The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Select all that apply) Select all that apply

Polyuria

Jaundice

Weight gain

Ascites

Steatorrhea

Polydipsia

Answer and Explanation

Correct Answer : A,B,E,F

Chronic pancreatitis is a progressive inflammatory disorder characterized by the irreversible destruction of pancreatic parenchyma and its replacement with fibrotic tissue. This results in both exocrine and endocrine insufficiency. The loss of acinar cells leads to malabsorption, while the destruction of Islets of Langerhans results in secondary diabetes mellitus. Clinical manifestations reflect the body’s inability to digest fats and regulate systemic glucose homeostasis.

Rationale:

A. Polyuria is expected in chronic pancreatitis due to the destruction of beta cells in the pancreas, leading to secondary diabetes mellitus. When insulin production fails, blood glucose rises, exceeding the renal threshold for reabsorption. This leads to osmotic diuresis, where the excess glucose in the urine pulls water with it, increasing the frequency and volume of urination.

B. Jaundice occurs in chronic pancreatitis when fibrotic changes or inflammation in the head of the pancreas compress the common bile duct. This mechanical obstruction prevents the flow of bile into the duodenum, causing conjugated bilirubin to back up into the bloodstream. This manifests as yellowing of the skin and sclera, indicating impaired biliary drainage due to pancreatic structural damage.

C. Weight gain is not expected; instead, weight loss is a hallmark of chronic pancreatitis. The loss of exocrine enzymes means the body cannot break down and absorb nutrients effectively. Combined with the metabolic demands of chronic inflammation and the onset of diabetes, patients typically present with significant malnutrition and unintentional weight loss over time.

D. Ascites is primarily a complication of liver cirrhosis and portal hypertension, rather than chronic pancreatitis. While pancreatic ascites can occur in rare cases of ductal rupture, it is not a standard finding. The primary pathological process in chronic pancreatitis involves parenchymal fibrosis and enzyme deficiency rather than the systemic venous congestion that typically produces peritoneal fluid accumulation.

E. Steatorrhea, or fatty, foul-smelling stools, is a classic finding resulting from exocrine insufficiency. Without adequate lipase secretion, the body cannot emulsify and absorb dietary lipids. The undigested fat remains in the intestinal lumen, leading to stools that are voluminous, greasy, and difficult to flush. This signifies a total breakdown of the digestive function of the pancreas.

F. Polydipsia, or excessive thirst, is a direct consequence of the hyperglycemia-induced polyuria associated with pancreatic endocrine failure. As the patient loses large volumes of fluid through the kidneys, the thirst center in the hypothalamus is stimulated to prevent dehydration. This is a key symptom of the secondary diabetes that develops as the Islets of Langerhans are destroyed.

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Correct Answer is D

Explanation

A perforated ulceroccurs when an erosion extends through the entire thickness of the gastrointestinal wall. This allows gastric or duodenal contents, including acid and bacteria, to leak into the peritoneal cavity. The resulting chemical peritonitiscauses an intense inflammatory response and severe muscle guarding, which is a clinical emergency requiring immediate surgical intervention to prevent sepsis.

Rationale:

A.A positive McBurney point refers to tenderness in the right lower quadrant and is a classic sign of acute appendicitis. While it indicates peritoneal irritation, it is anatomically misplaced for a duodenal ulcer, which is located in the upper gastrointestinal tract. A perforated ulcer would more likely cause generalized abdominal tenderness or upper quadrant pain.

B.Nausea and profuse vomiting are non-specific symptoms that can occur with many gastrointestinal disorders, including simple gastritis or bowel obstruction. While they may accompany a perforation, they do not provide the definitive evidence of peritoneal irritation that a physical exam finding does. Many patients with a sudden perforation may actually be in too much shock to vomit.

C.Absent bowel sounds can occur in the later stages of peritonitis as a paralytic ileus develops. However, this is a late and somewhat subjective finding. In the acute phase of a perforation, the most striking and diagnostic physical finding is the characteristic change in the abdominal wall's muscular tone in response to the chemical burn.

D.A rigid, board-like abdomenis the hallmark sign of a perforated ulcer. This is caused by involuntary muscle spasms and guarding as the peritoneum reacts to the leakage of acidic gastric contents. This "surgical abdomen" indicates a peritoneal emergencyand is the most significant assessment finding supporting a diagnosis of acute perforation and subsequent peritonitis.

A. "Notify the primary health care provider if output from your stoma has a sweetish odor.” B. "Remember that you must wear a pouch system at all times.” C. "Call your primary health care provider if your stoma has a bluish or pale look." D. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present."

Correct Answer is C

Explanation

An ileostomyinvolves the surgical creation of an opening into the ileum, bypassing the entire colon. The resulting stoma must be vibrant and moist, reflecting adequate microvascular perfusion. Any compromise in the arterial supply or venous drainage of the stoma can lead to tissue necrosisand ischemia, making visual inspection of the stoma the most critical postoperative nursing assessment for viability.

Rationale:

A.A sweetish odor from ileostomy output is not a clinical emergency and can be influenced by diet or medications. While changes in odor are worth noting for the patient's comfort, they do not indicate a life-threatening complication. Odor management is a secondary concern compared to the physical integrity and blood supply of the newly created stoma.

B.While it is true that an ileostomy pouch must be worn at all times because the output is continuous and liquid, this is a lifestyle and hygiene instruction. It does not address the immediate surgical safety of the patient. The most important information must always prioritize the detection of acute physiological failure, such as the loss of blood flow.

C.Calling the provider if the stoma is bluish or pale is the most important instruction because it indicates ischemiaor infarction. A healthy stoma should be beefy red or pink, signifying adequate oxygenation. A color change to blue, purple, or pale signifies a lack of blood perfusion, which is a surgical emergency requiring immediate intervention to save the tissue.

D.Describing the initial postoperative output is helpful for setting expectations, but it is a normal finding rather than a warning sign of a complication. Dark green liquid is common as the bowel begins to function. While the patient should know this is normal, the priority of teaching must always be focused on identifying abnormal, dangerous changes in stoma health.

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The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Select all that apply) Select all that apply

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who is diagnosed with a perforated duodenal ulcer. Which assessment finding supports the diagnosis?

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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