A client presents to the emergency department with acute abdominal pain and a provisional diagnosis of pancreatitis. The client reports nausea and vomiting from laboratory studies. Which information is most valuable in reporting the client’s status to the healthcare provider?
Reports of chronic constipation and serum gastrin levels
Serum Helicobacter pylori antibody results and urine output amounts
Presence of bowel sounds and degree of abdominal pain
Severity of nausea and vomiting and serum amylase results
The Correct Answer is D
Choice A reason: Chronic constipation and serum gastrin levels are not directly relevant to acute pancreatitis. Constipation may indicate gastrointestinal issues, but gastrin primarily relates to gastric acid secretion. These do not confirm pancreatitis or guide acute management, unlike amylase levels, which are diagnostic for pancreatic inflammation.
Choice B reason: Helicobacter pylori antibodies indicate gastric infection, unrelated to pancreatitis, which involves pancreatic inflammation. Urine output is a general vital sign but not specific to pancreatitis diagnosis. Amylase and symptom severity are more critical for confirming and managing acute pancreatitis, making this less valuable.
Choice C reason: Bowel sounds and abdominal pain degree provide general information but are nonspecific. Pain is expected in pancreatitis, and bowel sounds may vary. Serum amylase and nausea/vomiting severity are more diagnostic, directly reflecting pancreatic inflammation and its systemic effects, making them more critical to report.
Choice D reason: Serum amylase levels are a key diagnostic marker for acute pancreatitis, as pancreatic inflammation releases amylase into the blood. Severity of nausea and vomiting reflects disease impact and fluid loss, guiding treatment. These are the most valuable data for reporting, as they confirm diagnosis and inform management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Arterial blood gases assess oxygenation and acid-base balance, critical for diagnosing respiratory distress severity. However, this diagnostic measure does not immediately relieve airway obstruction. Clearing secretions is prioritized to restore ventilation, as hypoxia can rapidly cause tissue damage or cardiac arrest in acute respiratory distress.
Choice B reason: Suctioning removes airway secretions, directly addressing breathing difficulty. Secretions obstruct airways, reducing oxygen delivery to alveoli and impairing gas exchange. Immediate suctioning restores patency, enhances ventilation, and prevents hypoxia, making it the priority intervention to stabilize the client’s respiratory function in acute distress.
Choice C reason: PRN analgesia addresses pain, which is not indicated as the primary issue. Pain relief does not resolve airway obstruction or improve breathing. Administering analgesia prematurely could mask respiratory symptoms, delaying critical airway management and potentially worsening hypoxia by neglecting the underlying obstruction.
Choice D reason: An antipyretic reduces fever, improving comfort but not addressing breathing difficulty. Fever is secondary, and treating it does not restore airway patency or oxygenation. Airway management is prioritized in respiratory distress to prevent hypoxia and ensure effective gas exchange before managing fever symptoms.
Correct Answer is B
Explanation
Choice A reason: HIV does not primarily cause a deficiency in antibody production. B-cells produce antibodies, but HIV targets CD4 T-cells, impairing their ability to activate B-cells. This indirectly reduces antibody effectiveness, but the primary mechanism is T-cell destruction, not a direct antibody production deficit, making this incorrect.
Choice B reason: HIV infects and destroys helper T-cells (CD4 cells), critical for coordinating immune responses. By reducing CD4 cell counts, HIV impairs activation of B-cells and cytotoxic T-cells, leading to immune suppression. This is the primary mechanism of AIDS-related immune deficiency, making it the correct explanation for HIV pathology.
Choice C reason: Proliferation of suppressor T-cells (regulatory T-cells) is not a primary HIV mechanism. HIV depletes CD4 cells, not suppressor T-cells, which modulate immune responses. While immune dysregulation occurs, the hallmark is CD4 destruction, not suppressor T-cell proliferation, making this an inaccurate description of HIV’s action.
Choice D reason: HIV does not increase B-lymphocyte numbers. It impairs B-cell function indirectly by destroying CD4 cells, which are needed to activate B-cells for antibody production. B-cell hyperactivity may occur in early HIV, but the primary immune suppression results from CD4 cell loss, not B-cell proliferation.
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