Nursing 111 Pancreatitis exam questions with answers tested and verified solutions 2023/20, Exams of Nursing

Download Nursing 111 Pancreatitis exam questions with answers tested and verified solutions 2023/20 and more Exams Nursing in PDF only on Docsity! Nursing 111 Pancreatitis exam questions with answers tested and verified solutions 2023/2024 updates graded A+ Assessment The nurse is completing Jared's emergency center admission assessment. 1. To support the admitting diagnosis of acute pancreatitis, which question should the nurse ask Jared? A) "Do you currently, or have you ever, smoked cigarettes?" INCORRECT Cigarette smoking does not cause an acute exacerbation of pancreatitis. B) "How often do you drink alcohol, and when was your last drink?" CORRECT Longterm use of alcohol is commonly associated with the development of chronic pancreatitis, and alcohol ingestion is the primary cause of an acute exacerbation of pancreatitis. C) "What medications have you taken in the last 24 hours?" INCORRECT Corticosteroid use, thiazide diuretics, and oral contraceptives are associated with an increased incidence of developing chronic pancreatitis, but taking one dose of medication in the last 24 hours would not cause an acute exacerbation of pancreatitis. D) "Have you had any weight loss or gain in the last six months?" INCORRECT Weight loss is a major problem in chronic pancreatitis, but it is not a significant factor in the onset of an acute exacerbation. Jared shares with the nurse that he has been drinking alcohol every day for the last few years and that he drank a little more than usual last night at a poker party at a friend's house. He also tells the nurse that he has smoked two packs of cigarettes a day for the last 20 years. To further evaluate Jared's condition, the healthcare provider (HCP) prescribes several laboratory tests. Points Earned: 1.0/1.0 Correct Answer(s): B 2. Which laboratory data indicates that Jared is experiencing acute pancreatitis? A) Hemoglobin (Hgb) 12.9 g/dl and hematocrit (HCT) 42%. INCORRECT The hemoglobin and hematocrit are monitored to assess for bleeding, but they not are used to diagnose pancreatitis. B) White blood cell count of 10,000/mm3. INCORRECT The WBC count may be elevated in clients with pancreatitis, but this WBC count is within normal limits. C) Amylase of 982 U/L and lipase of 400 U/L. CORRECT Serum amylase and lipase levels can increase to an excess of three times their normal upper limits within 24 hours of an acute exacerbation of pancreatitis. Normal levels are amylase 23- 85 U/L and lipase 060 U/L. D) Blood alcohol level of 1.0 mg. INCORRECT An elevated blood alcohol level does not support the diagnosis of acute pancreatitis. Points Earned: 0.0/1.0 Correct Answer(s): C Emergency Center Nursing Interventions The emergency center nurse starts an intravenous (IV) infusion of D5 0.45 NS (normal saline) at 125 ml/hr with a 20 gauge angiocath in Jared's left forearm. Jared complains of severe abdominal pain rated "9" on a 0–10 numerical pain scale. Jared's abdomen is soft and non- tender, and there are bowel sounds in all 4 quadrants. 3. Which medication should the nurse expect to administer to relieve Jared's pain? A) Ondansetron (Zofran) 0.15 mg IV push diluted and administered over 15 minutes. INCORRECT Ondansetron (Zofran) is an antiemetic used to prevent nausea and vomiting associated with cancer chemotherapy and in the prevention of postoperative nausea and vomiting and is not an opioid needed for pain control. B) Ranitidine (Zantac) IV piggy back administered over 30 minutes. INCORRECT Histamine2 antagonists are prescribed to decrease pancreatic activity by inhibiting stomach acid secretion, but Zantac will not help alleviate Jared's acute pain. C) Morphine 5 mg IV push administered diluted over 5 minutes. CORRECT Morphine is considered a first line opioid analgesic and one of the most commonly prescribed opioids for moderate to severe pain. Others include, fentanyl (Duragesic), hydromorphone (Dilaudid), methadone (Metadol), and oxycodone (Percocet). D) Promethazine (Phenergan) 25 mg IV push, diluted and administered over 1 minute. INCORRECT This is an antiemetic agent that is prescribed to treat nausea and vomiting. It is not used to relieve acute pain. Promethazine is very toxic to the vein and should be administered over at least two minutes. D) Schedule Jared for endoscopic retrograde cholangiopancreatography (ERCP). INCORRECT This diagnostic test is not scheduled when the client is acute execerbation. It is performed to rule out chronic pancreatitis after recovery from an acute attack and plays a role in the management of clients with acute or chronic pancreatitis. Points Earned: 1.0/1.0 Correct Answer(s): A Three hours after being admitted to the emergency center, Jared is transferred to the medical unit in stable condition. Nursing Interventions on the Medical Unit The nasogastric tube is draining green bile, and Jared reports his pain is a "4" on the 0–10 pain scale. 6. Which intervention regarding positioning should the nurse implement to help alleviate Jared's pain? A) Ensure that Jared remains in a supine position. INCORRECT Jared should not lie flat in the bed because this position will increase pressure on the diaphragm due to the distended abdomen, increasing the client's pain. B) Place 6inch blocks under the foot of the bed. INCORRECT Elevating the foot of the bed will not help alleviate the pain experienced by a client with acute pancreatitis. C) Encourage side lying with legs drawn to chest. CORRECT The pain from pancreatitis is caused by stretching of the peritoneum secondary to edema caused by the inflamed pancreas. Sitting up, leaning forward, or lying in a fetal position helps alleviate this pain. D) No specific position will help Jared's pain. INCORRECT There are a number of different positions the client can try to help alleviate the pain. Points Earned: 1.0/1.0 Correct Answer(s): C The nurse develops a plan of care for Jared. 7. Which intervention should the nurse include in the plan of care? A) Encourage the client to ambulate in the hall. INCORRECT The client should remain on bedrest to decrease body metabolism and reduce pancreatic and gastric secretions. B) Administer oxygen via nasal cannula. CORRECT Oxygen will help decrease the workload of the respiratory system and the tissue's utilization of oxygen. C) Irrigate the nasogastic tube every four hours. INCORRECT The nasogastric should only be irrigated if the tube is clogged. D) Keep the client's room humidified and warm. INCORRECT The client should be placed in cool, comfortable room with airconditioning to help decrease the workload of the respiratory system and tissue's utilization of oxygen. Points Earned: 0.0/1.0 Correct Answer(s): B Nutritional Needs Four days after admission, Jared is still unable to tolerate any foods or fluids, so the HCP prescribes total parenteral nutrition (TPN). 8. Which intervention should the nurse implement prior to administering TPN? A) Assess the patency of the nasogastric tube. INCORRECT TPN is not administered through a nasogastric tube. B) Restart Jared's IV with an 18gauge angiocath. INCORRECT TPN is not administered through a peripheral IV. C) Assist the HCP with a subclavian line insertion. CORRECT Because TPN has a high glucose content which exerts osmotic pressure that is injurious to the intimal lining of peripheral veins, it is administered into the vascular system through a central venous catheter, often inserted into the subclavian vein.The HCP inserts a right subclavian line, and TPN bag #1 is administered via an IV pump at 75 ml/hr. D) Consult with a registered dietician about the formula. INCORRECT The nurse does not need to consult with a registered dietician regarding the TPN solution since the TPN was prescribed by the HCP. Points Earned: 0.0/1.0 Correct Answer(s): C 9. Which independent nursing action regarding the client's nutritional status should the nurse include when caring for Jared? A) Monitor his abdominal girth. INCORRECT The abdominal girth does not need to be monitored when a client is receiving TPN. B) Offer highprotein snacks frequently. INCORRECT Jared has a nasogastric tube. Any oral intake must be prescribed by the HCP in conjunction with clamping the nasogastric tube. C) Obtain and record a daily weight. CORRECT Shortterm weight changes (over hours or days) accurately reflect the client's fluid balance which can be influenced by the pancreatitis; weight changes over days or weeks reflects the client's nutritional status. D) Change the TPN IV tubing every 72 hours. INCORRECT Because the IV tubing used for TPN is an excellent medium for bacterial growth due to the high glucose content of the solution, it is changed with every bag. Points Earned: 0.0/1.0 Correct Answer(s): C Management The nurse, with the assistance of an unlicensed nursing assistant (UAP), is assigned to care for 5 clients including Jared. 10. Which task can the nurse delegate to the UAP when caring for Jared? B) Discuss ways to deal with stressful situations and avoid stress if possible. CORRECT Stress stimulates the pancreas to secrete pancreatic enzymes. Effective management of highly stressful situations can help decrease inflammation of the pancreas. C) Encourage daily exercise and teach the proper way to perform isotonic exercises. INCORRECT Daily exercise will not help prevent acute pancreatic attacks. D) Teach Jared to limit coffee, tea, and colas to no more than two a day. INCORRECT Because coffee, tea, and colas stimulate gastric and pancreatic secretions which may precipitate pain, these drinks should be avoided all together. Jared acknowledges the discharge teaching and states, "I will try to do what I'm supposed to do, but my job is very stressful, and it is going to be very hard to quit drinking and smoking." Jared's wife is very skeptical and indicates that she does not think her husband will be compliant with any of the discharge teaching. Points Earned: 0.0/1.0 Correct Answer(s): B Diagnostic Tests Three weeks after Jared is discharged home, he is admitted to the day procedure area for an endoscopic retrograde cholangiopancreatography (ERCP). When the nurse asks Jared to sign the procedure permit, he hesitates and states, "I don't understand why I need this procedure. I am not hurting any more, so I think I want to cancel the test." 14. Which statement by the nurse provides the best response to Jared's comment? A) "The test will allow the HCP to visualize your pancreas." INCORRECT It is correct that an ERCP permits direct visualization of the pancreas, but this is not the best response by the nurse. B) "I will contact your HCP to discuss this with you." CORRECT The procedure cannot be performed unless the client has been fully informed. Jared's comments indicate that he does not fully understand the need for the procedure, and it is the HCP’s responsibility to explain the procedure to the client. After receiving further explanation by the HCP, Jared signs the procedure permit form, and the nurse completes the preprocedure assessment. C) "You are not sure you want to have this procedure." INCORRECT This is a therapeutic response, but it is not the best response by the nurse in this situation. D) "The procedure is not done when you are hurting." INCORRECT Although the nurse provides Jared with accurate information regarding the test not being performed when the client is experiencing an acute exacerbation, this statement is not the best response in this situation. Points Earned: 1.0/1.0 Correct Answer(s): B 15. Which question should the nurse to ask Jared prior to the ERCP? A) When was the last time you had anything to eat or drink? CORRECT To reduce the risk of aspiration, clients should not have anything to eat or drink at least 8 hours prior to the procedure. B) When was the last time you had a bowel movement? INCORRECT This information is not pertinent to having an ERCP. C) Have you consumed any alcohol in the last 48 hours? INCORRECT Alcohol intake is not pertinent to having an ERCP. D) Do you have any difficulty swallowing or chewing? INCORRECT Difficulty swallowing or chewing is not pertinent to having an ERCP. Points Earned: 1.0/1.0 Correct Answer(s): A After the nurse completes the assessment, Jared undergoes the ERCP without any problems. 16. What intervention has the highest priority when caring for Jared after the procedure? A) Monitor the client's IV fluids. INCORRECT Jared will be receiving IV fluids, but monitoring fluids does not have the highest priority when providing post procedure nursing care. B) Assess the client's pulse and blood pressure. CORRECT Because esophageal and/or duodenal perforation can occur during the procedure, monitoring the client for manifestations of hypovolemia has the highest priority. C) Check the client's abdomen for pain and tenderness. INCORRECT Assessing the abdomen is an appropriate intervention, but it does not have the highest priority when providing postprocedure nursing care. D) Evaluate the client's hemoglobin and hematocrit. INCORRECT Evaluating Jared's Hgb and HCT is an appropriate intervention, but it does not have the highest priority. Points Earned: 0.0/1.0 Correct Answer(s): B Jared does not experience any complications secondary to the ERCP and is discharged home with his wife. He has a followup appointment in two days with his HCP to discuss the results of the ERCP and the treatment plan. FollowUp Appointment At Jared's followup visit after the ERCP, the clinic nurse asks Jared if he is complying with his discharge teaching. He tells the nurse that he doesn't drink much alcohol, and he is trying to cut down on his smoking. He adds that he has quit drinking tea and cola, but he has to have his morning coffee. He tells the nurse his stomach hasn't been hurting too much, but he reports that his stools look fatty, appear bubbly and frothy, float on top of the water, and are extremely malodorous. 17. How should the nurse respond? A) "We need to get a stool specimen and send it to the lab." INCORRECT There is no reason for the nurse to send a stool specimen to the laboratory. B) "Have you been eating any fatty foods in the last few days?" INCORRECT Fatty foods do not cause this type of stool. C) "This is common in persons with chronic pancreatitis." CORRECT Clients with chronic pancreatitis have steatorrhea (fatty, frothy, foulsmelling stools) due to a decrease in pancreatic enzyme production. D) "This happens when you drink too much alcohol." INCORRECT Alcohol intake does not cause an abnormal appearance of the stools. Points Earned: 1.0/1.0 21. When the nurse is discussing the complications of chronic pancreatitis with Jared and his wife, which information should be included in the teaching? A) The need to report any painful urinating or dribbling. INCORRECT Painful urination and dribbling urine are not signs of potential complications of pancreatitis. These symptoms may indicate a urinary tract infection or prostate enlargement. B) The signs/symptoms of hypovolemic shock. INCORRECT This is a complication that can occur with acute necrotic pancreatitis, not chronic pancreatitis. C) The importance of checking bilirubin levels. INCORRECT Altered bilirubin levels could indicate a complication from liver dysfunction, rather than chronic pancreatitis. D) The need to monitor blood glucose levels. CORRECT Because diabetes mellitus can develop secondary to chronic pancreatitis, blood glucose levels should be monitored. Points Earned: 1.0/1.0 Correct Answer(s): D Since Jared is asking questions and seems very interested in the discussion concerning complications of chronic pancreatitis, the nurse continues to talk about interventions that Jared can implement at home. 22. Which action should the nurse encourage Jared to take? A) Rest in bed as much as possible. INCORRECT Since Jared’s last acute attack was over three weeks ago, Jared should be progressing to a normal activity level. B) Weigh weekly and report any significant weight loss. CORRECT Weight loss is a major problem for clients with chronic pancreatitis. It is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. C) Increase fluid intake to 3–4 liters of water a day. INCORRECT Increasing fluids will not help prevent complications of chronic pancreatitis. D) Decrease the amount of dietary fiber. INCORRECT Decreasing the amount of fiber in the diet will not prevent complications and may lead to constipation. Points Earned: 1.0/1.0 Correct Answer(s): B Referral to Alcoholics Anonymous (A.A.) The clinic nurse is concerned that Jared continues to smoke cigarettes, but his inability to abstain from drinking alcohol is a greater priority. The nurse encourages Jared to attend an A.A. meeting. Jared asks the nurse, "How will this meeting help me quit drinking?" 23. How should the nurse respond? A) "It is a support group that uses a 12step recovery program to quit drinking." CORRECT A.A. is a program of total abstinence. According to A.A., sobriety is maintained through sharing experience, strength and hope at group meetings and through the suggested Twelve Steps for recovery from alcoholism. B) "If you go to these meetings instead of bars, you won’t be able to drink." INCORRECT Attending A.A. meetings does not ensure the client will not go to a bar and continue to drink. C) "A person cannot quit drinking on their own without some kind of help." INCORRECT This response does not explain how A.A. will help Jared quit drinking. D) "They discuss medications that can curb your desire to drink alcohol." INCORRECT A.A. does not encourage medication use to quit drinking alcohol. Points Earned: 1.0/1.0 Correct Answer(s): A After listening to the nurse explain Alcoholics Anonymous, Jared asks, "How much does it cost to go to these meetings?" 24. How should the nurse respond? A) "A nominal fee is charged when attending the meetings." INCORRECT A nominal fee is not charged when attending A.A. meetings. B) "A.A. meetings are supported by nonmember contributions." INCORRECT A.A. neither seeks or accepts contributions from nonmembers. C) "There are no due or fees to attend the meetings." CORRECT Although A.A. has longheld tradition of being fully selfsupporting, there are no dues or fees to attend the meetings. D) "Monthly dues encourage members to attend the meetings." INCORRECT There are no monthly dues. Points Earned: 1.0/1.0 Correct Answer(s): C Therapeutic Communication The nurse is concluding the teaching session when Jared asks, "Am I going to die if I keep drinking?" 25. How should the nurse respond to Jared's question? A) "You sound as if you are afraid you may die from this disease." INCORRECT Although this reflection of the client's statement and is a therapeutic technique the nurse is assuming that Jared is afraid, so this is not the best response to Jared's question. B) "Jared, if you don't stop drinking, this disease may kill you." CORRECT Chronic pancreatitis is a serious disease that can lead to disability and death. Since the risk of premature death may be reduced if abstinence from alcohol is maintained, the nurse should give Jared a straightforward answer in response to his question. C) "I can't answer that question; no one can answer it." INCORRECT The nurse can answer Jared's question and should do so in a caring, straightforward manner. D) "Why are you concerned about that now?" INCORRECT This response is likely to make Jared defensive and could be a block to further teaching or discussion. Points Earned: 0.0/1.0 Correct Answer(s): B