A nurse is caring for a client who has acute pancreatitis. After treating the client’s pain, which of the following should the nurse address as the priority intervention?
Withhold oral fluids and food.
Auscultate the client’s lungs.
Provide oral hygiene.
Assist the client to a side-lying position.
The Correct Answer is A
Choice A reason: Withhold oral fluids and food
Withholding oral fluids and food (NPO status) is a critical intervention for clients with acute pancreatitis. This helps to rest the pancreas by reducing the stimulation of pancreatic enzyme secretion, which can exacerbate inflammation and pain. Maintaining NPO status is essential to prevent further pancreatic damage and to allow the pancreas to heal.
Choice B reason: Auscultate the client’s lungs
While auscultating the lungs is an important part of the overall assessment, it is not the immediate priority after pain management in acute pancreatitis. Respiratory complications can occur, but the primary focus should be on managing the pancreatic inflammation and preventing further damage.
Choice C reason: Provide oral hygiene
Providing oral hygiene is important for overall patient care, especially when the client is NPO. However, it is not the priority intervention immediately after pain management. The primary concern is to prevent further pancreatic stimulation and manage the inflammation.
Choice D reason: Assist the client to a side-lying position
Assisting the client to a side-lying position can help with comfort and may be beneficial in managing pain. However, it is not the priority intervention. The main focus should be on preventing further pancreatic stimulation by withholding oral intake.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: There are no current occurrences of smallpox. Smallpox was declared eradicated in 1980 by the World Health Organization (WHO) after a successful global vaccination campaign. Therefore, the statement that there are rare, occasional occurrences of smallpox is incorrect.
Choice B reason: Smallpox lesions do not appear in various stages of healing at the same time. Unlike chickenpox, where lesions can be in different stages of healing simultaneously, smallpox lesions typically develop and progress through stages uniformly. This means that all lesions are generally at the same stage of development at any given time.
Choice C reason: The vesicles of smallpox are indeed more abundant on the face and extremities compared to the trunk. This distribution pattern is a distinguishing feature of smallpox, as opposed to chickenpox, which tends to have a more central distribution with more lesions on the trunk.
Choice D reason: Vaccination against smallpox provides lifelong immunity. The smallpox vaccine, which uses a live virus related to smallpox called vaccinia, has been shown to provide long-lasting immunity. Studies have indicated that immunity can last for decades, and even those vaccinated many years ago retain some level of protection.
Correct Answer is A
Explanation
Choice A reason: Weigh the client daily is important because chlorpromazine can cause weight gain as a side effect. Regular monitoring of the client’s weight helps in managing and mitigating this potential adverse effect.
Choice B reason: Monitor the client for signs of bleeding is not typically necessary for clients taking chlorpromazine. This medication does not commonly cause bleeding issues. Monitoring for bleeding would be more relevant for clients on anticoagulants or medications that affect platelet function.
Choice C reason: Monitor the client’s respirations every 4 hours is not specifically required for clients on chlorpromazine. While respiratory depression can be a concern with some medications, it is not a common side effect of chlorpromazine.
Choice D reason: Administer an antacid with the medication to decrease nausea is not recommended. Antacids can interfere with the absorption of chlorpromazine, reducing its effectiveness. If the client experiences nausea, other antiemetic strategies should be considered.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.