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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.
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The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has been moved to an air bed. What would be the nurses best response?
- A. Air beds allow the care team to reposition her more easily while shes on bed rest.
- B. Air beds are far more comfortable than regular beds and shell likely have to be on bed rest a long time.
- C. The bed automatically moves, so shes less likely to develop pressure sores while shes in bed.
- D. The bed automatically moves, so she is likely to have less pain.
Correct Answer: C
Rationale: It is important to turn the patient every 2 hours; use of specialty beds may be indicated to prevent skin breakdown. The rationale for a specialty bed is not related to repositioning, comfort, or ease of movement.
A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that over 80% of the patients pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurses best response?
- A. The symptoms of pancreatitis mimic those of much less serious illnesses.
- B. Your body doesnt require pancreatic function until it is under great stress, so it is easy to go unnoticed.
- C. Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.
- D. Your other organs were compensating for your decreased pancreatic function.
Correct Answer: C
Rationale: By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been lost. Late detection is not usually attributable to the vagueness of symptoms. The pancreas contributes continually to homeostasis and other organs are unable to perform its physiologic functions.
A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?
- A. Sudden increase in random blood glucose readings
- B. Increased abdominal girth accompanied by decreased level of consciousness
- C. Fever, increased heart rate and decreased blood pressure
- D. Abdominal pain unresponsive to analgesics
Correct Answer: C
Rationale: Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS). Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis.
A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?
- A. Laparoscopic cholecystectomy
- B. Methyl tertiary butyl ether (MTBE) infusion
- C. Intracorporeal lithotripsy
- D. Extracorporeal shock wave therapy (ESWL)
Correct Answer: A
Rationale: Most of the nonsurgical approaches, including lithotripsy and dissolution of gallstones, provide only temporary solutions to gallstone problems and are infrequently used in the United States. Cholecystectomy is the preferred treatment.
A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test?
- A. Glucose tolerance test
- B. ERCP
- C. Pancreatic biopsy
- D. Abdominal ultrasonography
Correct Answer: A
Rationale: A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making decisions about surgical resection of the pancreas. This specific clinical information is not provided by ERCP, biopsy, or ultrasound.