A client with acute pancreatitis is experiencing severe abdominal pain. Which additional finding would concern the nurse the most?

Choice A reason: Influenza increases metabolic stress, elevating blood glucose in type 1 diabetes due to stress hormones like cortisol and catecholamines, which promote gluconeogenesis. Frequent glucose monitoring ensures timely insulin adjustments, preventing hyperglycemia or diabetic ketoacidosis, critical for managing acute illness in insulin-dependent patients.

Choice B reason: Discontinuing insulin in type 1 diabetes, even during reduced food intake, is dangerous. Insulin is essential to prevent diabetic ketoacidosis, as the body continues gluconeogenesis and fat metabolism without it, leading to severe acidosis and metabolic collapse, making this instruction incorrect.

Choice C reason: Reducing food intake to diminish nausea may worsen glycemic control in type 1 diabetes. Illness increases glucose levels, requiring consistent carbohydrate intake to prevent hypoglycemia or ketosis. This approach ignores the need for balanced nutrition and insulin adjustments during illness, making it inappropriate.

Choice D reason: Taking half the insulin dose is unsafe, as illness often increases insulin requirements due to stress-induced hyperglycemia. Arbitrary dose reduction risks diabetic ketoacidosis, as insufficient insulin fails to counter gluconeogenesis and ketogenesis, making this instruction dangerous for type 1 diabetes management during influenza.

Choice A reason: Beta blockers are used in cirrhosis to reduce portal hypertension and variceal bleeding risk but are not a priority in acute liver failure. They do not address immediate life-threatening issues like hemodynamic instability or respiratory compromise, which are critical in acute liver failure management.

Choice B reason: Maintaining airway and stabilizing circulation is the priority in acute liver failure, as patients may develop cerebral edema, causing respiratory compromise, or coagulopathy, leading to bleeding and shock. Ensuring oxygenation and hemodynamic stability prevents multi-organ failure, addressing the most immediate life-threatening complications of liver failure.

Choice C reason: Paracentesis removes ascitic fluid in cirrhosis but is not a priority in acute liver failure, where ascites is less prominent. It does not address urgent issues like airway compromise or circulatory shock, which are critical in preventing rapid deterioration in acute liver failure.

Choice D reason: Vitamin K corrects coagulopathy from liver dysfunction but is not the priority in acute liver failure. While bleeding risk is significant, airway and circulatory stability take precedence, as respiratory failure or shock are more immediately life-threatening than correctable coagulopathy in this acute setting.