NUR 397 Pancreatitis/Pancreatic Disorders Exam

NUR 397 Pancreatitis/Pancreatic Disorders Exam
The nurse is caring for a patient who has been admitted multiple times for pancreatitis.
The patient has inflammation and fibrosis of the tissue and diminished pancreatic
function. Which assessment finding is priority for this patient?
alcohol consumption
Rationale
The patient who undergoes a microdiskectomy typically can return home the same day.
The patient who undergoes a traditional open laminectomy typically can return home 48
hours after the procedure, will have a drain in place after the procedure, and will need to
wear special stockings after the procedure
The nurse is providing teaching about pancreatic enzyme replacement to a patient
diagnosed with chronic pancreatitis. Which statement by the patient indicates the need
for further teaching?
I will take the pancreatic enzyme half an hour before meals.
Which scan will provide the most reliable diagnosis of acute pancreatitis?
contrast enhanced CT
Rationale
Contrast-enhanced CT provides more reliable images and diagnosis of acute
pancreatitis. A chest x-ray will show elevation but is not diagnostic. An abdominal
ultrasound is not helpful to view the whole pancreas. An ERCP is better for diagnosing
pancreatic stones, not acute pancreatitis.
A patient reports severe mid-epigastric pain radiating to the left flank and back. The
nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen
and periumbilical area. The nurse suspects which cause of acute pain in this patient?
pancreatitis
Rationale
Patients with acute pancreatitis will have severe mid-epigastric pain that radiates to the
left side and back and may have generalized jaundice and a gray-blue discoloration
caused by pancreatic enzyme leakage into the cutaneous tissue. Biliary colic and
cholecystitis will present with right-sided abdominal pain. Patients with gastroenteritis
will have generalized discomfort.
A patient is diagnosed with acute pancreatitis. Which test is a sensitive indicator of
biliary obstruction in this disorder?
serum alanine aminotransferase
Rationale
Serum alanine aminotransferase is a sensitive indicator of biliary obstruction in acute
pancreatitis. A threefold or greater rise in concentration indicates that the diagnosis of
acute biliary pancreatitis is valid. Serum bilirubin, alkaline phosphatase, and serum
amylase are diagnostic tests prescribed for a patient with acute pancreatitis but do not
reflect biliary obstruction.
Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells
of the pancreas?
Lipase
Rationale
The lipase enzyme is involved in enzymatic fat necrosis of both the endocrine and
exocrine cells of the pancreas. Trypsin activates elastase, which dissolves the elastic
fibers of the blood vessels and ducts. Kallikrein releases vasoactive peptides,
bradykinin, and a plasma kinin known as kallidin.
Which symptom of chronic pancreatitis also occurs with acute pancreatitis?
abdominal pain
Rationale
Abdominal pain occurs with both types of pancreatitis, though pain intensity does vary
between the two. Ascites, loss of exocrine function, and protein malabsorption occur
only with chronic pancreatitis.
Which assessment finding would the nurse monitor to evaluate the effectiveness of
pancreatic enzyme therapy?
Consistency and number of stools.
Rationale
If the pancreatic enzymes are effective, the patient should have less frequent, less fatty
stools. Blood glucose monitoring is performed when patients receive total parenteral
nutrition. Urine output does not indicate effectiveness of pancreatic enzyme therapy.
Monitoring weight is necessary for patients who have fat and protein malabsorption.
Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a
plasma kinin?
Kallikrein
Rationale
Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known
as kallidin. These substances cause vasodilation and increased vascular permeability,
compounding the hemorrhagic process. Lipase enzyme is involved in enzymatic fat
necrosis. Trypsin activates elastase, which dissolves elastic fibers of the blood vessels
and ducts. 

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