An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

Choice A reason: Potatoes are gluten-free, safe for celiac disease, as they lack wheat, barley, or rye proteins. They provide carbohydrates without triggering villous atrophy in the small intestine, indicating the client’s correct understanding of dietary restrictions, requiring no further teaching for this choice.

Choice B reason: Corn chips, if made from corn, are gluten-free and safe for celiac disease. They avoid gluten-containing grains, preventing intestinal inflammation. This choice reflects proper dietary knowledge, as corn does not contain gliadin, making it appropriate and requiring no additional instruction.

Choice C reason: Fried rice may contain gluten if prepared with soy sauce, which often includes wheat. This choice suggests potential misunderstanding, but oatmeal’s gluten content is more definitive, as rice can be gluten-free if prepared correctly, making this less incorrect than oatmeal.

Choice D reason: Oatmeal often contains gluten due to cross-contamination with wheat during processing, triggering celiac disease’s autoimmune response, damaging intestinal villi. This choice indicates a need for teaching, as gluten-free oats are required, and the client must avoid standard oatmeal to prevent symptoms.

Choice A reason: Pancreatitis is indicated by elevated amylase and lipase, abdominal pain radiating to the back, vomiting, and fever. Cholecystectomy can trigger pancreatic inflammation due to bile duct manipulation or gallstone migration, causing enzyme leakage, making this the condition to observe for based on the findings.

Choice B reason: Peritonitis causes diffuse abdominal pain and fever but not typically elevated pancreatic enzymes. Post-cholecystectomy, localized pain and specific amylase/lipase elevation point to pancreatitis, not peritoneal infection, making this condition less likely based on the client’s presentation.

Choice C reason: Cholangitis involves bile duct infection, causing jaundice and right-upper-quadrant pain, but not elevated amylase/lipase. The client’s pancreatic enzyme elevation and back-radiating pain align with pancreatitis, not bile duct inflammation, making this condition incorrect for the observed findings.

Choice D reason: Ileus causes vomiting and abdominal distension but not elevated pancreatic enzymes or back-radiating pain. Pancreatitis better explains the client’s enzyme levels, pain pattern, and fever post-cholecystectomy, as ileus lacks specific pancreatic involvement, making this condition unlikely.