A client with chronic pancreatitis is being discharged.
The nurse should anticipate teaching the client about which medication to help with their nutritional needs?
Probiotics.
Ondansetron.
Lactulose.
Pancrelipase (digestive enzymes).
The Correct Answer is D
Choice A rationale
Probiotics are live microorganisms intended to provide health benefits when consumed, generally by improving or restoring the gut flora. While they are useful for certain gastrointestinal conditions like antibiotic-associated diarrhea or irritable bowel syndrome, they do not address the primary pathophysiology of chronic pancreatitis. In this condition, the inflammatory process leads to permanent structural damage and the loss of exocrine function. Probiotics cannot replace the essential digestive enzymes needed for the breakdown of macronutrients in the duodenum.
Choice B rationale
Ondansetron is a selective 5-HT3 receptor antagonist used primarily as an antiemetic to treat nausea and vomiting. Although a client with chronic pancreatitis may experience these symptoms during acute exacerbations, the medication does not facilitate the digestion or absorption of nutrients. The client's nutritional needs are compromised due to malabsorption and steatorrhea resulting from enzyme deficiency. While ondansetron manages symptoms, it does not provide the metabolic support required for the long-term nutritional management of exocrine pancreatic insufficiency.
Choice C rationale
Lactulose is a synthetic sugar used primarily to treat constipation or hepatic encephalopathy by reducing ammonia levels in the blood. In the context of chronic pancreatitis, there is no physiological indication for lactulose unless the client has concurrent end-stage liver disease. It does not aid in the secretion of amylase, lipase, or protease. Giving lactulose would not improve the client's ability to digest fats or proteins and could potentially cause osmotic diarrhea, further complicating the client's nutritional status.
Choice D rationale
Chronic pancreatitis causes exocrine insufficiency, where the pancreas fails to produce enough enzymes to digest food. Pancrelipase contains a mixture of lipases, proteases, and amylases that mimic endogenous secretions. These enzymes are essential for the hydrolysis of fats into fatty acids, proteins into peptides, and starches into dextrins. By taking these with every meal and snack, the client can prevent malabsorption, reduce steatorrhea, and maintain adequate caloric intake. This is the gold standard for managing nutritional deficits.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Nausea and vomiting at 10 weeks gestation is a common physiological occurrence due to rising human chorionic gonadotropin (hCG) levels. While it requires assessment for hyperemesis gravidarum, it is rarely an immediate life-threatening emergency unless accompanied by severe dehydration, electrolyte imbalances, or inability to keep any fluids down for 24 hours. Normal potassium levels are 3.5 to 5.0 mEq/L. This client is stable compared to one with potential fetal demise or acute distress.
Choice B rationale
Occasional uterine cramping at 36 weeks gestation often represents Braxton Hicks contractions, which are irregular and non-productive. While the nurse must assess for signs of true preterm labor or placental issues, this is a common finding in the late third trimester as the body prepares for parturition. If the contractions are not increasing in frequency, duration, or intensity, and there is no vaginal bleeding, this client is considered a lower priority than a client reporting absent fetal movement.
Choice C rationale
Thick, white vaginal discharge during the second trimester is often indicative of leukorrhea or a yeast infection (Candidiasis). While uncomfortable and requiring treatment with antifungal agents, it does not pose an immediate threat to the mother or the fetus. The nurse should schedule an appointment for a vaginal swab and clinical evaluation, but this call does not take precedence over an urgent report of decreased fetal movement which may signal intrauterine hypoxia or fetal death.
Choice D rationale
A report of absent fetal movement at 28 weeks gestation is a critical red flag for potential fetal distress or intrauterine fetal demise. Fetal kick counts are a primary indicator of fetal well-being and oxygenation. After 24 to 28 weeks, the fetus should have a consistent movement pattern. Lack of movement requires immediate clinical evaluation via a non-stress test (NST) or biophysical profile to assess the fetal heart rate and placental perfusion. This represents the highest priority.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
Muscle weakening in bulimia nervosa stems from electrolyte imbalances and chronic dehydration caused by recurrent purging behaviors. Specifically, the loss of potassium through emesis or laxative abuse leads to hypokalemia, where serum potassium levels fall below the normal range of 3.5 to 5.0 mEq/L. Since potassium is essential for proper skeletal muscle contraction and electrochemical signaling, its depletion results in physical weakness and fatigue, which are common clinical manifestations in these patients.
Choice B rationale
Dental caries are a classic hallmark of bulimia nervosa due to the frequent exposure of tooth enamel to gastric acid during self-induced vomiting. The stomach acid has an extremely low pH, which chemically erodes the protective enamel and creates a high-acid environment that promotes tooth decay and cavities. This process, often referred to as perimylolysis, typically affects the lingual surfaces of the teeth and is an important physical indicator for nurses during a systemic assessment.
Choice C rationale
Lanugo is a fine, downy hair growth that is typically a diagnostic feature of anorexia nervosa rather than bulimia nervosa. It is a physiological adaptation to extreme malnutrition and the loss of subcutaneous fat as the body attempts to maintain core temperature and provide insulation. Since individuals with bulimia nervosa often maintain a weight within or near the normal range, they do not usually experience the severe thermoregulatory deficits that trigger the growth of lanugo.
Choice D rationale
Calluses on the hands, specifically over the knuckles or dorsal surface, are known as Russells sign. This physical manifestation occurs when a patient uses their fingers to induce the gag reflex for purging. Repeated friction and contact with the upper incisors during this process lead to skin thickening and scarring in that specific area. It is a highly specific physical finding that suggests the presence of self-induced vomiting behavior even when the patient denies purging.
Choice E rationale
Normal weight is a significant diagnostic differentiator for bulimia nervosa compared to other eating disorders. While patients with anorexia nervosa are significantly underweight, those with bulimia often stay within a normal body mass index range or may even be slightly overweight. This occurs because the binge-purge cycle does not always result in a net caloric deficit. Therefore, maintaining a normal weight does not rule out the disorder and is a common assessment finding in this population.
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