A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?
Pancrelipase 500 units/kg PO three times daily with meals
Pantoprazole 80 mg IV bolus twice daily
Initiate a low-residue diet
D Ambulate twice day
The Correct Answer is B
A. Pancrelipase 500 units/kg PO three times daily with meals: Pancrelipase is an enzyme replacement therapy used to aid in the digestion of fats, proteins, and carbohydrates in clients with pancreatic insufficiency. However, in acute pancreatitis, the pancreas is inflamed and typically unable to produce sufficient enzymes. Therefore, enzyme replacement therapy is not typically initiated during the acute phase of pancreatitis.
B. Pantoprazole 80 mg IV bolus twice daily: This is the correct answer. Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion. It is commonly prescribed in acute pancreatitis to decrease gastric acid production and reduce pancreatic enzyme activity, thereby promoting pancreatic rest and reducing further pancreatic inflammation and injury.
C. Initiate a low-residue diet: In acute pancreatitis, clients are typically kept NPO (nothing by mouth) initially to allow the pancreas to rest and inflammation to decrease. Once oral intake is resumed, a low-fat, easily digestible diet is usually recommended. However, the initiation of a low-residue diet is not typically indicated during the acute phase of pancreatitis.
D. Ambulate twice daily: While early ambulation is generally encouraged in hospitalized clients to prevent complications such as deep vein thrombosis and pneumonia, ambulation may be limited initially in clients with acute pancreatitis due to pain and discomfort. Ambulation is not typically a priority during the acute phase of pancreatitis; instead, pain management and supportive care are emphasized.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Dry the skin: The priority nursing action immediately following birth is to ensure the newborn's warmth. Drying the newborn's skin helps prevent hypothermia, which is a significant risk for neonates. The nurse should dry the newborn's skin using a warm, dry towel to prevent heat loss through evaporation.
B. Administer vitamin K: Administering vitamin K is an important procedure shortly after birth to prevent hemorrhagic disease of the newborn. However, ensuring warmth by drying the skin takes precedence over administering vitamin K as the newborn's temperature regulation is crucial immediately after delivery.
C. Place an identification bracelet: Placing an identification bracelet on the newborn is essential for proper identification and security purposes, but it is not the priority immediately after birth. Ensuring the newborn's warmth and maintaining physiological stability take precedence.
D. Administer eye prophylaxis: Administering eye prophylaxis, typically in the form of erythromycin ointment or another antimicrobial agent, is important to prevent neonatal conjunctivitis due to exposure to maternal pathogens during delivery. However, this intervention can wait until after the newborn's warmth is ensured through drying the skin.
Correct Answer is A, C, B, D, E
Explanation
A. Open the airway using a jaw-thrust maneuver: The first step in a primary survey is to assess the airway and ensure it is open. The jaw-thrust maneuver is used to open the airway without moving the neck in case of a potential cervical spine injury.
C. Determine effectiveness of ventilator efforts: Once the airway is open, the next step is to assess breathing. This includes observing for chest rise and fall, listening for breath sounds, and feeling for air movement.
B. Establish IV access: After the airway and breathing have been assessed, circulation is the next priority. This includes establishing IV access for fluid and medication administration.
D. Perform a Glasgow Coma Scale assessment: The Glasgow Coma Scale is used to assess the client’s level of consciousness, which is part of the disability assessment in the primary survey.
E. Remove clothing for a thorough assessment: Finally, removing the client’s clothing allows for a thorough assessment of injuries. This is typically done after the immediate life-threatening issues have been addressed.
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