A nurse is planning care for a client who has acute pancreatitis. Which of the following interventions should the nurse include in the client’s plan? (Select all that apply.)

Initiate insulin drip.

Monitor blood glucose levels.

Continue regular diet as tolerated.

Maintain NPO status until pain-free.

Manage acute pain.

Answer and Explanation

Correct Answer : B,E

Choice A Reason:

Initiating an insulin drip is not a standard intervention for all clients with acute pancreatitis. This intervention is typically reserved for clients who develop hyperglycemia or diabetes as a complication of pancreatitis. Acute pancreatitis can affect the pancreas’ ability to produce insulin, but not all clients will require an insulin drip.

Choice B Reason:

Monitoring blood glucose levels is crucial for clients with acute pancreatitis because the pancreas plays a key role in regulating blood sugar. Inflammation or damage to the pancreas can lead to fluctuations in blood glucose levels, making regular monitoring essential to manage potential hyperglycemia or hypoglycemia.

Choice C Reason:

Continuing a regular diet as tolerated is not appropriate for clients with acute pancreatitis. These clients are typically kept NPO (nothing by mouth) to rest the pancreas and reduce the secretion of pancreatic enzymes, which can exacerbate inflammation and pain.

Choice D Reason:

Maintaining NPO status until the client is pain-free is a standard intervention for acute pancreatitis. This approach helps to rest the pancreas and prevent the release of digestive enzymes that can further inflame the pancreas. Once the client is pain-free and inflammation has subsided, a gradual reintroduction of oral intake can be considered.

Choice E Reason:

Managing acute pain is a critical aspect of care for clients with acute pancreatitis. Pain management can include medications such as opioids, as well as non-pharmacological interventions like positioning and relaxation techniques. Effective pain management improves the client’s comfort and can help reduce stress on the pancreas.

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Correct Answer is B

Explanation

Choice A Reason

“Lie on your left side.” This statement is incorrect. After a liver biopsy, the client should lie on their right side to apply pressure to the biopsy site and help prevent bleeding.

Choice B Reason

“Lie on your right side.” This is the correct instruction. Lying on the right side helps compress the liver biopsy site, reducing the risk of bleeding and promoting clot formation.

Choice C Reason

“Increase your fluid intake.” This statement is not specifically related to post-liver biopsy care. While staying hydrated is generally good advice, it is not a primary instruction for post-biopsy care.

Choice D Reason

“Decrease your fluid intake.” This statement is incorrect. There is no need to decrease fluid intake after a liver biopsy. Proper hydration is important for overall health and recovery.

A. “It is okay to not want to touch the burned areas of your body.” B. “Cosmetic surgery should be performed within the next year to be effective.” C. “Reconstructive surgery can completely restore your previous appearance.” D. “It could be helpful for you to attend a support group for people who have burn injuries.”

Correct Answer is D

Explanation

Choice A Reason

“It is okay to not want to touch the burned areas of your body.” This statement is empathetic and acknowledges the client’s feelings, but it does not provide a constructive way to address their concerns about altered appearance. While it is important to validate the client’s feelings, offering a solution or support mechanism is more beneficial.

Choice B Reason

“Cosmetic surgery should be performed within the next year to be effective.” This statement is misleading. While timely intervention can be important, the timing of reconstructive or cosmetic surgery depends on various factors, including the extent of the burns, the healing process, and the patient’s overall health. It is not accurate to generalize that surgery must be performed within a year.

Choice C Reason

“Reconstructive surgery can completely restore your previous appearance.” This statement is incorrect and can give false hope. Reconstructive surgery aims to improve function and appearance, but it cannot completely restore the previous appearance. Managing expectations is crucial in the recovery process.

Choice D Reason

“It could be helpful for you to attend a support group for people who have burn injuries.” This statement is correct. Support groups provide emotional and psychological support, helping burn survivors cope with changes in appearance and other challenges. They offer a sense of community and shared experiences, which can be very beneficial for recovery.

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A nurse is planning care for a client who has acute pancreatitis. Which of the following interventions should the nurse include in the client’s plan? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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