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A nurse cares for a client with end-stage pancreatic cancer. The client asks, 'Why is this happening to me?' How should the nurse respond?
- A. I don't know. I wish I had an answer for you, but I don't.
- B. It helps to keep a positive attitude for your family right now.
- C. Scientists have not determined why cancer develops in certain people.
- D. I think this is a trial so you can become a better person because of it.
Correct Answer: A
Rationale: The client is not asking the nurse to actually explain why the cancer has occurred. The client may be experiencing feelings of confusion, frustration, distress, and grief related to the diagnosis. The nurse should validate that there is no easy or straightforward answer as to why the client has cancer. Other options do not address the client's emotions or current concerns.
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After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
- A. The capsules can be opened and the powder sprinkled on applesauce if needed.
- B. I will take the enzymes with a small sip of water.
- C. The best time to take the enzymes is immediately after I have a meal or a snack.
- D. I will not mix the enzyme powder with food or liquids that contain protein.
Correct Answer: C
Rationale: The enzymes should be taken immediately before eating meals or snacks. If the client cannot swallow the capsule, they can be opened and the powder sprinkled on applesauce or similar foods. The client should wipe their lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.
A nurse cares for a client with acute pancreatitis who is prescribed gentamicin (Garamycin) 3 mg/kg/day in 3 divided doses. The client's weight is 264 lb. How many milligrams should the nurse administer for each dose? (Record your answer using a whole number.)
Correct Answer: 120 mg/dose
Rationale: 264 lb (120 kg) ? 3 mg/kg/day = 360 mg/day. 360 mg/day ÷ 3 divided doses = 120 mg/dose.
A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort?
- A. Administer morphine sulfate intravenously every 4 hours as needed.
- B. Maintain nothing by mouth (NPO) and administer intravenous fluids.
- C. Provide small, frequent feedings with no concentrated sweets.
- D. Place the client in semi-Fowler's position with the head of bed elevated.
Correct Answer: B
Rationale: The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 5 hours. A fetal position with legs drawn up to the chest will promote comfort.
A nurse cares for a client with acute pancreatitis. The client states, 'I am hungry.' How should the nurse reply?
- A. Are your bowels rumbling, or do you have bowel sounds?
- B. I need to check your gag reflex before you can eat.
- C. You will not be able to eat until the pain subsides.
- D. You can have a small snack to tide you over.
Correct Answer: C
Rationale: Paralytic ileus is a common complication of acute pancreatitis. The client should not eat until this has resolved. Bowel sounds and decreased pain are not reliable indicators of peristalsis. Instead, the nurse should assess for passage of flatus or bowel movement.
A nurse cares for a client who has obstructive jaundice. The client asks, 'Why is my skin so itchy?' How should the nurse respond?
- A. Bile salts accumulate in the skin and cause the itching.
- B. Toxes released from an inflamed gallbladder lead to itching.
- C. The nurse assesses the client who is itching.
- D. Itching is caused by a hypersensitivity reaction.
Correct Answer: A
Rationale: In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.