Download The Client with Pancreatitis

The Client with Pancreatitis
15. A client has an amylase level of 450 units/L
and lipase level of 659 units/L. The client has
mid-epigastric pain with nausea. What assessment
helps the nurse to determine severity of the client’s
condition?
■ 1. Ranson’s criteria.
■ 2. Vital signs.
■ 3. Urine output.
■ 4. Glasgow Coma Scale.
16. The client who has been hospitalized with
pancreatitis does not drink alcohol because of her
religious convictions. She becomes upset when
the physician persists in asking her about alcohol
intake. The nurse should explain that the reason for
these questions is that:
■ 1. There is a strong link between alcohol use
and acute pancreatitis.
■ 2. Alcohol intake can interfere with the tests
used to diagnose pancreatitis.
■ 3. Alcoholism is a major health problem, and all
clients are questioned about alcohol intake.
■ 4. The physician must obtain the pertinent facts,
regardless of religious beliefs.
17. The nurse monitors the client with pancreatitis
for early signs of shock. Which of the following
conditions is primarily responsible for making it
diffi cult to manage shock in pancreatitis?
■ 1. Severity of intestinal hemorrhage.
■ 2. Vasodilating effects of kinin peptides.
■ 3. Tendency toward heart failure.
■ 4. Frequent incidence of acute tubular necrosis.
18. A client with acute pancreatitis has a blood
pressure of 88/40, heart rate of 128 beats per minute,
respirations of 28 per minute, and Grey Turner’s
sign. What action should the nurse perform fi rst?
■ 1. Assess the urine output.
■ 2. Place an intravenous line.
■ 3. Position on the left side.
■ 4. Insert a nasogastric tube.
19. A client is admitted with acute necrotizing
pancreatitis. Lab results have been obtained and a
peripheral I.V. has been inserted. Which of the following
orders from a health care provider should
the nurse question?
■ 1. Infuse a 500 mL normal saline bolus.
■ 2. Calcium gluconate 90 mg in 100 mL NS.
■ 3. Total parenteral nutrition (TPN) at 72 mL/
hour.
■ 4. Placement of a Foley catheter.
20. Which of the following medications would
the nurse question for a client with acute pancreatitis?
■ 1. Furosemide (Lasix) 20 mg I.V. push.
■ 2. Imipenem (Primaxin) 500 mg I.V.
■ 3. Morphine Sulfate 2 mg I.V. push.
■ 4. Famotidine (Pepcid) 20 mg I.V. push.
21. The nurse should monitor the client with
acute pancreatitis for which of the following complications?
■ 1. Heart failure.
■ 2. Duodenal ulcer.
■ 3. Cirrhosis.
■ 4. Pneumonia.
22. When providing care for a client hospitalized
with acute pancreatitis who has acute abdominal
pain, which of the following nursing interventions
would be most appropriate for this client? Select all
that apply.
■ 1. Placing the client in a side-lying position.
■ 2. Administering morphine sulfate for pain as
needed.
■ 3. Maintaining the client on a high-calorie, highprotein
diet.
■ 4. Monitoring the client’s respiratory status.
■ 5. Obtaining daily weights.
23. The nurse notes that a client with acute pancreatitis
occasionally experiences muscle twitching
and jerking. How should the nurse interpret the
signifi cance of these symptoms?
■ 1. The client may be developing hypocalcemia.
■ 2. The client is experiencing a reaction to meperidine
(Demerol).
■ 3. The client has a nutritional imbalance.
■ 4. The client needs a muscle relaxant to help
him rest.
24. A client is receiving Propantheline bromide
(Pro-Banthine) in the management of acute pancreatitis.
Which of the following would indicate that the
nurse should withhold the medication?
■ 1. Absent bowel sounds.
■ 2. Increased urine output.
■ 3. Diarrhea.
■ 4. Decreased heart rate.
25. Which of the following dietary instructions
would be appropriate for the nurse to give a client
who is recovering from acute pancreatitis?
■ 1. Avoid crash dieting.
■ 2. Restrict carbohydrate intake.
■ 3. Eat six small meals a day.
■ 4. Decrease sodium in the diet.
26. Pancreatic enzyme replacements are ordered
for the client with chronic pancreatitis. When
should the nurse instruct the client to take them to
obtain the most therapeutic effect?
■ 1. Three times daily between meals.
■ 2. With each meal and snack.
■ 3. In the morning and at bedtime.
■ 4. Every 4 hours, at specifi ed times.
27. The nurse should teach the client with
chronic pancreatitis to monitor the effectiveness of
pancreatic enzyme replacement therapy by doing
which of the following?
■ 1. Monitoring fl uid intake.
■ 2. Performing regular glucose fi ngerstick tests.
■ 3. Observing stools for steatorrhea.
■ 4. Testing urine for ketones.
28. The client with chronic pancreatitis should
be monitored closely for the development of which
of the following disorders?
■ 1. Cholelithiasis.
■ 2. Hepatitis.
■ 3. Irritable bowel syndrome.
■ 4. Diabetes mellitus.
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Nursing Care of Clients with Pancreatic
Endocrine Disorders
A 23-year-old client manifests symptoms of hyperinsulinism.
56. In response to a question about timing of symptoms
during the nursing history, when is the client most likely to
describe that symptoms typically occur?
[ ] 1. After fasting more than 6 hours
[ ] 2. About 2 hours after eating a meal
[ ] 3. Late in the evening, before bedtime
[ ] 4. Early in the morning, before breakfast
A glucose tolerance test is ordered to determine if the
client has functional hypoglycemia.
57. Which instruction by the nurse concerning the test
procedure is most accurate?
[ ] 1. “You need to eat a large meal just before the test.”
[ ] 2. “Bring a voided urine specimen to the laboratory.”
[ ] 3. “You can drink coffee or tea in the morning before
the test.”
[ ] 4. “You will be given a sweetened drink before the
test.”
58. To reduce or eliminate the symptoms that a client
with functional hypoglycemia experiences, it is best for the
nurse to recommend eating fi ve or six small meals containing
which nutrient?
[ ] 1. Simple sugars
[ ] 2. Complete proteins
[ ] 3. Complex carbohydrates
[ ] 4. Unsaturated fats
59. Which of the following provides the best evidence
that the dietary measures to control functional hypoglycemia
are therapeutic?
[ ] 1. The client experiences fewer incidences of weakness
and tremors.
[ ] 2. The client experiences fewer incidences of thirst
and dry mouth.
[ ] 3. The client experiences fewer incidences of muscle
spasms and fatigue.
[ ] 4. The client experiences fewer incidences of hunger
and abdominal cramps.
A nurse participates in a community-wide screening
to identify adults who may have undiagnosed diabetes
mellitus.
60. If the screening includes a measurement of postprandial
blood glucose, the nurse is correct in explaining that
blood will be drawn at which time?
[ ] 1. Approximately 2 hours before breakfast
[ ] 2. Approximately 2 hours after a meal
[ ] 3. Approximately 2 hours before bedtime
[ ] 4. Approximately 2 hours after fasting
61. Which statement indicates that a client with an
elevated 2-hour postprandial blood glucose level understands
the signifi cance of the screening test?
[ ] 1. “I need to eat less frequently.”
[ ] 2. “I need to stop eating candy.”
[ ] 3. “I need to consult my physician.”
[ ] 4. “I need to begin taking insulin.”
62. Which signs and symptoms are most appropriate for
the nurse to investigate when screening adults who have
come to have their blood glucose tested?
[ ] 1. Diarrhea, anorexia, and weight gain
[ ] 2. Constipation, weight loss, and thirst
[ ] 3. Polycholia, polyemia, and polyplegia
[ ] 4. Polyuria, polydipsia, and polyphagia
After the screening test, one client is referred to a physician
for additional follow-up. Further diagnostic tests
confi rm that the client has type 2 diabetes mellitus.
63. When given the news, the client denies the diagnosis
and becomes angry, stating there has been a mistake in the
tests. Which nursing action is most appropriate at this time?
[ ] 1. Emphasizing the importance of treatment
[ ] 2. Reassuring the client that the disease is easily
managed
[ ] 3. Explaining that many people live with diabetes
[ ] 4. Listening as the client expresses current feelings
The client with newly diagnosed type 2 diabetes mellitus is
referred to the diabetes clinic for teaching.
64. When the client asks the nurse why regular exercise
is recommended for diabetic clients, the best answer is that
exercise tends to facilitate which positive outcome?
[ ] 1. Regular exercise helps to control weight.
[ ] 2. Regular exercise helps to decrease appetite.
[ ] 3. Regular exercise helps to reduce blood glucose levels.
[ ] 4. Regular exercise helps to improve circulation to
the feet.
A dietitian explains how to use the American Diabetes
Association exchange list.
65. Which statement by the client provides the best
evidence that the client understands the principle of an
exchange list for meal planning?
[ ] 1. “I can eat one serving from each category on the
exchange list per day.”
[ ] 2. “Measured amounts of food in each category are
equal to one another.”
[ ] 3. “The number of servings from the exchange list is
unlimited.”
[ ] 4. “I need to use the exchange list to determine the
nutrition in food.”
66. The nurse knows the diabetic client understands
what “free” foods on the exchange list means if the client
excludes which one of the following from a meal plan?
[ ] 1. Iced tea
[ ] 2. Flavored water
[ ] 3. Light beer
[ ] 4. Club soda
67. Using the Dietary Exchange Plan for a 1,500 calorie
diet in the chart below, which item is appropriate for the
diabetic client to have in the midafternoon?
Starch/
bread Meat Vegetable Fruit Milk Fat
Breakfast 2 1 1 1
Lunch 2 1 1 1 1
Snack 1
Dinner 2 2 1 1 2
Bedtime 1 1 1
[ ] 1. An 8-oz carton of milk
[ ] 2. Two graham crackers
[ ] 3. A medium apple
[ ] 4. A 2-oz slice of turkey
The physician prescribes glyburide (DiaBeta) orally for
the client to treat diabetes.
68. When the client asks why a diabetic relative cannot
take insulin orally, what is the best answer?
[ ] 1. Insulin is inactivated by digestive enzymes.
[ ] 2. Insulin is absorbed too quickly in the stomach.
[ ] 3. Insulin is irritating to the gastric mucosa.
[ ] 4. Insulin is incompatible with many foods.
69. The diabetic client tells the nurse that breakfast is
always skipped. Which response by the nurse is most
appropriate?
[ ] 1. “If you drink a glass of milk and eat a breakfast
bar, that will be suffi cient for breakfast.”
[ ] 2. “You should eat each meal and snack at the same
time each day.”
[ ] 3. “If you skip breakfast, eat a high-calorie snack at
midmorning.”
[ ] 4. “Wait to take your medication until you eat your
fi rst meal of the day.”
After the client is discharged from the hospital, the
physician wants the client to continue to self-monitor the
response to the diet and medication management.
70. Which monitoring approach is best for the nurse to
recommend?
[ ] 1. Testing the urine with a chemical reagent strip
[ ] 2. Using a glucometer to check capillary blood
glucose levels
[ ] 3. Having laboratory personnel draw venous blood
samples
[ ] 4. Arranging for testing by a home health agency
Nurse
Emergency medical personnel bring a client who is lethargic
and confused to the emergency department. A tentative
diagnosis of type 1 diabetes mellitus and diabetic ketoacidosis
(DKA) is made.
71. Which assessment fi ndings would the nurse expect to
document if the client has DKA? Select all that apply.
[ ] 1. The client is hypertensive and tachycardic.
[ ] 2. The client is dyspneic and hypotensive.
[ ] 3. The client breathes noisily and smells of acetone.
[ ] 4. The client stares blankly and smells of alcohol.
[ ] 5. The client has warm, fl ushed skin and has vomited.
[ ] 6. The client complains of abdominal pain and is
thirsty.
The nurse documents that Kussmaul’s respirations were
detected during the initial assessment.
72. Which respiratory pattern is the best description of
the client’s breathing?
[ ] 1. Fast, deep, labored respirations
[ ] 2. Shallow respirations, alternating with apnea
[ ] 3. Slow inhalation and exhalation through pursed lips
[ ] 4. Shortness of breath with pauses
The nurse plans to monitor the client’s response to insulin
therapy closely with an electronic glucometer and instructs
the emergency department technician to take periodic
capillary blood glucose measurements.
73. Which techniques are correct when using an electronic
glucometer to monitor the client’s capillary blood
glucose level? Select all that apply.
[ ] 1. Clean the client’s fi nger with povidone-iodine
(Betadine).
[ ] 2. Take a set of vital signs before the test.
[ ] 3. Pierce the central pad of the client’s fi nger.
[ ] 4. Apply a large drop of blood to a test strip or area.
[ ] 5. Don gloves before piercing the client’s fi nger.
[ ] 6. Perform a quality control before the test.
After using the glucometer, the emergency department
technician reports to the nurse that the client’s capillary
blood glucose measures 498 mg/dL.
74. Based on the client’s blood glucose measurement, the
nurse immediately reevaluates the client. Which physician
orders should the nurse anticipate? Select all that apply.
[ ] 1. STAT serum blood glucose
[ ] 2. Intravenous regular insulin
[ ] 3. Vital signs every 2 hours
[ ] 4. A diet of six small, frequent meals
[ ] 5. Electronic glucometer measurements before meals
and at bedtime
[ ] 6. Continuous cardiac monitoring
After stabilization in the emergency department, the client
with diabetic ketoacidosis (DKA) is admitted to a stepdown
unit for further observation and treatment. After
several episodes of hyperglycemia, the physician orders
sliding-scale regular insulin administered subcutaneously
for the client.
75. How soon after administering the client’s dose of
regular insulin subcutaneously should the nurse assess for
signs of hypoglycemia?
[ ] 1. 5 minutes later
[ ] 2. 30 minutes later
[ ] 3. 6 hours later
[ ] 4. 10 hours later
76. The nurse teaches the client with newly diagnosed
diabetes mellitus about the signs and symptoms of hypoglycemia.
Which of the following should the nurse stress
in teaching? Select all that apply.
[ ] 1. Sleepiness
[ ] 2. Shakiness
[ ] 3. Thirst
[ ] 4. Hunger
[ ] 5. Diaphoresis
[ ] 6. Confusion
During the midmorning after receiving insulin, the client
reports feeling weak, shaky, and dizzy. The nurse asks the
nursing assistant to obtain a capillary blood glucose measurement
with a glucometer.
77. The nursing assistant reports to the nurse that the client’s
blood glucose reading is 58 mg/dL. What is the most
appropriate nursing action at this time?
[ ] 1. Administer the next scheduled dose of insulin.
[ ] 2. Give the client ¼ cup of sweet fruit juice.
[ ] 3. Report the client’s symptoms to the physician.
[ ] 4. Perform a complete head-to-toe assessment.
The client with type 1 diabetes mellitus must learn to combine
two insulins—regular and intermediate-acting—and
self-administer the injection before being discharged.
78. Which action is the best indication that the client
needs more practice in combining two insulins in one
syringe?
[ ] 1. The client rolls the vial of intermediate-acting
insulin to mix it with its additive.
[ ] 2. The client instills air into both the fast-acting and
intermediate-acting insulin vials.
[ ] 3. The client instills the intermediate-acting insulin
into the vial of rapid-acting insulin.
[ ] 4. The client inverts each vial before withdrawing the
specifi ed amount of insulin.
79. When the client practices self-administration of the
insulin, which action is correct?
[ ] 1. Piercing the skin at a 30-degree angle
[ ] 2. Using a syringe calibrated in minims
[ ] 3. Using a 29-gauge needle on the syringe
[ ] 4. Rotating abdominal sites for each injection
80. The nurse receives an order to administer Novolin R
10 units with Novolin N 20 units to be given subcutaneously
at 0730 hours. Place the following actions in correct
sequence to show how the nurse would mix the medications.
Use all the options.
1. Instill 20 units of air in
the vial of Novolin N.
2. Instill 10 units of air in
the vial of Novolin R.
3. Withdraw 20 units of
insulin from the vial of
Novolin N.
4. Withdraw 10 units of
insulin from the vial of
Novolin R.
The nurse implements a diabetes teaching plan in anticipation
of the client’s discharge.
81. Which statement indicates that the client has misunderstood
the nurse’s teaching?
[ ] 1. “I may need more insulin during times of stress.”
[ ] 2. “I may need more food when exercising strenuously.”
[ ] 3. “My insulin needs may change as I get older.”
[ ] 4. “My dependence on insulin may stop eventually.”
82. The nurse discusses the long-term effects of diabetes
mellitus with the client and realizes that the client needs
further teaching when the client identifi es which occurrence
as a complication of this disease?
[ ] 1. Blindness
[ ] 2. Stroke
[ ] 3. Renal failure
[ ] 4. Liver failure
83. When the client asks how to store an opened vial of
insulin, which answer by the nurse offers the most correct
instruction?
[ ] 1. The best place for storing insulin is in the bathroom,
close to the shower.
[ ] 2. The best place to store insulin is in the refrigerator.
[ ] 3. The best way to store insulin is at room temperature.
[ ] 4. The best place for storing insulin is in a warm
location but out of sunlight.
The nurse includes foot care as a component of diabetes
teaching.
84. Which statement by the client about foot care indicates
a need for further teaching?
[ ] 1. “I need to inspect my feet daily.”
[ ] 2. “I should soak my feet each day.”
[ ] 3. “I need to wear shoes whenever I’m not sleeping.”
[ ] 4. “I need to schedule regular appointments with the
podiatrist.”
After 3 months, the client returns for a follow-up appointment
with the physician to evaluate the progress of
s elf-care.
85. Which information is most important for the nurse
to elicit from the client to effectively evaluate compliance
with the prescribed therapy?
[ ] 1. The dosage and frequency of insulin
administration
[ ] 2. The client’s glucose monitoring records for the
past week
[ ] 3. The client’s weight and vital signs before the offi ce
interview
[ ] 4. The symptoms experienced in the past month
86. Which laboratory test is most important for the nurse
to monitor to determine how effectively the client’s diabetes
is being managed?
[ ] 1. Fasting blood glucose
[ ] 2. Blood chemistry profi le
[ ] 3. Complete blood count
[ ] 4. Glycosylated hemoglobin (HbA1c)
During the physician’s visit, the client reports researching
the use of insulin pumps on the Internet and wants to know
the possibility of being a candidate. After evaluating the
client and discussing the request, the physician asks the
nurse to provide instructions about management of the client’s
diabetes using a continuous insulin infusion pump.
87. The nurse teaches the client how the infusion pump
operates and correctly points out that the infusion is typically
administered in which location?
[ ] 1. In a vein within the nondominant hand
[ ] 2. In the muscular tissue of the thigh
[ ] 3. In the subcutaneous tissue of the abdomen below
the belt line
[ ] 4. In an implanted I.V. catheter threaded into the neck
The nurse cares for an older client who is insulin dependent
and lives in a long-term care facility.
88. When developing the client’s care plan, which intervention
is most appropriate to add?
[ ] 1. Encourage the client to use an electric razor.
[ ] 2. Tell the client to fi le rather than cut toenails.
[ ] 3. Make sure that the client receives mouth care twice
per day.
[ ] 4. Advise the client to use deodorant soap when bathing.
89. The nurse has prepared 24 units of Humulin N insulin
for subcutaneous administration. Identify with an X the
preferred location for insulin administration to facilitate
rapid absorption.
90. Which sign is most suggestive that a client with type
2 diabetes is developing hyperosmolar hyperglycemic
nonketotic syndrome (HHNS)?
[ ] 1. The client’s serum glucose level is 650 mg/dL.
[ ] 2. The client’s urinary output is 3,000 mL/24 hours.
[ ] 3. The client’s skin is cool and moist.
[ ] 4. The client’s urine contains acetone.
A client with type 1 diabetes mellitus comes to the clinic
complaining of persistent bouts of nausea, vomiting,
and diarrhea for the past 4 days. The client has skipped
insulin injections because of not being able to eat or keep
anything down.
91. Which instruction should the nurse give the client
about insulin administration during periods of illness?
[ ] 1. Monitor blood glucose levels every 2 to 4 hours.
[ ] 2. Eat candy or sugar frequently.
[ ] 3. Attempt to drink a high-calorie beverage every
hour.
[ ] 4. Test urine daily for protein.
92. During change of shifts, a nurse discovers that a
hospitalized client with diabetes received two doses of
insulin. After notifying the physician, which nursing
action is most appropriate?
[ ] 1. Completing an incident report
[ ] 2. Calling the intensive care unit (ICU)
[ ] 3. Performing frequent neurologic checks
[ ] 4. Monitoring the client’s blood glucose level
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