Pancreatitis – Flashcards with Answers

1. These laboratory values are monitored for clients in kidney failure. 2. These laboratory values are elevated in clients with a myocardial infarction. ***3. Serum amylase increases within 2 to 12 hours of the onset of acute pancreatitis to 2 to 3 times normal and returns to normal in 3 to 4 days; lipase elevates and remains elevated for 7 to 14 days. 4. Bilirubin may be elevated as a result of compression of common duct, and hypocalcemia develops in up to 25% of clients with acute pancreatitis, but these laboratory values do not confirm the diagnosis. TEST-TAKING HINT: The test taker must be able to identify at least two (2) laboratory values that reflect each organ function prior to taking the RN-NCLEX. There is really no Test- Taking Hint that can help select the correct answer; this is knowledge.

1. The client will be NPO to help decrease pain, but it is not the priority problem because the client will have intravenous fluids. ***2. Autodigestion of the pancreas results in severe epigastric pain, accompanied by nausea, vomiting, abdominal tenderness, and muscle guarding. 3. Nutritional imbalance would be a possible client problem, but it is not priority. 4. Knowledge deficit is always a client problem, but it is not priority over pain. TEST-TAKING HINT: The test taker should apply Maslow's Hierarchy of Needs when selecting the priority problem for a client. After airway, pain is usually priority

***1. Pancreatic enzymes must be administered with meals to enhance the digestion of starches and fats in the gastrointestinal tract. 2. The client's respiratory rate is within normal limits; therefore the morphine should be administered to the client who is having pain. 3. This is a normal potassium level; therefore the nurse would not need to question administering this medication. 4. The apical pulse is within normal limits; therefore the nurse should not question administering this medication. TEST-TAKING HINT: The test taker must determine if the assessment data provided in the answer option are abnormal, unexpected, or life-threatening so that it warrants questioning the administration of the medication. The test taker should also think about whether the administration of the medication would create an abnormal or life-threatening situation.

1. Bed rest will decrease metabolic rate, gastrointestinal secretion, pancreatic secretions, and pain; therefore this HCP's order should not be questioned. 2. The client will be NPO; therefore, initiating IV therapy would be an appropriate order. 3. Short-term weight gain changes reflect fluid balance because the client will be NPO and receiving IV fluids. Daily weighing would be an appropriate HCP's order. ***4. The client will be NPO, which will decrease stimulation of the pancreatic enzymes, which will result in decreased autodigestion of the pancreas, therefore decreasing pain. TEST-TAKING HINT: The test taker must determine which HCP's order is not expected for the diagnosis. Sometimes if the test taker asks which order would be expected, it is easier to identify the unexpected or abnormal HCP order.

29. 1. Alcohol must be avoided entirely because it can cause stones to form, blocking pancreatic ducts and the outflow of pancreatic juice, causing further inflammation and destruction of the pancreas. 2. Stress stimulates the pancreas and should be dealt with, but it is unrealistic to think that a client can avoid all stress. By definition, the absence of all stress is death. ***3. Smoking stimulates the pancreas to release pancreatic enzymes and should be stopped. 4. The client has acute pancreatitis, and pancreatic enzymes are only needed for chronic pancreatitis. TEST-TAKING HINT: The test taker should eliminate "2" because of the word "all," which is an absolute and there are very few absolutes in health care. The test taker should note the adjective "acute" in the stem, which may help the test taker eliminate option "4" because enzymes are given for a chronic condition.

30. 1. Any change in the client's stool should be a cause for concern to the clinic nurse. 2. This is not necessary because the nurse knows changes in stool occur as a complication of pancreatitis and the client needs to see the HCP. ***3. Steatorrhea (fatty, frothy, foul-smelling stool) is caused by a decrease in pancreatic enzyme secretion and indicates impaired digestion and possibly an increase in the severity of the pancreatitis. The client should see the HCP. 4. Decreasing fat in the diet will not help stop this type of stool. TEST-TAKING HINT: This question requires the test taker to have knowledge of the disease process, but if the test taker knows that the exocrine function of the pancreas is part of the gastrointestinal system, the test taker might think that altered stool would be cause for concern.

1. The client is at risk for diabetes mellitus (destruction of beta cells), not diabetes insipidus, a disorder of the pituitary gland. 2. Crohn's disease is an inflammatory disorder of the lining of the gastrointestinal system, especially of the terminal ileum. ***3. Narcotic addiction is related to the frequent, severe pain episodes that often occur with chronic pancreatitis and its complications and that require narcotics for relief. 4. Peritonitis, an inflammation of the lining of the abdomen, is not a common complication of chronic pancreatitis. TEST-TAKING HINT: The test taker may be able to delete options based on normal anatomical and physiological data. Diabetes insipidus is a complication of the pituitary gland; Crohn's disease is a disease of the GI tract; and the peritoneum is the lining of the abdomen. Therefore, options "1," "2," and "4" can be eliminated.

32. 1. During this procedure a scope is placed down the client's mouth; therefore, assessing for rectal bleeding would not be a common intervention. 2. The client's throat has been anesthetized to insert the scope; therefore, fluid and food are withheld until the gag reflex has returned. ***3. The gag reflex will be suppressed as a result of the local anesthesia applied to the throat to insert the endoscope into the esophagus; therefore, the gag reflex must be assessed prior to allowing the client to resume eating or drinking. 4. The client should be in a semi-Fowler's or side-lying position to prevent aspiration. TEST-TAKING HINT: The test taker should apply the nursing process and select an option that addresses assessment—either "1" or "3." The medical suffix "endo" should help the test taker select "3" as the correct answer.

1. Lying on the stomach will not help to decrease the client's pain. 2. This is a position used by clients with chronic obstructive pulmonary disease to help lung expansion. ***3. This fetal position decreases pain caused by stretching of the peritoneum as a result of edema. 4. Laying supine causes the peritoneum to stretch, which increases the pain. TEST-TAKING HINT: The test taker should think about where the pancreas is located in the abdomen to help identify the correct answer. Prone or supine would cause the abdomen to be stretched, which would increase pain.

***1. The return of bowel sounds indicates the return of peristalsis, and the nasogastric suction is usually discontinued within 24 to 48 hours thereafter. ***2. Daily weight gain reflects fluid gain. ***3. The nurse should assess for signs of infection or infiltration. ***4. Fasting and the N/G tube increase the client's risk for mucous membrane irritation and breakdown. ***5. Blood glucose levels are monitored because clients with chronic pancreatitis can develop diabetes mellitus. TEST-TAKING HINT: This alternative-type question requires the test taker to select all interventions that are appropriate for the client's diagnosis. The test taker should not try to eliminate options because all options could be correct.

***1. Pancreatic enzymes enhance the digestion of starches (carbohydrates) in the gastrointestinal tract by supplying an exogenous (outside) source of the pancreatic enzymes protease, amylase, and lipase. 2. Pancreatic enzymes decrease the number of bowel movements. 3. The enzymes are enteric coated and should not be crushed because the hydrochloric acid in the stomach will destroy the enzymes; these enzymes work in the small intestine. 4. Pancreatic enzymes help break down carbohydrates, and bile breaks down fat. TEST-TAKING HINT: Remember that enzymes break down other foods and end in "ase." The test taker must know the normal function of organs to identify correct answers.

1. Coffee, tea, and cola stimulate gastric and pancreatic secretions and may precipitate pain, so these foods should be avoided, not decreased. ***2. High-fat and spicy foods stimulate gastric and pancreatic secretions and may precipitate an acute pancreatic attack. 3. Amylase and lipase levels must be checked via venipuncture with laboratory tests, and there are no daily tests the client can monitor at home. 4. The client will be fatigued as a result of decreased metabolic energy production and will need to rest and not return to work immediately. TEST-TAKING HINT: The test taker should be careful with words such as "decrease" because many times the client must avoid certain foods and situations completely, not decrease their intake of them. There are only a few blood studies that can be monitored at home on a daily basis—mainly glucose levels, which would cause the test taker to eliminate option "3."

1. A yellow haze is a sign of a toxic level of digoxin, with the client seeing through the yellow haze. Seeing a yellow haze is not the same as the client being jaundiced. In jaundice, the skin and sclera are yellow, signs of pancreatic cancer. ***2. The abdominal pain is often made worse by eating and lying supine in clients diagnosed with cancer of the pancreas. 3. The client would not know these terms, and the HCP would be the one to check these laboratory values. 4. Clients diagnosed with cancer of the pancreas lose weight, not gain weight. TEST-TAKING HINT: The test taker could arrive at the correct answer by correlating words in the stem of the question and words in the answer options—the abdomen with eating and pain with pain.

1. Tube feedings are collaborative interventions, but the stem did not say the client had a feeding tube. 2. This is an independent intervention. 3. Assessment is an independent intervention and the first step in the nursing process. No one should have to tell the nurse to assess the client. ***4. A collaborative intervention would be to refer to the nutrition expert, the dietitian. TEST-TAKING HINT: The key word in the stem is "collaborative." which means another healthcare discipline must be involved. Only options "1" and "4" involve other members of the health-care team. The test taker could eliminate distracter "1" by rereading the stem and realizing that the stem did not say the client had a feeding tube.

1. Monitoring the blood glucose at random intervals, as would be done at a health fair, can pick up possible diabetes mellitus or the presence of a pancreatic tumor, but detecting a disease at an early stage is secondary screening, not primary prevention. 2. Inspecting the skin for jaundice would be a secondary nursing intervention. ***3. Limiting the intake of meat and fats in the diet would be an example of primary interventions. Risk factors for the development of cancer of the pancreas are cigarette smoking and eating a high-fat diet that is high in animal protein. By changing these behaviors the client could possibly prevent the development of cancer of the pancreas. Other risk factors include genetic predisposition and exposure to industrial chemicals. 4. Instructing a client with hyperglycemia (diabetes mellitus) is an example of tertiary nursing care. TEST-TAKING HINT: Even if the test taker was not sure of the definition of primary, secondary, or tertiary nursing care, primary means first. Only one answer option is preventive, and preventing something comes before treating it.

***1. The nursing assistant can help a client to turn to the side and assume the fetal position, which would decrease some abdominal pain. 2. This is a high-level nursing intervention that the unlicensed nursing assistant is not qualified to implement, 3. Evaluation of the effectiveness of a PRN medication must be done by the nurse. 4. The nurse should empty the bedside commode to determine if the client is continuing to pass melena (blood in the stool). TEST-TAKING HINT: There are basic rules to delegation. The nurse cannot delegate assessment, evaluation, unstable clients, or situations requiring nursing judgment.

1. This would be the routine for radiation therapy, but chemotherapy is given one (1) to three (3) or four (4) days in a row and then a period of three (3) to four (4) weeks will elapse before the next treatment. This is called intermittent pulse therapy. ***2. The most important person in the treatment of the cancer is the client. Research has proved that the more involved a client becomes in his or her care, the better the prognosis. Clients should have a chance to ask all the questions that they have. 3. Cancer of any kind is a serious problem. 4. Most antineoplastic medications are given intravenously. Many of the medications can cause severe complications if given intramuscularly. TEST-TAKING HINT: The test taker can eliminate option "3" on the basis that this statement is denial of the problem.

1. The client should stay in the outpatient department after the procedure for observation unless the HCP determines that a more extensive workup should be completed. 2. This is not the type of procedure where the results warrant an emergency surgery. A cardiac catheterization sometimes results in an emergency surgery and the client is prepared for this possibility, but this is not the case with an ERCP. ***3. The client should be NPO after midnight to make sure the stomach is empty to reduce the risk of aspiration during the procedure. 4. The possible blockage would be of the duodenum, common bile duct, or pancreatic outlet. TEST-TAKING HINT: The nurse should never preface any instruction with "if done correctly" because this sets the nurse, HCP, and facility up for a lawsuit. The client is NPO for any procedure or surgery where the client will receive general or twilight sleep anesthesia.

***1. The client will have jaundice, clay-colored stools, and tea-colored urine resulting from blockage of the bile drainage. 2. Night sweats and fevers are associated with lymphoma. 3. Left lower abdominal cramps are associated with diverticulitis, and tenesmus is straining when defecating. 4. Nausea and coffee-ground emesis are symptoms of gastric ulcers. TEST-TAKING HINT: The test taker should remember anatomical placement of organs. This would eliminate answer options "3" and "4." The pancreas empties pancreatic enzymes into the small bowel to aid in the digestion of carbohydrates and fats in close proximity to where the common bile duct enters the intestine.

1. Clients diagnosed with cancer of the pancreas have a poor prognosis, but this is not the priority problem at this time. ***2. This is a major abdominal surgery, and there are massive fluid volume shifts that occur when this type of trauma is experienced by the body. Maintaining the circulatory system without overloading it requires extremely close monitoring. 3. Pain is a priority but not over fluid volume status. 4. Altered nutrition would be the next highest priority. The client will be NPO with a nasogastric tube to suction and will be receiving total parenteral nutrition TEST-TAKING HINT: The nurse should identify all of the problems, but one—fluid volume imbalance—has the greatest priority because if not addressed promptly and correctly, it could lead to severe complications.

1. The client is being discharged. There is no need for the client to continue recording intake and outputs at home. ***2. The client has undergone a radical and extensive surgery and will need to be administered narcotic pain medication, and a bowel regimen should be in place to prevent constipation. ***3. Removal of the pancreas will create a diabetic state for the client. The client will need insulin and pancreatic enzyme replacement. ***4. Client should not allow pain to reach above a "5" before taking pain medication or it will be more difficult to get the pain under control. 5. There is no reason for the client to sleep with the head of the bed elevated. TEST-TAKING HINT: The test taker might choose option "3" by remembering that the pancreas secretes insulin. Option "4" is taught to all clients in pain.

1. The client may need IV medication, but in this case if it is needed, it would be 50% dextrose. 2. The HCP might be notified, but the nurse needs to assess the client first. ***3. These are symptoms of an insulin reaction (hypoglycemia). A bedside glucose check should be done. Pancreatic islet tumors can produce hyperinsulinemia or hypoglycemia. 4. This would be done after the nurse knows the glucose reading. TEST-TAKING HINT: The test taker should remember the function of the pancreas. This would lead the test taker

1. Food preferences are important for the caregiver to know because this will be the person preparing meals for the client. ***2. Cancer of the pancreas has a poor prognosis for most clients, and the nurse should determine if the client has executed an advance directive regarding their wishes. 3. This is important because of payment issues, but it is not the highest priority. 4. Clients diagnosed with cancer frequently have anorexia, and explaining that the client should eat does not mean the client will eat. TEST-TAKING HINT: The test taker would need to know general information about the disease process to answer this question, but "2" is a good choice for many terminal diseases. Remember to read the questions carefully. The home health nurse is not arranging meals for the client.

1. The client is at risk for poor nutrition and malabsorption syndrome for which tissue turgor assessment is appropriate, but the client problem here is pruritus, or itching. 2. The itching is associated with the cancer and not a fungus. 3. The client should be monitored for skin breakdown, but pruritus is itching and an intervention is needed to prevent skin problems from scratching. ***4. Keeping the fingernails short will reduce the chance of breaks in the skin from scratching. TEST-TAKING HINT: The problem is "risk for skin breakdown." The etiology is "pruritus." Interventions address the etiology. Goals address the problem.

1. The client would be NPO and can live without food for a number of days as long as he or she receives fluids. 2. The client is not on strict bed rest and can move about in the bed; therefore, skin integrity would not be a priority problem. In pancreatitis, the tissue damage is internal. 3. The client may be anxious, but psychosocial problems are not priority. **4. The client with pancreatitis is in excruciating pain because the enzymes are autodigesting the pancreas; severe abdominal pain is the hallmark symptom of pancreatitis.

**15. 1. These laboratory data are used to diagnose and monitor pancreatitis because amylase and lipase are the enzymes produced by the pancreas. 2. Pancreatitis is not an infection of the pancreas resulting from bacteria; such an infection would cause an elevation in the WBCs. 3. Bilirubin is used to monitor liver problems. 4. BUN monitors kidney function.

1. A paracentesis is used to remove fluid from the abdominal cavity. **2. The pancreas lies immediately below the diaphragm. When the cyst ruptures alkaline substances in the abdomen cause fluid leaks at the esophageal diaphragmatic opening into the thorax. The fluid must be removed to prevent lung collapse. 3. Lumbar puncture is used to diagnose meningitis. 4. Biopsies are performed to confirm a diagnosis; they are not used for treatment.

1. A history of smoking cigarettes would be pertinent, but a history of chewing tobacco is not. 2. A diet high in fat, not low in fat, would be a risk factor. 3. Chronic alcoholism is not a risk factor, but chronic pancreatitis is a risk factor. **4. Exposure to industrial chemicals or environmental toxins is a risk factor for pancreatic cancer.

**1. If deep tendon reflexes are hypoactive or absent, the nurse should hold the magnesium and notify the health-care provider. 2. The arterial blood gases are not affected by the serum magnesium level. 3. The client's skin turgor will not be affected by the client's serum magnesium level. 4. The client's capillary refill time is not affected by the client's serum magnesium level.