In planning the care for a patient with acute pancreatitis, the nurse should make which of these goals the highest?

Effective pain management.

Decrease patient anxiety.

Adequate hydration achieved.

Decrease potassium intake.

Answer and Explanation

The Correct Answer is A

Choice A reason: Effective pain management is the highest priority in the care of a patient with acute pancreatitis. Severe abdominal pain is a hallmark of acute pancreatitis and can significantly impact the patient's comfort and ability to participate in other aspects of their care. Managing pain effectively helps improve the patient's overall well-being and allows for better participation in treatments and recovery.

Choice B reason: Decreasing patient anxiety is important, but it is not the primary goal in the acute management of pancreatitis. Addressing anxiety can help improve the patient's experience and adherence to treatment, but managing pain and hydration are more critical in the immediate care.

Choice C reason: Adequate hydration is crucial in the management of acute pancreatitis, as dehydration can worsen the condition and lead to complications. However, pain management takes precedence because uncontrolled pain can lead to further stress and complications, hindering the effectiveness of hydration and other treatments.

Choice D reason: Decreasing potassium intake is not a primary goal in the management of acute pancreatitis. While electrolyte balance is important, there is no direct indication that potassium levels need to be specifically managed unless there is a documented imbalance. The focus should be on pain management and hydration.

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Correct Answer is D

Explanation

Choice A reason: An increased albumin level, while noteworthy, is not typically an urgent finding to communicate immediately following paracentesis. Albumin levels can fluctuate for various reasons, and elevated levels do not generally indicate a critical issue requiring immediate intervention.

Choice B reason: A normal platelet count is a good sign, indicating that the patient has an adequate number of platelets for blood clotting and wound healing. This finding does not indicate an urgent need to notify the healthcare provider immediately.

Choice C reason: A 2-cm area of serous drainage on the dressing is relatively small and expected after a procedure like paracentesis. It suggests that the site is draining some fluid, which is normal post-procedure. While it should be monitored, it does not necessitate urgent communication unless it worsens or there are signs of infection.

Choice D reason: A heart rate of 122 beats/min is tachycardia and can indicate several potential complications, including hypovolemia (low blood volume) due to the large fluid removal, infection, or other stressors on the patient's body. This finding is the most critical to communicate to the healthcare provider promptly as it may require immediate intervention to address the underlying cause and stabilize the patient.

A. Decreased heart rate. B. Decrease in chest pain. C. Hypokalemia. D. Decreased blood pressure.

Correct Answer is D

Explanation

Choice A reason: A decreased heart rate is not a typical outcome of ACE inhibitor therapy. ACE inhibitors primarily work by relaxing blood vessels, which lowers blood pressure. They do not directly affect the heart rate. While some blood pressure medications can influence heart rate, this is not a common effect of ACE inhibitors like lisinopril.

Choice B reason: A decrease in chest pain is also not a primary outcome of ACE inhibitor therapy. While lowering blood pressure can help reduce the workload on the heart and potentially decrease angina (chest pain), this is more of an indirect effect. ACE inhibitors are primarily used for hypertension and heart failure, not specifically for pain relief.

Choice C reason: Hypokalemia, or low potassium levels, is not an expected outcome of taking an ACE inhibitor. In fact, ACE inhibitors can lead to hyperkalemia (high potassium levels) because they decrease aldosterone production, which causes the body to retain potassium. Patients on ACE inhibitors are often monitored for signs of hyperkalemia rather than hypokalemia.

Choice D reason: The correct and expected outcome of taking lisinopril, an ACE inhibitor, is decreased blood pressure. ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By reducing levels of angiotensin II, ACE inhibitors help relax blood vessels, which lowers blood pressure and makes it easier for the heart to pump blood. This is the primary therapeutic effect of the medication.

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In planning the care for a patient with acute pancreatitis, the nurse should make which of these goals the highest?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the healthcare provider (HCP)?

Correct Answer is D

Explanation

The nurse is caring for a client who is receiving the ACE inhibitor lisinopril. Which of the following outcomes should the nurse anticipate?

Correct Answer is D

Explanation

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