Nokea
A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize?
- A. Disturbed Body Image
- B. Impaired Skin Integrity
- C. Nausea
- D. Risk for Deficient Fluid Volume
Correct Answer: B
Rationale: While each of the diagnoses may be applicable to a patient with pancreatic drainage, the priority nursing diagnosis is Impaired Skin Integrity. The drainage is often perfuse and destructive to tissue because of the enzyme contents. Nursing measures must focus on steps to protect the skin near the drainage site from excoriation. The application of ointments or the use of a suction apparatus protects the skin from excoriation.
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A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this patient?
- A. Oral oxycodone
- B. IV hydromorphone (Dilaudid)
- C. IM meperidine (Demerol)
- D. Oral naproxen (Aleve)
Correct Answer: B
Rationale: The pain of acute pancreatitis is often very severe and pain relief may require parenteral opioids such as morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). There is no clinical evidence to support the use of meperidine for pain relief in pancreatitis. Opioids are preferred over NSAIDs.
A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the patient is most likely to require which of the following?
- A. Inpatient rehabilitation
- B. Rehabilitation in the home setting
- C. Intensive physical therapy
- D. Hospice care
Correct Answer: D
Rationale: Pancreatic carcinoma has only a 5% survival rate at 5 years regardless of the stage of disease at diagnosis or treatment. As a result, there is a higher likelihood that the patient will require hospice care than physical therapy and rehabilitation.
A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients laboratory studies, what finding is most closely associated with this diagnosis?
- A. Increased bilirubin
- B. Decreased serum cholesterol
- C. Increased blood urea nitrogen (BUN)
- D. Decreased serum alkaline phosphatase level
Correct Answer: A
Rationale: If the flow of blood is impeded, bilirubin, a pigment derived from the breakdown of red blood cells, does not enter the intestines. As a result, bilirubin levels in the blood increase. Cholesterol, BUN, and alkaline phosphatase levels are not typically affected.
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 nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?
- A. Fried chicken
- B. Mashed potatoes
- C. Dinner roll
- D. Tapioca pudding
Correct Answer: A
Rationale: The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The patient should avoid fried foods such as fried chicken, as fatty foods may bring on an episode of cholecystitis.