A client diagnosed with pancreatitis is reporting severe epigastric pain and intense nausea.

After the nurse administers a narcotic analgesic and an antiemetic, the client insists on sitting up and leaning forward. Which action should the nurse implement?

Reinforce bed rest until analgesic is effective.

Place bed in reverse Trendelenburg position.

Raise head of bed until at a 90-degree angle.

Position bedside table for client to lean across.

Answer and Explanation

The Correct Answer is D

A.   Reinforcing bed rest until the analgesic is effective may not address the client's need to sit up and lean forward. It's important to respond to the client's discomfort and find a position that
provides relief.
B.   Placing the bed in reverse Trendelenburg position (head elevated, feet lowered) may not be the most effective position for a client experiencing severe epigastric pain and nausea. This
position could potentially worsen symptoms or discomfort.
C.   Raising the head of the bed to a 90-degree angle may not provide optimal relief for the client.
While it's essential to elevate the head of the bed for comfort and to prevent aspiration, it may not address the client's specific need to lean forward.
D.   Positioning a bedside table for the client to lean across allows the client to assume a position that often provides relief for epigastric pain associated with pancreatitis. Leaning forward can
help reduce pressure on the pancreas and alleviate discomfort. This position also facilitates drainage of gastric contents and may help alleviate nausea.

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Correct Answer is C

Explanation

A. Monitor and document strict intake and output: While monitoring intake and output is
important in managing fluid balance, it may not directly address the potential complications associated with hyperkalemia and hyperglycemia.
B. Assess the serum potassium level every 4 hours: While monitoring potassium levels is important, obtaining a 12-lead electrocardiogram provides immediate information about the cardiac effects of hyperkalemia, which can be life-threatening.
C. Obtain a 12-lead electrocardiogram daily: Hyperkalemia can lead to serious cardiac arrhythmias, including bradycardia, heart block, and ventricular fibrillation. Daily
electrocardiograms can help detect these changes early.
D. Evaluate glucose levels before and after meals: While monitoring glucose levels is important, the immediate concern in this scenario is the potential cardiac effects of hyperkalemia.

A. Mild sedation. B. Somnambulism. C. A change in the sleep-wake cycle. D. Dizziness reported after the initial dose.

Correct Answer is B

Explanation

A. Mild sedation is a common side effect of ramelteon and typically does not require immediate medical attention. It may improve with continued use as the body adjusts to the medication.
B. Somnambulism (sleepwalking) is a less common but potentially serious side effect of ramelteon. It can pose safety risks to the client, and the healthcare provider should be notified promptly to assess the severity and determine if the medication needs to be adjusted or
discontinued.
C. A change in the sleep-wake cycle is a common intended effect of ramelteon as it helps regulate sleep patterns. However, if the change is extreme or disruptive, it may warrant further evaluation by the healthcare provider.
D. Dizziness reported after the initial dose is a common side effect of ramelteon and usually
diminishes with continued use. It may not require immediate medical attention unless it persists or worsens.

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A client diagnosed with pancreatitis is reporting severe epigastric pain and intense nausea. After the nurse administers a narcotic analgesic and an antiemetic, the client insists on sitting up and leaning forward. Which action should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A client who recently received a prescription for ramelteon to treat sleep deprivation reports experiencing several side effects since taking the drug. Which side effect should the nurse report to the healthcare provider?

Correct Answer is B

Explanation

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A client diagnosed with pancreatitis is reporting severe epigastric pain and intense nausea.

After the nurse administers a narcotic analgesic and an antiemetic, the client insists on sitting up and leaning forward. Which action should the nurse implement?