolonged or severe anorexia and those who are vomiting or eating poorly for any
reason may receive nutrients by the enteral or parenteral route.
A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse
should prioritize which of the following in the patient’s plan?
A) Increased potassium intake
B) Fluid restriction to 2 L per day
C) Reduction in sodium intake
D) High-protein, low-fat diet
Ans: C
Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no
need for fluid restriction or increased protein intake.
1
, FALL RNSG 2539
My Exam 2 BP
A nurse is amending a patient’s plan of care in light of the fact that the patient has recently developed ascites. What should the nurse
include in this patient’s care plan?
A) Mobilization with assistance at least 4 times daily
B) Administration of beta-adrenergic blockers as ordered
C) Vitamin B12 injections as ordered
D) Administration of diuretics as ordered
Ans: D
Feedback: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites
and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.
A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient’s increased risk of
bleeding. The nurse recognizes that this risk is related to the patient’s inability to synthesize prothrombin in the liver. What factor most
likely contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: D
Feedback: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This
probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile
salts, or albumin.
A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate
the patient's liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly.
Ans: C
Feedback: To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the
other hand
A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse
should prioritize which of the following in the patient's plan?
A) Increased potassium intake
B) Fluid restriction to 2 L per day
C) Reduction in sodium intake
D) High-protein, low-fat diet
Ans: C
Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased.
2. Metabolism/ Pancreatitis/Diagnostic Findings- Applying (Ch 50)
Assessment and Diagnostic Findings of ACUTE Pancreatitis
The diagnosis of acute pancreatitis is based on a history of abdominal pain, the presence of known risk factors,
physical examination findings, and diagnostic findings. Serum amylase and lipase levels are used in making the
diagnosis of acute pancreatitis, although their elevation can be attributed to many other causes. In most cases,
serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms. Serum amylase usually
returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days
longer than amylase. Urinary amylase levels also become elevated and remain elevated longer than serum amylase
levels. The white blood cell count is usually elevated; hypocalcemia is present in many patients and correlates well
with the severity of pancreatitis. Transient hyperglycemia and glucosuria and elevated serum bilirubin levels occur
in some patients with acute pancreatitis.
X-ray studies of the abdomen and chest may be obtained to differentiate pancreatitis from other disorders that
can cause similar symptoms and to detect pleural effusions. Ultrasound studies, contrast-enhanced CT scans, and
magnetic resonance imaging (MRI) scans are used to identify an increase in the diameter of the pancreas and to
detect pancreatic cysts, abscesses, or pseudocysts.
Hematocrit and hemoglobin levels are used to monitor the patient for bleeding. Peritoneal fluid, obtained
through paracentesis or peritoneal lavage, may contain increased levels of pancreatic enzymes. ERCP is rarely used
in the diagnostic evaluation of acute pancreatitis, because the patient is acutely ill; however, it may be valuable in
the treatment of gallstone pancreatitis.
Assessment and Diagnostic Findings of CHRONIC Pancreatitis
ERCP (endoscopic retrograde cholangiopancreatography) is the most useful study in the diagnosis of chronic
pancreatitis. It provides details about the anatomy of the pancreas and the pancreatic and biliary ducts. It is also
helpful in obtaining tissue for analysis and differentiating pancreatitis from other conditions, such as carcinoma.
Various imaging procedures, including MRI, CT scans, and ultrasound, are used in the diagnostic evaluation of
patients with suspected pancreatic disorders. A CT scan or ultrasound study is also helpful to detect pancreatic cysts.
2
, FALL RNSG 2539
My Exam 2 BP
A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making
decisions about surgical resection of the pancreas. An abnormal glucose tolerance test may indicate the presence of
diabetes associated with pancreatitis. Acute exacerbations of chronic pancreatitis may result in increased serum
amylase levels. Steatorrhea is best confirmed by laboratory analysis of fecal fat content.
Chart 49-10 ASSESSMENT
Assessing for Cirrhosis
Be alert to the following signs and symptoms:
Compensated
Abdominal pain
Ankle edema
Firm, enlarged liver
Flatulent dyspepsia
Intermittent mild fever
Palmar erythema (reddened palms)
Splenomegaly
Unexplained epistaxis
Vague morning indigestion
Vascular spiders
Decompensated
Ascites
Clubbing of fingers
Continuous mild fever
Epistaxis
Gonadal atrophy
Hypotension
Jaundice
Muscle wasting
Purpura (due to decreased platelet count)
Sparse body hair
Spontaneous bruising
Weakness
Weight loss
White nails
3
, FALL RNSG 2539
My Exam 2 BP
A nurse is assessing a patient who has been diagnosed with cholecystitis and is experiencing localized abdominal pain. When assessing the
characteristics of the patient’s pain, the nurse should anticipate that it may radiate to what region?
A) Left upper chest
B) Inguinal region
C) Neck or jaw
D) Right shoulder
Ans: D
Feedback: The patient may have biliary colic with excruciating upper right abdominal pain that radiates to the back or right shoulder. Pain from
cholecystitis does not typically radiate to the left upper chest, inguinal area, neck, or jaw.
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain.
The patient’s abdomen is rigid, and there is bruising to the patient’s flank. The patient’s wife states that he was on a drinking binge for
the past 2 days. The ED nurse should assist in assessing the patient for what health problem?
A) Severe pancreatitis with possible peritonitis
B) Acute cholecystitis
C) Chronic pancreatitis
D) Acute appendicitis with possible perforation
Ans: A
Feedback: Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Pain in pancreatitis is
accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen
may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24
to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or
cholecystitis.
A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When
providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?
A) The need to protect the incision post-procedure
B) The use of moderate sedation
C) The need to infuse 50% dextrose during the procedure
D) The use of general anesthesia
Ans: B
Feedback: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the procedure does not involve the creation of an
incision.
A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that
over 80% of the patient’s pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process.
What would be the nurse’s best response?
A) “The symptoms of pancreatitis mimic those of much less serious illnesses.”
B) “Your body doesn’t require pancreatic function until it is under great stress, so it is easy to go unnoticed.”
C) “Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.”
D) “It’s likely that your other organs were compensating for your decreased pancreatic function.”
Ans: C
Feedback: By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been
lost. Late detection is not usually attributable to the vagueness of symptoms. The pancreas contributes continually to homeostasis and other
organs are unable to perform its physiologic functions.
A patient is admitted to the ICU with acute pancreatitis. The patient’s family asks what causes acute pancreatitis. The critical care nurse
knows that a majority of patients with acute pancreatitis have what?
A) Type 1 diabetes
B) An impaired immune system
C) Undiagnosed chronic pancreatitis
D) An amylase deficiency
Ans: C
Feedback: Eighty percent of patients with acute pancreatitis have biliary tract disease or a history of long-term alcohol abuse. These patients
usually have had undiagnosed chronic pancreatitis before their first episode of acute pancreatitis. Diabetes, an impaired immune function, and
amylase deficiency are not specific precursors to acute pancreatitis.
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing
Pattern Related to Pain. What intervention should the nurse perform in order to address this diagnosis?
A) Position the patient supine to facilitate diaphragm movement.
B) Administer corticosteroids by nebulizer as ordered.
C) Perform oral suctioning as needed to remove secretions.
D) Maintain the patient in a semi-Fowler's position whenever possible.
Ans: D
Feedback: The nurse maintains the patient in a semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to
increase respiratory expansion.
A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent
visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is
the nurse's most appropriate action?
A) Administer a PRN dose of pancreatic enzymes as ordered.
B) Teach the patient about the importance of abstaining from alcohol.
C) Arrange for the patient to be transported to the hospital.
D) Insert an NG tube, if available, and stay with the patient.
Ans: C
4
