The nurse receives report for a client with acute pancreatitis on hospital day 2: NPO with NGT to low intermittent suction, VS: 110/60, 99.2°F-97- 22, 0.9% NS infusing at 125 mL/hour, and IV antibiotics have been started. Chart review reveals the following current laboratory results. Which is a priority for the nurse to report to the healthcare provider?

WBC 10,000/mm3 (5,000-10,000 mm3)

Serum potassium 3.5 mEq/L (3.5-5.0 mEq/L)

Serum albumin 4.8 g/dL (3.5-5 g/dL)

Lipase 900 u/L (20-180 u/L)

Answer and Explanation

The Correct Answer is D

A) While an elevated WBC count may indicate infection, it is not unexpected in acute pancreatitis.
B) Serum potassium within normal range does not require immediate intervention.

C) Serum albumin within normal range does not require immediate intervention.

D) Lipase levels significantly elevated above the normal range indicate ongoing pancreatic inflammation and may require intervention or adjustment of treatment.

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Correct Answer is B

Explanation

A) Ascites, the accumulation of fluid in the abdominal cavity, typically presents with weight gain rather than weight loss.
B) Ascites often accompanies peripheral edema, particularly in the lower extremities.

C) Ascites is not typically associated with flushed skin; rather, it may lead to pallor due to anemia or jaundice due to liver dysfunction.
D) Ascites is not directly associated with vomiting blood; hematemesis may indicate complications such as esophageal varices, which can occur in advanced liver disease.

A. Auscultate lungs B. Monitor I&O C. Check stools for blood D. Initiate fall precautions

Correct Answer is C

Explanation

A) While important, it is not directly related to the coagulopathy indicated by the prolonged PT.
B) Important for overall fluid management but not directly related to the risk of bleeding.
C) With a significantly prolonged PT, assessing for signs of gastrointestinal bleeding is a priority.

D) Important for safety, but the immediate risk of bleeding due to coagulopathy takes precedence.

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Naxlex Comprehensive Predictor Exams

The nurse is admitting a client diagnosed with ascites. Which assessment finding would the nurse anticipate?

Correct Answer is B

Explanation

The nurse notes these laboratory results for a client with cirrhosis: PT 20 seconds (11-12.5 sec) and serum ammonia 35 mcg/dL (15-45 mcg/dL). What action by the nurse would be a priority?

Correct Answer is C

Explanation

A nurse is planning care for a client who has hepatitis B. Which of the following interventions should the nurse include in the plan?

The client with cirrhosis is at risk for developing complications. Which condition is the most serious and potentially life-threatening?

The nurse is preparing a community presentation about hepatitis B virus (HBV). Which information should be included in the teaching session?

What does the nurse identify as a potential complication of chronic pancreatitis?

The nurse is admitting a client with liver disease who presents with dyspnea, weight gain and abdominal distention. Which order would the nurse anticipate?

A client with cirrhosis has the following laboratory results: albumin 4.9 g/dl. (3.5-5 g/dL), PT 13 seconds (11-12.5 sec), and serum ammonia 68 mcg/dL (15-45 mcg/dL). Based on this information, what is the nurse's next action?

When planning care for a client with acute pancreatitis, which order would the nurse anticipate that will contribute to pain control?

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