Question 1

A patient is diagnosed with severe pancreatitis. Which type of nutrition should the nurse expect to be prescribed for this patient?

Accepted Answer

1. A clear liquid diet is no longer recommended.
2. A soft diet is recommended if the patient has no nausea or vomiting and the abdominal pain has resolved.
3. In severe pancreatitis, enteral nutrition is preferred over total parenteral nutrition (TPN).
4. In severe pancreatitis, enteral nutrition is preferred over total parenteral nutrition (TPN).

Question 2

A patient being prepared for an endoscopy to diagnose an upper gastrointestinal bleed asks why a nasogastric tube has to be inserted. What should the nurse respond to this patient?

Accepted Answer

1. The nasogastric tube is not used to assist with placement of the ostomy tube.
2. The nasogastric tube may be utilized to reduce blood and aid removal of clots that might hinder observation by the physician during the test.
3. This response does not meet the patient's request for information.
4. Vomiting is not managed by a nasogastric tube during this procedure. A local anesthetic spray is applied to the back of the throat before the procedure to reduce gagging and vomiting.

Question 3

A patient with an active gastrointestinal bleed has the following vital signs: BP 80/50 mm Hg, HR 102 bpm, RR 24, and oxygen saturation of 80%. What blood component should the nurse expect the health care provider to prescribe?

Accepted Answer

1. Whole blood may be ordered in an emergent situation while awaiting cross-matched blood.
2. Patients who are hemodynamically unstable and have had considerable blood loss will require blood transfusions of packed red blood cells. Packed RBCs are preferred as this replaces the lost red blood cells, which will help improve oxygenation. The plasma will help expand volume.
3. Platelets are not indicated at this time with this situation.
4. Fresh frozen plasma is not indicated at this time with this situation.

Question 4

A patient with acute pancreatitis asks for something to eat. Which response by the nurse is most appropriate?

Accepted Answer

1. Vomiting is a concern but not the greatest determinant of when eating will be allowed.
2. Unless the patient's GI symptoms prevent him from eating, oral feedings should be considered within 24-72 hours.
3. Dietary intake is typically resumed once the abdominal pain is in control, use of opiates is no longer needed, there is no anorexia, and bowel sounds have returned. New data suggests that initiating feeding with a low-fat soft diet is safe and can reduce the length of the hospitalization.
4. Tube feeding is used for moderate to severe pancreatitis and if the patient cannot tolerate oral nutrition.

Question 5

The nurse has been assigned to provide care for several patients on the medical-surgical unit. Which data should the nurse use to decide the patient to assess first?

Accepted Answer

1. The presence of a mildly elevated temperature of 99.2°F and complaints of nausea, although uncomfortable for the patient, do not indicate the presence of an immediate problem.
2. Feelings of fullness and the lack of a bowel movement are consistent with constipation and warrant action but are not a priority.
3. The patient's heart rate of 82 bpm signal that the patient is not in immediate danger. The presence of coffee ground emesis may signal slowed or halted bleeding.
4. The patient with melena likely has an active gastrointestinal bleed. This is a serious health concern warranting further assessment and frequent evaluation by the nurse.

Question 6

A patient prescribed pantoprazole (Protonix) asks the purpose of the medication. Which response by the nurse is most appropriate?

Accepted Answer

1. This medication does not stop gastrointestinal bleeding.
2. This medication will not provide a protective coating to the gastrointestinal system.
3. Pantoprazole (Protonix) is a proton pump inhibitor. Aggressive PPI treatment is used to increase the gastric pH and is recommended to promote clot stability.
4. The management of H. pylori infection is treated with pantoprazole (Protonix) and the use of antibiotics.

Question 7

A patient arrives in the emergency department with clinical manifestations consistent with a lower gastrointestinal bleed. What should the nurse assess to determine the patient's stability?

Accepted Answer

1. Initially the patient's hemoglobin will not illustrate the true blood loss. This is due to a 6-12-hour delay in intravascular equilibrium related to blood loss.
2. Initially the patient's hematocrit will not illustrate the true blood loss. This is due to a 6-12-hour delay in intravascular equilibrium related to blood loss.
3. The evaluation of vital signs is the best means to determine the patient's stability. Vital signs provide information concerning cardiac and vascular compensation.
4. Abdominal rigidity will provide a key to the presence of blood in the abdomen, but it does not distinguish the amount of bleeding or the patient's level of homeostasis nor does it pinpoint the location.

Question 8

A patient with a serious gastrointestinal bleed arrives in the emergency department, and the physician intends to initiate aggressive intravenous therapy. Which solution should the nurse anticipate being used to manage this patient's condition?

Accepted Answer

1. Dextrose 5% and 0.9% normal saline is a hypertonic solution that is not used for aggressive fluid replacement. 2. D₅W is a hypotonic fluid that will not stay in the vascular space but rather will be absorbed by the cells. This fluid will not increase intravascular volume. 3. Aggressive intravenous management of a patient with gastrointestinal bleeding is done with an isotonic crystalloid solution such as 0.9% NS. This type of fluid will provide intravascular fluid replacement to the depleted circulating fluid. This is done until the patient can be typed and crossed-matched for blood replacement therapy. 4. Normal saline of 0.45% is a hypotonic fluid that will not stay in the vascular space but rather will be absorbed by the cells. This fluid will not increase intravascular volume.

Question 9

A patient with symptoms consistent with pancreatitis reports feeling ill for the past week. Which diagnostic test will provide the most definitive diagnosis of pancreatitis?

Accepted Answer

1. The erythrocyte sedimentation rate is used to assess for the presence of inflammation but is not specific to pancreatitis.
2. The patient indicates that the illness has lasted for a week. The serum lipase results are more sensitive and will be most beneficial given the delay in seeking treatment. The serum lipase results will remain elevated for up to 14 days.
3. Serum amylase alone is not specific for pancreatitis as it will become elevated with other conditions.
4. A complete blood count will reflect the presence of infection but will not be specific for pancreatitis.

Question 10

A patient admitted to determine the presence of an upper gastrointestinal bleed does not believe the diagnosis because of the absence of pain. How should the nurse respond to this patient?

Accepted Answer

1. Pain tolerance may have little to do with the absence of pain with this disorder.
2. The majority of upper gastrointestinal bleeding is painless.
3. The patient should share any concerns with the physician, but this response does not address the patient's comment.
4. This is misinformation regarding this disease process.

Question 11

The nurse assembles equipment needed to begin caring for a patient with a gastrointestinal bleed who is hemodynamically unstable. What size of intravenous catheter should the nurse choose?

Accepted Answer

1. Smaller gauge, longer catheters will slow administration time of the fluid. The lumen of this IV access device do not allow for large and rapid amounts of fluid to be administered. If it is used, there is too much pressure and the vein may infiltrate.
2. A large-bore IV catheter is needed to rapidly administer large volumes of intravenous fluids that hemodynamically unstable patients need. The patient should have two large-bore intravenous catheters placed immediately. Studies have indicated that short large-bore peripheral IV catheters are capable of faster flow rates than longer central line catheters of the same gauge.
3. This size catheter would not be adequate to administer large volumes of intravenous fluids.
4. The length of the catheter would not be adequate to administer large volumes of intravenous fluids.

Question 12

A patient with acute pancreatitis is concerned about becoming addicted to the morphine prescribed for pain management. What response by the nurse is appropriate?

Accepted Answer

1. Waiting until the patient is unable to tolerate any additional pain would be inefficient in managing this disorder. Once the acute period of pain has passed, the patient may be managed with nonsteroidal anti-inflammatory medications.
2. Demerol is not currently recommended as highly as morphine in the management of pancreatitis. There is better pain control with morphine.
3. The use of narcotic analgesics during periods of acute pain is unlikely to result in addiction. Prompt pain management is a key to care of this disorder.
4. During times of intense pain, there is little to no risk of addiction as the medications block the pain receptors in the brain.

Question 13

A patient being treated for a gastrointestinal bleed has the following assessment findings: temperature 97.2°F, blood pressure 99/70 mm Hg, heart rate 74 bpm, capillary refill of 3 seconds, and oxygen saturation 94%. Four hours later, the nurse identifies changes in the patient's condition. Which change is associated with complications from management of the condition? Select all that apply.

Accepted Answer

1. This temperature is within normal limits.
2. Tachycardia is a manifestation of fluid overload.
3. Oxygen desaturation is a manifestation of fluid overload.
4. This capillary refill is within normal limits.
5. Abnormal lung sounds are a manifestation of fluid overload.

Question 14

The nurse cares for a patient with severe pancreatitis. Which intravenous fluid should the nurse anticipate providing to this patient?

Accepted Answer

1. D₅W is a hypotonic fluid that does not increase intravascular volume. It expands intracellular volume. 2. In a prospective randomized trial, resuscitation with Lactated Ringer's solution decreased the incidence of SIRS compared to saline resuscitation. ACG guidelines state that Lactated Ringer's may be the preferred solution. 3. D₅1/2NS is hypotonic and will not contribute to the expansion to intravascular volume. 4. Resuscitation with 0.9% NS was the preferred fluid in the past. Lactated Ringer's is recommended now.

Question 15

A patient with an active lower gastrointestinal bleed has the following vital signs: temperature 97.0°F, HR 68, RR 20, and BP 82/60 mm Hg. The nurse should place the patient in which position?

Accepted Answer

1. Positioning the patient prone will not enhance venous return or perfusion to vital tissues and organs.
2. Positioning the patient supine with the legs bent at the knees will hinder venous blood return and not increase cardiac output.
3. The patient's vital signs indicate distress. Placing the patient in a supine position with the legs elevated will promote the venous blood return to the heart. This will help the heart to fill and increase cardiac output and blood pressure.
4. Positioning the patient to lie on her side will not enhance venous return or perfusion to vital tissues and organs.

Question 16

A patient with severe acute pancreatitis has the following vital signs after fluid resuscitation: BP 84/53 mm Hg and HR 61 bpm. What should the nurse consider as the next step of care for this patient?

Accepted Answer

1. If the patient's fluid status does not improve or worsens, consider hypovolemic shock.
2. This patient's fluid status is low. A diuretic would cause a further loss of fluid and would not be the next step of care for this patient.
3. The patient's blood pressure is low. An antihypertensive would not be the next step of care for this patient.
4. The administration of an electrolyte replacement would not be indicated unless laboratory data supports the need. This would not be the next step of care for this patient.

Question 17

A patient being treated for a lower gastrointestinal bleed has a capillary refill of 3 seconds, a urinary output of 20 mL/hour, a heart rate of 88, and reports "feeling tired." Which finding should the nurse report to the physician?

Accepted Answer

1. A capillary refill of 3 seconds is a normal finding.
2. The patient's urinary output is indicative of a worsening condition related to hypovolemia and reduced renal perfusion. Urinary output less than 30 cc/hour should be reported to the physician.
3. A heart rate of 88 bpm is a normal finding.
4. The patient with a lower gastrointestinal bleed will likely report feelings of fatigue related to the blood loss.

Question 18

A patient with severe acute pancreatitis receives aggressive fluid replacement therapy. Which assessment finding indicates that management of this disorder has been effective?

Accepted Answer

1. Oxygen desaturation is a complication that may indicate that the patient's condition is worsening.
2. An elevated heart rate indicates hemodynamic instability related to hypovolemia.
3. Initially the hematocrit may be elevated as a result of fluid volume deficits. A reduction of the hematocrit toward the normal value is a sign that the fluid therapy has been successful.
4. Reduced blood pressure indicates hemodynamic instability related to hypovolemia.

Question 19

A patient recovering from a colonoscopy reports abdominal pain of 4 on a 5-point scale. The patient's abdomen is rigid, and vital signs are T 99.2, HR 94, R 28, and BP 98/69. What initial action by the nurse is indicated?

Accepted Answer

1. The patient may experience flatus after a colonoscopy, but this would not cause abdominal rigidity or cause pain to be rated 4 on a 5-point scale.
2. Taking no action is negligent of the nurse. These findings indicate there is a complication present that needs immediate intervention.
3. The presence of abdominal rigidity following a colonoscopy may indicate the presence of a bowel perforation. The observations require prompt reporting to the physician.
4. Medication for pain may be necessary, but the priority action is notification of the physician.

Question 20

The nurse prepares a presentation for new graduates about pancreatitis. After attending the seminar, which statement by a graduate nurse indicates the need for additional instruction? Select all that apply.

Accepted Answer

1. There are a large number of predisposing factors associated with the development of pancreatitis. Additional teaching would be required.
2. Two main laboratory tests to diagnose this are serum amylase and serum lipase that is elevated at least three times the normal limit.
3. The serum amylase rises within 6-12 hours and remains elevated for 3-5 days.
4. Necrotizing pancreatitis is not a complication of the disorder as it is seen in only about 20% of the individuals. Additional teaching would be required.
5. The volume that is lost from the intravascular space into the interstitial space is significant and can result in hypovolemia and shock if it is not replaced quickly.

Quiz 13: Care of the Patient With an Acute Gastrointestinal Bleed or Pancreatitis