A nurse is collecting data on a client who has acute pancreatitis.
Which of the following factors should the nurse anticipate in the client’s history?
Gallstones
GERD
Diabetes mellitus
Shock
The Correct Answer is A
Choice A rationale
Acute pancreatitis is a condition characterized by inflammation of the pancreas. The most common cause of acute pancreatitis is gallstones, which can become lodged in a bile or pancreatic duct and cause inflammation. Gallstones are hardened deposits of digestive fluid that can form in your gallbladder, and when they block the ducts leading from the gallbladder to the intestines, they can cause sharp pain in the upper abdomen that quickly worsens. This pain can radiate to the back, another common symptom of acute pancreatitis. Therefore, a history of gallstones is a significant factor to anticipate in a client with acute pancreatitis.
Choice B rationale
GERD, or gastroesophageal reflux disease, is a chronic condition where stomach acid flows back up into the esophagus causing heartburn and other symptoms. While GERD can lead to discomfort and complications like esophagitis, it does not typically cause acute pancreatitis.
Choice C rationale
Diabetes mellitus is a chronic condition that affects the body’s ability to use blood sugar for energy. While diabetes can lead to a host of health complications, it is not typically a direct cause of acute pancreatitis.
Choice D rationale
Shock is a life-threatening condition that requires immediate medical attention. It occurs when the body is not getting enough blood flow, leading to insufficient oxygen and nutrients for your cells and organs. Shock can be a result of severe acute pancreatitis, but it is not a cause.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Pursed-lip breathing can help improve oxygenation and reduce shortness of breath in clients with COPD. However, it is not the priority action when a client reports difficulty breathing.
Choice B rationale
Increasing the oxygen flow rate without a physician’s order can lead to oxygen toxicity or suppress the respiratory drive in clients with COPD. Therefore, this is not the priority action.
Choice C rationale
Coughing and expectorating secretions can help clear the airways, but it is not the priority action when a client reports difficulty breathing.
Choice D rationale
Evaluating the client’s respiratory status is the priority action. The nurse should assess the client’s breath sounds, respiratory rate, use of accessory muscles, and oxygen saturation to determine the severity of the client’s difficulty breathing and guide further interventions.
Correct Answer is A
Explanation
Choice A rationale
Coffee ground vomitus is a symptom that indicates upper gastrointestinal bleeding. One of the conditions that can cause this symptom is a hiatal hernia. A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm, and it can cause acid reflux, which can lead to esophagitis and bleeding. When the blood mixes with stomach acid, it can look like coffee grounds when vomited.
Choice B rationale
Gallbladder disease typically presents with symptoms such as abdominal pain (especially after eating), nausea, vomiting, bloating, and fever. While it can cause discomfort and complications like gallstones and inflammation, it does not typically cause coffee ground vomitus.
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