A nurse is collecting data on a client who has acute pancreatitis.
Which of the following factors should the nurse anticipate in the client’s history?

Gallstones

GERD

Diabetes mellitus

Shock

Answer and Explanation

The Correct Answer is A

Choice A rationale

Acute pancreatitis is a condition characterized by inflammation of the pancreas. The most common cause of acute pancreatitis is gallstones, which can become lodged in a bile or pancreatic duct and cause inflammation. Gallstones are hardened deposits of digestive fluid that can form in your gallbladder, and when they block the ducts leading from the gallbladder to the intestines, they can cause sharp pain in the upper abdomen that quickly worsens. This pain can radiate to the back, another common symptom of acute pancreatitis. Therefore, a history of gallstones is a significant factor to anticipate in a client with acute pancreatitis.
Choice B rationale
GERD, or gastroesophageal reflux disease, is a chronic condition where stomach acid flows back up into the esophagus causing heartburn and other symptoms. While GERD can lead to discomfort and complications like esophagitis, it does not typically cause acute pancreatitis.
Choice C rationale
Diabetes mellitus is a chronic condition that affects the body’s ability to use blood sugar for energy. While diabetes can lead to a host of health complications, it is not typically a direct cause of acute pancreatitis.
Choice D rationale
Shock is a life-threatening condition that requires immediate medical attention. It occurs when the body is not getting enough blood flow, leading to insufficient oxygen and nutrients for your cells and organs. Shock can be a result of severe acute pancreatitis, but it is not a cause.

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Correct Answer is C

Explanation

Choice A rationale
Monitoring peripheral pulses every 8 hours is not a specific intervention for a client who has acute pancreatitis. While it is important to monitor peripheral pulses as part of overall patient assessment, it does not directly address the needs of a patient with acute pancreatitis.
Choice B rationale
Ambulating the client three times daily is not a specific intervention for a client who has acute pancreatitis. While physical activity is generally beneficial for overall health, it does not directly address the needs of a patient with acute pancreatitis, especially during an acute attack.
Choice C rationale
Maintaining NPO (nothing by mouth) status is a common intervention for a client who has acute pancreatitis. This allows the pancreas to rest and recover, reducing inflammation and pain.
Choice D rationale
Measuring urine output every 4 hours is not a specific intervention for a client who has acute pancreatitis. While it is important to monitor urine output as part of overall patient assessment, it does not directly address the needs of a patient with acute pancreatitis.

A. Administer pain medication B. Prepare the client for surgery C. Initiate IV fluid resuscitation D. Obtain a stat abdominal X-ray

Correct Answer is B

Explanation

Choice A rationale
While administering pain medication may provide temporary relief, it does not address the underlying issue of a perforated ulcer, which is a medical emergency.
Choice B rationale

Preparing the client for surgery is the priority action for a nurse when a perforated ulcer is suspected. A perforated ulcer is a medical emergency that often requires immediate surgery.
Choice C rationale
Initiating IV fluid resuscitation may be part of the management for a suspected perforated ulcer, but it is not the first priority. The first priority is to stabilize the patient and prepare for possible surgery.
Choice D rationale
Obtaining a stat abdominal X-ray may help confirm the diagnosis of a perforated ulcer, but it is not the first priority. The first priority is to stabilize the patient and prepare for possible surgery.

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A nurse is collecting data on a client who has acute pancreatitis. Which of the following factors should the nurse anticipate in the client’s history?

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Naxlex Comprehensive Predictor Exams

A nurse is contributing to the plan of care for a client who has acute pancreatitis. Which of the following interventions should the nurse include?

Correct Answer is C

Explanation

A client presents to the emergency department with severe abdominal pain. The client’s history reveals a previous diagnosis of peptic ulcer disease. The nurse suspects a perforated ulcer. What is the priority action by the nurse?

Correct Answer is B

Explanation

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A nurse is collecting data on a client who has acute pancreatitis.
Which of the following factors should the nurse anticipate in the client’s history?