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A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem?
- A. Severe pancreatitis with possible peritonitis
- B. Acute cholecystitis
- C. Chronic pancreatitis
- D. Acute appendicitis with possible perforation
Correct Answer: A
Rationale: Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis.
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A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?
- A. The need to protect the incision postprocedure
- B. The use of moderate sedation
- C. The need to infuse 50% dextrose during the procedure
- D. The use of general anesthesia
Correct Answer: B
Rationale: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the procedure does not involve the creation of an incision.
A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The patient asks how this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drugs pharmacodynamics?
- A. It inhibits the synthesis of bile.
- B. It inhibits the synthesis and secretion of cholesterol.
- C. It inhibits the secretion of bile.
- D. It inhibits the synthesis and secretion of amylase.
Correct Answer: B
Rationale: UDCA acts by inhibiting the synthesis and secretion of cholesterol, thereby desaturating bile. UDCA does not directly inhibit either the synthesis or secretion of bile or amylase.
A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain?
- A. Aspirin every 4 to 6 hours as ordered
- B. Application of heat 15 to 20 minutes each hour
- C. Application of an ice pack for no more than 15 minutes
- D. Application of liniment rub to affected area
Correct Answer: B
Rationale: If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the abdominal cavity during the procedure), the nurse may recommend use of a heating pad for 15 to 20 minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding.
A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick gallbladder. What rationale would underlie the nurses response?
- A. Surgery is delayed until the patient can eat a regular diet without vomiting.
- B. Surgery is delayed until the acute symptoms subside.
- C. The patient requires aggressive nutritional support prior to surgery.
- D. Time is needed to determine whether a laparoscopic procedure can be used.
Correct Answer: B
Rationale: Unless the patients condition deteriorates, surgical intervention is delayed just until the acute symptoms subside (usually within a few days). There is no need to delay surgery pending an improvement in nutritional status, and deciding on a laparoscopic approach is not a lengthy process.
A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply.
- A. How many alcoholic drinks do you typically consume in a week?
- B. Have you ever been tested for diabetes?
- C. Have you ever been diagnosed with gallstones?
- D. Would you say that you eat a particularly high-fat diet?
- E. Does anyone in your family have cystic fibrosis?
Correct Answer: A,C
Rationale: Eighty percent of patients with acute pancreatitis have biliary tract disease such as gallstones or a history of long-term alcohol abuse. Diabetes, high-fat consumption, and cystic fibrosis are not noted etiologic factors.