Pancreatitis (10 Questions)

1. A 52-year-old male presents to the Emergency Department complaining of excruciating epigastric pain radiating to the mid-back that started after a heavy meal. He admits to a history of heavy alcohol consumption. On assessment, he is diaphoretic, anxious, and curled in a fetal position. His vital signs are: BP 90/50 mmHg, HR 122 bpm, RR 24 breaths/min, and Temp 38.1°C. His abdomen is rigid and board-like.

Question:
What is the nurse's immediate priority intervention? *

Administer IV morphine to control severe pain and reduce metabolic demand.

Initiate aggressive intravenous fluid resuscitation with isotonic crystalloids.

Insert a nasogastric tube to decompress the stomach and stop vomiting.

Draw blood for serum amylase and lipase levels to confirm the diagnosis.

2. You are caring for a 60-year-old female admitted three days ago with severe acute pancreatitis caused by gallstones. While taking her vital signs, you notice her hands are trembling. When you inflate the blood pressure cuff on her arm, her wrist and fingers flex into a spasm (carpopedal spasm). She also mentions numbness around her lips.

Question:
Based on these assessment findings, which laboratory value should the nurse check immediately? *

Serum Potassium

Serum Calcium

Serum Glucose

Serum Amylase

3. A 45-year-old client with chronic pancreatitis is being discharged. He has lost 10 kg over the last two months and reports frequent, frothy, foul-smelling stools. The physician has prescribed pancreatic enzyme replacement therapy (pancrelipase). The nurse is providing education on how to take this medication effectively.

Question:
Which instruction is essential for the nurse to include in the discharge teaching? *

"Take the medication once a day in the morning on an empty stomach."

"Only take the medication if you are eating a high-fat meal."

"Crush the pills and mix them with hot soup if you have trouble swallowing."

"Take the medication with every meal and snack to aid digestion."

4. A patient with acute pancreatitis has been NPO (nothing by mouth) with a nasogastric tube (NGT) to low suction for 48 hours. The patient reports that his pain has decreased from 9/10 to 3/10. He is asking the nurse if the NGT can be removed because it is uncomfortable and causing a sore throat.

Question:
What is the nurse’s best response regarding the rationale for the NGT? *

"We can remove it now since your pain has decreased significantly."

"The tube must stay in until your amylase levels return to normal."

"The tube keeps your stomach empty to stop the pancreas from releasing enzymes that hurt you."

"We need to keep the tube in to administer your medications until you can swallow."

5. A 55-year-old male is hospitalized with acute pancreatitis. During the morning assessment, the nurse notes bluish discoloration on the patient’s flanks (Grey Turner’s sign). The patient’s hemoglobin has dropped from 120 g/L to 105 g/L overnight.

Question:
How should the nurse interpret these findings? *

The pancreas is hemorrhaging into the retroperitoneal space.

The patient is developing localized skin necrosis from bed rest.

The patient has developed a coagulation disorder related to liver failure.

This is a normal resolution of pancreatic inflammation.

6. A patient with a history of alcohol use disorder is admitted with acute pancreatitis. Thirty-six hours after admission, the patient becomes agitated, tremulous, and diaphoretic. He tells the nurse, "There are bugs crawling on the ceiling." His heart rate is 110 bpm and BP is 150/90 mmHg.

Question:
What is the nurse’s priority action? *

Reorient the patient to his surroundings and dim the lights.

Administer a PRN analgesic for pancreatic pain.

Initiate the alcohol withdrawal protocol and administer benzodiazepines as ordered.

Call security to restrain the patient for safety.

7. A nurse is caring for a client with acute pancreatitis who is developing Acute Respiratory Distress Syndrome (ARDS). The client is on high-flow oxygen, but saturation remains at 88%. The nurse notes that the patient is struggling to breathe while lying supine.

Question:
What is the most appropriate nursing intervention to improve oxygenation before considering intubation? *

Place the patient in a prone position if tolerated.

Administer a nebulizer treatment with a bronchodilator.

Encourage the patient to cough and deep breathe every 15 minutes.

Place the patient in a semi-Fowler’s or high-Fowler’s position.

9. A 30-year-old female is admitted following an Endoscopic Retrograde Cholangiopancreatography (ERCP) for gallstone removal. Two hours post-procedure, she reports severe, sudden onset abdominal pain rated 10/10, distinct from the procedure discomfort, accompanied by vomiting.

Question:
What does the nurse suspect is occurring? *

A normal reaction to the air insufflation used during ERCP.

Post-ERCP acute pancreatitis.

An adverse reaction to the sedation used during the procedure.

Spasm of the Sphincter of Oddi.

10. A patient with chronic pancreatitis is prescribed an H2-receptor blocker (e.g., ranitidine or famotidine) in addition to their pancreatic enzymes. The patient asks, "I don't have heartburn, why am I taking this stomach acid pill?"

Question:
What is the nurse’s best explanation? *

"It prevents the stress ulcers that are common with your condition."

"It reduces stomach acid so that your pancreatic enzyme pills work better."

"It helps coat the stomach to prevent nausea from the enzymes."

"It treats the acid reflux that caused your pancreatitis."