Tissue damage in pancreatitis is initially triggered by:

Choice A reason:
Morphine is not most effective when given orally due to the high first-pass effect. The first-pass effect refers to the metabolism of a drug in the liver immediately after it enters the bloodstream from the gastrointestinal tract, significantly reducing the amount of active drug that reaches systemic circulation. Therefore, oral administration of morphine is not the most effective route because much of it is metabolized before it can exert its effect.

Choice B reason:
Morphine will be more effective when given via a non-enteral route such as intravenous (IV) or subcutaneous (SQ) because these routes bypass the liver, thereby avoiding the first-pass metabolism. This allows a higher concentration of the active drug to reach the systemic circulation, providing a more potent and effective pain relief.

Choice C reason:
Oral and IV administration of morphine do not have the same effect due to the first-pass metabolism. When morphine is administered orally, a significant amount is metabolized by the liver before it reaches the systemic circulation, whereas IV administration delivers the drug directly into the bloodstream, bypassing the liver and allowing a higher active concentration.

Choice D reason:
Morphine is not primarily excreted by the lungs; it is mainly metabolized by the liver and excreted by the kidneys. This statement does not accurately demonstrate an understanding of the first-pass effect or the pharmacokinetics of morphine.

Choice A reason:
Telling the patient to stop taking the medication if they experience constipation is not appropriate. While side effects should be reported to the healthcare provider, discontinuing the medication without professional guidance can lead to inadequate management of cholesterol levels. The nurse should advise the patient to consult their provider about any side effects.

Choice B reason:
Continuing an exercise program to increase HDL serum levels is important advice. Regular physical activity is beneficial in raising HDL (good cholesterol) levels, which help reduce the risk of heart disease. Exercise complements the effects of cholesterol-lowering medications and supports overall cardiovascular health.

Choice C reason:
Stating that the medication will replace other interventions is incorrect. Cholesterol-lowering medications should be part of a comprehensive treatment plan that includes lifestyle modifications such as diet, exercise, and weight management. These interventions work synergistically to improve lipid profiles and reduce cardiovascular risk.

Choice D reason:
Doubling the dose if a dose is missed is unsafe and not recommended. Patients should follow their prescribed dosing schedule and consult their healthcare provider for instructions if they miss a dose. Taking an extra dose can increase the risk of adverse effects and complications.