Pancreatitis Management Practice Questions
20 free Pancreatitis Management practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which laboratory result should the nurse expect to see significantly elevated within the first 24 hours?
- A Serum calcium
- B Serum amylase
- C Serum bilirubin
- D White blood cell count
Correct answer: Serum amylase
Serum amylase levels rise early (within 2 to 12 hours) in acute pancreatitis and usually return to normal within 3 days. Serum lipase is also elevated and stays high longer, but amylase is the hallmark of early diagnostic elevation.
The nurse is assessing a client with acute pancreatitis and notes bluish discoloration around the umbilicus. How should the nurse document this finding?
- A Turner's sign
- B Chvostek's sign
- C Cullen's sign
- D Homan's sign
Correct answer: Cullen's sign
Cullen's sign is a superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus, indicating severe necrotizing pancreatitis with retroperitoneal bleeding. Turner's sign refers to similar bruising on the flanks.
A client with acute pancreatitis is experiencing severe abdominal pain. Which position should the nurse encourage the client to assume for comfort?
- A Supine with legs extended
- B Side-lying with knees flexed toward the chest
- C Prone with a pillow under the abdomen
- D High-Fowler's with the head of the bed at 90 degrees
Correct answer: Side-lying with knees flexed toward the chest
Fetal position or sitting up and leaning forward helps relieve the pain of pancreatitis by reducing the tension on the peritoneum and the pressure of the inflamed pancreas on the retroperitoneal nerves.
A client with acute pancreatitis has a serum calcium level of 6.2 mg/dL. Which clinical manifestation should the nurse monitor for?
- A Constipation, lethargy, and muscle weakness
- B Hyperactive deep tendon reflexes and tetany
- C Polyuria and polydipsia
- D Bradycardia and hypertension
Correct answer: Hyperactive deep tendon reflexes and tetany
Hypocalcemia is a common complication of severe pancreatitis due to fat necrosis and the binding of calcium in the abdomen (saponification). Signs of low calcium include tetany, tremors, and positive Chvostek's or Trousseau's signs.
What is the primary rationale for maintaining a client with acute pancreatitis on NPO (nothing by mouth) status?
- A To prevent the development of a paralytic ileus.
- B To reduce the secretion of pancreatic enzymes that cause autodigestion.
- C To prepare the client for an emergency surgical removal of the gallbladder.
- D To minimize the risk of aspiration pneumonia.
Correct answer: To reduce the secretion of pancreatic enzymes that cause autodigestion.
Food and fluids entering the duodenum trigger the release of secretin and cholecystokinin, which stimulate pancreatic enzyme production. Keeping the client NPO 'rests' the pancreas and stops the cycle of autodigestion.
The nurse is preparing to administer pancrelipase to a client with chronic pancreatitis. Which instruction is essential for the nurse to provide?
- A Take the medication 1 hour after meals.
- B Swallow the capsules whole or sprinkle them on alkaline foods like milk.
- C Take the medication with every meal and snack.
- D Do not drink any water for 30 minutes after taking the enzyme.
Correct answer: Take the medication with every meal and snack.
Pancreatic enzyme replacement therapy (PERT) must be taken with all meals and snacks to aid in the digestion of fats and proteins. The enzymes must be present in the duodenum at the same time as the food.
A client with chronic pancreatitis reports that their stools are foul-smelling, frothy, and float in the toilet. How should the nurse document this finding?
- A Melena
- B Steatorrhea
- C Hematochezia
- D Obstipation
Correct answer: Steatorrhea
Steatorrhea is the excretion of abnormal quantities of fat with the feces due to reduced pancreatic lipase production. It is a common symptom of chronic pancreatitis indicating malabsorption.
A nurse is caring for a client with acute pancreatitis. The nurse notes a twitching of the client's lip when tapping over the parotid gland. Which action should the nurse take first?
- A Notify the provider of a positive Cullen's sign.
- B Check the client's most recent serum calcium level.
- C Administer the scheduled dose of IV morphine.
- D Assess the client's blood pressure for orthostatic changes.
Correct answer: Check the client's most recent serum calcium level.
The twitching is a positive Chvostek's sign, indicating hypocalcemia. Because hypocalcemia can lead to seizures and laryngospasm, the nurse must verify the lab value and prepare to administer calcium gluconate.
Which complication should the nurse monitor for most closely in a client with acute pancreatitis in the first 48 hours?
- A Diabetes mellitus
- B Chronic pseudocyst formation in the pancreas
- C Acute Respiratory Distress Syndrome (ARDS)
- D Pancreatic cancer
Correct answer: Acute Respiratory Distress Syndrome (ARDS)
Acute pancreatitis can lead to systemic inflammation and the release of phospholipase A, which destroys lung surfactant. This places the client at high risk for ARDS, a life-threatening respiratory complication.
A nurse is providing discharge teaching to a client following an episode of acute pancreatitis. Which dietary modification should be emphasized?
- A A high-protein, high-fat diet to promote healing.
- B A low-carbohydrate diet to prevent hyperglycemia.
- C Fluid restriction to 1,000 mL per day.
- D Strict avoidance of alcohol and a low-fat diet.
Correct answer: Strict avoidance of alcohol and a low-fat diet.
Alcohol is a primary trigger for pancreatitis and must be avoided entirely to prevent recurrence. A low-fat diet is recommended because fats require pancreatic enzymes for digestion, which can overwork the inflamed gland.
The nurse is evaluating the effectiveness of pancrelipase therapy in a client with chronic pancreatitis. Which finding indicates the medication is effective?
- A The client's skin is less jaundiced.
- B The client's blood glucose levels are within normal range.
- C The client has a decrease in the number of fatty stools.
- D The client's serum amylase levels have decreased.
Correct answer: The client has a decrease in the number of fatty stools.
The purpose of pancrelipase is to assist with digestion. A decrease in steatorrhea (fatty, bulky stools) and improved nutritional status/weight gain indicate that the enzymes are effectively breaking down nutrients.
A nurse is caring for a client with acute pancreatitis who has a nasogastric (NG) tube to low intermittent suction. What is the primary purpose of the NG tube for this client?
- A To provide a route for enteral nutrition.
- B To monitor for signs of upper gastrointestinal bleeding and perforation.
- C To administer crushed pancreatic enzymes.
- D To decompress the stomach and reduce pancreatic stimulation.
Correct answer: To decompress the stomach and reduce pancreatic stimulation.
NG suctioning reduces abdominal distension and prevents gastric contents from entering the duodenum. This minimizes the hormonal stimulation of the pancreas, further aiding in 'pancreatic rest'.
Which assessment finding would indicate that a client's acute pancreatitis is progressing to the development of a pancreatic abscess?
- A Persistent high fever and increasing abdominal pain.
- B Sudden onset of polyphagia.
- C Decreased white blood cell count over several consecutive days.
- D Development of a sweet, musty breath odor.
Correct answer: Persistent high fever and increasing abdominal pain.
A pancreatic abscess is a serious complication involving an infected collection of fluid within the pancreas. Manifestations include a high fever, leukocytosis, and an increase in abdominal pain and tenderness.
A client with acute pancreatitis is receiving aggressive IV fluid resuscitation. Which assessment finding indicates that the fluid therapy is effective?
- A Weight gain of 2 lbs in 24 hours.
- B Increased hematocrit level.
- C Decreased heart rate and clear breath sounds.
- D Urine output of 40 mL/hour.
Correct answer: Urine output of 40 mL/hour.
Maintaining adequate organ perfusion is vital in pancreatitis. A urine output of at least 30-50 mL/hour is a standard indicator that the kidneys are being adequately perfused and that fluid resuscitation is sufficient.
A nurse is caring for a client with acute pancreatitis. The client is suddenly tachypneic and appears restless. What is the nurse's priority action?
- A Give a PRN anti-anxiety medication.
- B Re-position the client to a supine position.
- C Auscultate bowel sounds in all four quadrants.
- D Check the client's oxygen saturation level.
Correct answer: Check the client's oxygen saturation level.
Tachypnea and restlessness are early signs of hypoxia or the development of ARDS in pancreatitis. The nurse must assess oxygenation immediately and prepare for potential oxygen therapy or intubation.
Which of the following is a known risk factor for the development of chronic pancreatitis?
- A Prolonged use of NSAIDs.
- B History of viral hepatitis A.
- C Vegetarian diet.
- D Chronic alcoholism.
Correct answer: Chronic alcoholism.
Chronic alcoholism is the most common cause of chronic pancreatitis in the United States. It leads to repeated episodes of inflammation, eventually resulting in permanent scarring and loss of pancreatic function.
A client with acute pancreatitis is at risk for hypovolemic shock. What is the physiological cause of this risk?
- A Excessive vomiting and diarrhea.
- B Decreased production of antidiuretic hormone.
- C Excessive internal bleeding from the pancreas into the surrounding tissue.
- D Fluid shifting into the retroperitoneal space (third-spacing).
Correct answer: Fluid shifting into the retroperitoneal space (third-spacing).
Inflammation of the pancreas causes increased capillary permeability, leading to a massive shift of protein-rich fluid into the peritoneal and retroperitoneal spaces. This third-spacing results in decreased circulating blood volume.
The nurse is providing education to a client with chronic pancreatitis. The nurse explains that the client is at risk for developing which endocrine disorder?
- A Hypothyroidism
- B Cushing's syndrome
- C Diabetes mellitus
- D Diabetes insipidus
Correct answer: Diabetes mellitus
As chronic pancreatitis progresses, the insulin-producing beta cells in the Islets of Langerhans are destroyed. This leads to secondary diabetes mellitus, requiring blood glucose monitoring and possibly insulin therapy.
A nurse is assessing a client for Turner's sign. Where should the nurse look for this finding?
- A On the client's flanks.
- B Around the umbilicus.
- C On the palms of the hands.
- D Along the lower extremities.
Correct answer: On the client's flanks.
Turner's sign is a grey-blue discoloration of the flanks. Like Cullen's sign, it is a marker of retroperitoneal hemorrhage associated with severe, necrotizing acute pancreatitis.
A client with acute pancreatitis is being transitioned from NPO to a regular diet. Which food should the nurse recommend the client avoid initially?
- A White toast with jelly.
- B Steamed vegetables and rice.
- C Whole milk and fried eggs.
- D Skinless chicken breast.
Correct answer: Whole milk and fried eggs.
When reintroducing food, the client should start with low-fat, high-carbohydrate options. High-fat foods like whole milk and fried items stimulate the pancreas significantly and are poorly tolerated during recovery.