A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?

Pancrelipase 500 units/kg PO three times daily with meals

Pantoprazole 80 mg IV bolus twice daily

Initiate a low-residue diet

D Ambulate twice day

Answer and Explanation

The Correct Answer is B

A. Pancrelipase 500 units/kg PO three times daily with meals: Pancrelipase is an enzyme replacement therapy used to aid in the digestion of fats, proteins, and carbohydrates in clients with pancreatic insufficiency. However, in acute pancreatitis, the pancreas is inflamed and typically unable to produce sufficient enzymes. Therefore, enzyme replacement therapy is not typically initiated during the acute phase of pancreatitis.
B. Pantoprazole 80 mg IV bolus twice daily: This is the correct answer. Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion. It is commonly prescribed in acute pancreatitis to decrease gastric acid production and reduce pancreatic enzyme activity, thereby promoting pancreatic rest and reducing further pancreatic inflammation and injury.
C. Initiate a low-residue diet: In acute pancreatitis, clients are typically kept NPO (nothing by mouth) initially to allow the pancreas to rest and inflammation to decrease. Once oral intake is resumed, a low-fat, easily digestible diet is usually recommended. However, the initiation of a low-residue diet is not typically indicated during the acute phase of pancreatitis.
D. Ambulate twice daily: While early ambulation is generally encouraged in hospitalized clients to prevent complications such as deep vein thrombosis and pneumonia, ambulation may be limited initially in clients with acute pancreatitis due to pain and discomfort. Ambulation is not typically a priority during the acute phase of pancreatitis; instead, pain management and supportive care are emphasized.

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Correct Answer is D

Explanation

A. pH 7.55, HCO3 30 mEq/L, PaCO2 31 mm Hg: These values indicate respiratory alkalosis with metabolic alkalosis. The pH is elevated, indicating alkalosis. The HCO3 level is elevated, indicating metabolic alkalosis, while the PaCO2 is low, indicating respiratory alkalosis. This pattern is not typically seen in chronic kidney disease.
B. pH 7.30, HCO3 26 mEq/L, PaCO2 50 mm Hg: These values indicate metabolic acidosis with respiratory acidosis. The pH is low, indicating acidosis. The HCO3 level is slightly low, indicating metabolic acidosis, while the PaCO2 is elevated, indicating respiratory acidosis. This pattern is not typically seen in chronic kidney disease.
C. pH 7.50, HCO3 20 mEq/L, PaCO2 32 mm Hg: These values indicate metabolic alkalosis with respiratory alkalosis. The pH is elevated, indicating alkalosis. The HCO3 level is elevated, indicating metabolic alkalosis, while the PaCO2 is slightly low, indicating respiratory alkalosis. This pattern is not typically seen in chronic kidney disease.
D. pH 7.25, HCO3 19 mEq/L, PaCO2 30 mm Hg: These values indicate metabolic acidosis. The pH is low, indicating acidosis. The HCO3 level is decreased, indicating metabolic acidosis, while the PaCO2 is within the normal range. In chronic kidney disease, impaired kidney function leads to the retention of metabolic acids, resulting in metabolic acidosis. This pattern is consistent with chronic kidney disease.

A. Erythema and edema of the affected ear B. Tugging on the affected ear lobe C. Pain when manipulating the affected ear lobe D. Clear drainage from the affected ear

Correct Answer is A

Explanation

A. Erythema (redness) and edema (swelling) of the affected ear are classic signs of otitis media, an infection or inflammation of the middle ear. In otitis media, the middle ear becomes inflamed and fluid accumulates behind the eardrum, leading to redness and swelling of the tympanic membrane and surrounding tissues.
B. Tugging on the affected ear lobe is a common behavior observed in children with otitis media. Ear pulling or rubbing is often a sign of ear pain or discomfort, which can result from the pressure caused by the accumulation of fluid and inflammation in the middle ear.
C. Pain when manipulating the affected ear lobe is another common symptom of otitis media. Children with this condition may experience tenderness or discomfort when the affected ear is touched or manipulated due to the underlying inflammation and infection.
D. Clear drainage from the affected ear is not typically associated with otitis media. Instead, otitis media is characterized by the presence of middle ear effusion, which may manifest as fluid behind the eardrum. The drainage from otitis media is more commonly serous or purulent rather than clear.

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