The nurse should anticipate which of these dietary measures for a patient admitted with a diagnosis of acute pancreatitis?

Maintain NPO status.

Soft, bland diet.

Regular diet.

Low-fat, high-fiber diet.

Answer and Explanation

The Correct Answer is A

Choice A reason: Maintaining NPO (nothing by mouth) status is essential for patients with acute pancreatitis. This allows the pancreas to rest and decreases the secretion of pancreatic enzymes, reducing inflammation and promoting healing. NPO status is typically maintained until the patient's symptoms improve and the inflammation subsides.

Choice B reason: A soft, bland diet is not appropriate for the initial management of acute pancreatitis. Introducing food too early can stimulate pancreatic enzyme production and worsen inflammation. Once the patient stabilizes, dietary recommendations may include a gradual reintroduction of low-fat, bland foods.

Choice C reason: A regular diet is not suitable for patients with acute pancreatitis. Consuming a regular diet can exacerbate symptoms and inflammation by stimulating pancreatic enzyme secretion. Patients need to follow a more controlled dietary plan to manage their condition effectively.

Choice D reason: A low-fat, high-fiber diet is beneficial for general health but not for the initial management of acute pancreatitis. Once the patient's condition stabilizes and they are no longer NPO, a low-fat diet may be introduced gradually to avoid stimulating pancreatic enzyme production.

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Correct Answer is B

Explanation

Choice A reason: Administering 2 tablets of digoxin 0.125 mg would provide the correct dosage of 0.25 mg. However, given the client's heart rate of 54/min, administering the medication could further lower the heart rate, which can be dangerous. The nurse should withhold the medication and notify the physician.

Choice B reason: Withholding the digoxin dose for decreased heart rate is the correct action. Digoxin is used to slow down the heart rate and strengthen heart contractions. A heart rate of 54/min is considered bradycardia (slow heart rate), and administering digoxin could exacerbate the bradycardia, leading to potential complications such as heart block or severe arrhythmias. Therefore, it is critical to withhold the medication and inform the physician of the client's current heart rate.

Choice C reason: Administering one tablet of digoxin 0.125 mg would not provide the full prescribed dose of 0.25 mg. More importantly, the client's low heart rate makes it unsafe to administer any dose of digoxin at this time.

Choice D reason: Withholding the digoxin dose for elevated blood pressure is not appropriate. Although the client has elevated blood pressure (144/96), the more immediate concern is the low heart rate. Digoxin affects heart rate more than blood pressure, and the risk of exacerbating bradycardia takes precedence.

A. Initiate a bowel regimen program. B. Apply tight-fitting clothing. C. Complete frequent skin checks. D. Restrict all patient visitors. E. Insert an indwelling Foley catheter.

Correct Answer is ["A","C","E"]

Explanation

Choice A reason: Initiating a bowel regimen program is essential to avoid constipation, which can be a trigger for autonomic dysreflexia in patients with spinal cord injuries. Ensuring regular bowel movements helps prevent the discomfort and complications that can lead to this potentially life-threatening condition.

Choice B reason: Applying tight-fitting clothing is contraindicated as it can cause skin irritation, pressure sores, and other discomforts that could trigger autonomic dysreflexia. Loose and comfortable clothing is recommended to prevent these issues.

Choice C reason: Completing frequent skin checks is crucial for detecting and preventing pressure ulcers, skin infections, and other skin conditions that can act as noxious stimuli, triggering autonomic dysreflexia. Regular skin assessments help ensure early identification and management of potential issues.

Choice D reason: Restricting all patient visitors is not necessary for preventing autonomic dysreflexia. While it is important to manage the patient's environment and stress levels, complete visitor restriction is not a standard intervention for this condition.

Choice E reason: Inserting an indwelling Foley catheter is beneficial for managing bladder function and preventing urinary retention, a common trigger for autonomic dysreflexia. Continuous bladder drainage helps prevent distention and the subsequent risk of triggering this condition.

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The nurse should anticipate which of these dietary measures for a patient admitted with a diagnosis of acute pancreatitis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

The nurse is caring for a mechanically ventilated spinal cord injury patient in the ICU. To avoid the complication of autonomic dysreflexia, the nurse plans to implement the following orders: Select all that apply.

Correct Answer is ["A","C","E"]

Explanation

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