Exemplar 4.4: Pancreatitis

Olivia McRitchie
Quiz by Olivia McRitchie, updated more than 1 year ago
Olivia McRitchie
Created by Olivia McRitchie over 2 years ago
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Description

NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 4.4: Pancreatitis, created by Olivia McRitchie on 04/16/2018.

Resource summary

Question 1

Question
There are 2 types of pancreatitis: Acute and chronic (what a shocker). Below are descriptions of the 2 types. Drag and drop the correct answer. Acute pancreatitis is an inflammatory disorder that involves self-destruction of the pancreas by its own enzymes through [blank_start]autodigesion[blank_end]. The milder form is called [blank_start]interstitial edematous pancreatitis[blank_end]; it leads to inflammation and edema of the pancreatic tissue, and it is often self limiting. The more severe form is called [blank_start]necrotizing pancreatitis[blank_end]; it is characterized by inflammation, hemorrhage, and ultimately death of pancreatic tissue. Although the exact cause of acute pancreatitis is unknown, the following factors may lead to activation of the pancreatic enzymes and cause the symptoms of acute pancreatitis: -[blank_start]Gallstones[blank_end] may obstruct the pancreatic duct or cause bile reflux, activating pancreatic enzymes in the duct system. -[blank_start]Alcohol[blank_end] causes duodenal edema, and may increase pressure and spasm in the sphincter of Oddi, causing pancreatic outflow. Regardless of what caused it, the process begins with the release of activated pancreatic enzymes into pancreatic tissue. [blank_start]Trypsin[blank_end] in particular will digest pancreatic tissue and activate other enzymes, such as [blank_start]phospholipase A[blank_end] (responsible for digesting cell membrane phospholipids) and [blank_start]elastase[blank_end] (responsible for digesting elastic tissue of blood vessel walls). All of this will lead to proteolysis, edema, vascular damage and hemorrhage, and necrosis of parenchymal cells. Chronic pancreatitis, on the other hand, is characterized by chronic inflammation, fibrosis, and gradual destruction of functional pancreatitis tissue. [blank_start]Alcoholism[blank_end] is the primary risk factor, but about 10-20% of cases are idiopathic. A genetic mutation associated with [blank_start]cystic fibrosis[blank_end] may play a role in the idiopathic cases. In chronic cases related to alcoholism, pancreatic secretions have an increased concentration of [blank_start]insoluble proteins[blank_end]. These proteins calcify and block the [blank_start]pancreatic ducts[blank_end] and flow of pancreatic juices. In other cases, a stricture or stone may block the outflow, causing [blank_start]chronic obstructive pancreatitis[blank_end]. Recurrent episodes of inflammation eventually lead to [blank_start]fibrotic[blank_end] changes in the perenchyma, with loss of exocrine function. This leads to malabsorption from pancreatic insufficiency. It can also cause a loss of endocrine function.
Answer
  • autodigesion
  • autolysis
  • interstitial edematous pancreatitis
  • necrotizing pancreatitis
  • Gallstones
  • Kidney stones
  • Alcohol
  • Tobacco
  • Trypsin
  • phospholipase A
  • elastase
  • Alcoholism
  • Drug addiction
  • Tobacco use
  • cystic fibrosis
  • tay-sachs disease
  • insoluble proteins
  • proteins
  • soluble proteins
  • chronic obstructive pancreatitis
  • fibrotic
  • elastic
  • pancreatic ducts
  • biliary ducts

Question 2

Question
Alcoholism is a risk factor in both acute and chronic pancreatitis.
Answer
  • True
  • False

Question 3

Question
Destruction from chronic pancreatitis is reversible. Destruction from acute pancreatitis, on the other hand, is not.
Answer
  • True
  • False

Question 4

Question
Which of the following is NOT a factor associated with acute pancreatitis?
Answer
  • Gallstones
  • Alcoholism
  • Tissue ischemia or anoxia
  • Trauma or surgery
  • Pancreatic tumors
  • Infectious agents
  • Third trimester pregnancy
  • Elevated calcium levels
  • Hyperlipidemia
  • Genetic mutation

Question 5

Question
Select the individuals that display a risk factor for developing chronic pancreatitis.
Answer
  • A 50 year old female with rheumatoid arthritis.
  • A 10 year old male with cystic fibrosis.
  • A 60 year old male with elevated LDL that's taking a thiazide diuretic for hypertension.
  • A 40 year old female with hyperparathyroidism.
  • A 16 year old female on sertaline for major depressive disorder.
  • A 50 year female with osteoporosis

Question 6

Question
You have a male patient come after passing out at home. His wife reports that he's been nauseated and hasn't been able to keep anything down for the past 24 hours. She also reports that he's been complaining of pain right above his belly button. Upon physical assessment, you find that his abdomen is distended and rigid. His heart rate is at 110 bpm, his BP is at 90/60, his respirations are at 25 per minute, and his temperature is at 102.5 degrees Fahrenheit. When you were taking his pulse, his hands were cold and clammy. Which type of pancreatitis do you think this patient has, based off his symptoms?
Answer
  • Acute pancreatitis
  • Chronic pancreatitis.
  • Neither.

Question 7

Question
Select the options that are NOT a complication of untreated acute pancreatitis.
Answer
  • Manifestations of ARDS
  • Pancreatic necrosis
  • Shock and multiple organ failure
  • Pancreatic pseudocysts
  • Generalized peritonitis
  • Pancreatic ascites
  • Malabsorption and malnutrition
  • Peptic ulcer disease
  • Pancreatic abscesses.

Question 8

Question
You have a patient in your office complaining about recurrent episodes of pain in her left upper abdomen. She hasn't been able to eat, and whenever the pain comes back she feels nauseated. She said that she's dropped about 10 pounds from being unable to eat. She also notes that she's been taking laxatives a lot more often because she's having a hard time defecating. When she does defecate, she notes that her fecal matter is frothy and smells absolutely horrible. Which kind of pancreatitis does this individual have?
Answer
  • Acute pancreatitis
  • Chronic pancreatitis
  • Neither

Question 9

Question
Select all of the potential complications of chronic pancreatitis.
Answer
  • Malabsorption
  • Malnutrition
  • Peptic ulcer disease
  • Pancreatic pseudocyst or abscess
  • Stricture of the common duct
  • Diabetes mellitus
  • Generalized peritonitis
  • Chronic kidney failure

Question 10

Question
Which of the following is NOT an appropriate intervention for treating acute pancreatitis?
Answer
  • Giving an opioid analgesic, such as morphine sulfate or hydromorphone (Dilaudid).
  • Prophylactic antibiotics.
  • Pancreatic enzyme supplements
  • Withholding oral food and fluids.

Question 11

Question
Which of the following is NOT a medication given for chronic pancreatitis?
Answer
  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)
  • Omeprazole (Prilosec).
  • Pancreatic enzyme supplements.
  • Metoclopramide (Reglan)

Question 12

Question
You are assessing a patient that you believe has pancreatitis. Select everything that would be in your assessment.
Answer
  • Bowel sounds
  • Abdominal distension
  • Jaundice
  • Nausea/vomiting.
  • Presence of flatus
  • Last bowel movement.
  • Last time bladder was voided.
  • Presence of fever

Question 13

Question
You are implementing care for a patient with pancreatitis. He will need an endoscopic transduodenal sphincterotomy. He is NPO, both in preparation for his surgery and to promote rest of his pancreas. You believe him to be at risk of electrolyte imbalances. due to presence of abdominal distension. Select the appropriate interventions
Answer
  • Offer frequent oral hygiene.
  • Administer oral opioid analgesics.
  • Closely monitor intake and output.
  • Maintain a stool chart that notes the frequency, color, odor, and consistency of stools.
  • Assess cardiovascular status once a day.
  • Assess urine output once every 4 hours,
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