The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? (Select all that apply)
Maintain NPO (nothing by mouth) status.
Encourage coughing and deep breathing.
Give small, frequent high-calorie feedings.
Maintain the client in a supine and flat position.
Give hydromorphone intravenously as prescribed for pain.
Maintain intravenous fluids at 10 mL/hr to keep the vein open.
Correct Answer : A,B,E
Choice A reason: NPO status rests the pancreas, reducing enzyme secretion in acute pancreatitis. This aligns with treatment protocols, making it a correct intervention the nurse would expect to be prescribed for the client to manage pancreatic inflammation effectively.
Choice B reason: Coughing and deep breathing prevent respiratory complications like atelectasis in pancreatitis patients, who are often immobile. This aligns with standard care, making it a correct intervention the nurse would anticipate in the client’s treatment plan.
Choice C reason: Small, frequent high-calorie feedings are contraindicated in acute pancreatitis, as they stimulate the pancreas. NPO is correct, making this incorrect, as it’s inappropriate for the nurse’s expected interventions in managing acute pancreatitis.
Choice D reason: Supine and flat positioning may increase discomfort and aspiration risk in pancreatitis. Semi-Fowler’s is preferred, making this incorrect, as it’s not an expected intervention compared to the nurse’s focus on optimal positioning for the client.
Choice E reason: Hydromorphone IV provides effective pain relief in acute pancreatitis, reducing patient discomfort. This aligns with pain management protocols, making it a correct intervention the nurse would expect to be prescribed for the client’s care.
Choice F reason: IV fluids at 10 mL/hr are insufficient for pancreatitis, which requires aggressive hydration. Higher rates are standard, making this incorrect, as it’s inadequate compared to the nurse’s expected fluid management in acute pancreatitis treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Pulse pressure is calculated as systolic (90) minus diastolic (72), equaling 18 mm Hg, not 40. This is incorrect, as it overestimates the pulse pressure, unlike the nurse’s accurate calculation based on the patient’s blood pressure readings.
Choice B reason: A pulse pressure of 25 mm Hg doesn’t match the calculation of 90 minus 72, which is 18 mm Hg. This is incorrect, as it’s inaccurate compared to the nurse’s correct determination of the patient’s pulse pressure from the given values.
Choice C reason: Pulse pressure is systolic (90 mm Hg) minus diastolic (72 mm Hg), equaling 18 mm Hg. This aligns with cardiovascular assessment, making it the correct value the nurse would calculate for the patient’s blood pressure of 90/72 mm Hg.
Choice D reason: A pulse pressure of 12 mm Hg is incorrect, as 90 minus 72 equals 18 mm Hg. This underestimates the value, making it incorrect compared to the nurse’s accurate calculation of the patient’s pulse pressure based on the blood pressure.
Correct Answer is D
Explanation
Choice A reason: Antibiotics treat infection, but fever, tenderness, and rising creatinine suggest rejection, not infection. Immunosuppression addresses rejection, making this incorrect, as it’s less likely than the nurse’s anticipation of therapy to manage transplant rejection in the client.
Choice B reason: Peritoneal dialysis is used for kidney failure, not acute transplant rejection, which causes fever and creatinine rise. Immunosuppression is needed, making this incorrect, as it’s irrelevant to the nurse’s expected treatment for the client’s post-transplant symptoms.
Choice C reason: Removing the kidney is a last resort, not the first response to rejection signs like fever and tenderness. Increased immunosuppression is standard, making this incorrect, as it’s premature compared to the nurse’s anticipation of rejection management.
Choice D reason: Increased immunosuppression treats acute transplant rejection, indicated by fever, tenderness, rising creatinine, and kidney enlargement. This aligns with post-transplant care, making it the correct treatment the nurse would anticipate for the client’s symptoms one week after transplantation.
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