A nurse reads in a drug information guide that PO (oral) morphine has a high first-pass effect. Which of the following statements would demonstrate the nurse's understanding of the first-pass effect?

Choice A reason:
Alcohol abuse is the leading cause of chronic pancreatitis in many cases. Chronic alcohol consumption leads to repeated episodes of pancreatic inflammation, resulting in fibrosis, loss of pancreatic function, and structural damage. Alcohol directly stimulates pancreatic secretions and contributes to the formation of protein plugs that obstruct pancreatic ducts, exacerbating the condition.
Choice B reason:
Bulimia is not a known contributing factor for chronic pancreatitis. While eating disorders can have gastrointestinal manifestations, they do not directly lead to the chronic inflammatory process seen in pancreatitis.
Choice C reason:
A history of gallstones is a recognized contributing factor to chronic pancreatitis. Gallstones can intermittently block the pancreatic duct, leading to inflammation and damage over time. While gallstones are more commonly associated with acute pancreatitis, they also play a role in the chronic form if untreated or recurrent.
Choice D reason:
Bacterial infection is not a primary contributing factor to chronic pancreatitis. While infections can complicate pancreatic conditions, they do not typically initiate the chronic inflammatory process. Chronic pancreatitis is more often caused by mechanical, toxic, or genetic factors rather than infectious agents.

Choice A reason:
Hypotension is not the likely cause of chest pain that does not improve after sublingual Nitroglycerin in a patient with a history of atherosclerosis. While hypotension can cause symptoms, the description of chest pain at rest that does not respond to Nitroglycerin suggests a more severe cardiac issue.

Choice B reason:
Stable angina typically occurs with exertion and is relieved by rest or Nitroglycerin. Chest pain consistent at rest that does not improve with Nitroglycerin suggests unstable angina, which is a more serious condition and requires immediate medical attention.

Choice C reason:
Unstable angina is the correct answer. It occurs when chest pain happens at rest and is not relieved by Nitroglycerin, indicating that the blood flow to the heart is severely restricted. This condition is a medical emergency as it can lead to a myocardial infarction.

Choice D reason:
Coronary vasodilation would typically relieve chest pain by increasing blood flow to the heart. The pain described is more consistent with unstable angina, where there is a significant reduction in blood flow to the heart that does not respond to vasodilation.