Question

1. A patient with severe acute pancreatitis has the following vital signs after fluid resuscitation. BP 84/53 mm Hg and HR 121 bpm.  What should the nurse consider as the next step of care for this patient?

A: Prepare to administer diuretics

B: Ask the physician if an antihypertensive would be indicated

C: Assess for hypovolemic shock

D: Prepare to administer potassium chloride

2. A patient being treated in the infectious disease clinic has a history of IV drug use and chronic kidney disease requiring dialysis. He presents today with jaundice and arthralgia. Which of the following would the patient be at increased risk for? Select all that apply.

A: Hepatitis E

B: Hepatitis B

C: Hepatitis C

D: Hepatitis A

3. Patients receiving total parenteral nutrition therapy should be monitored closely. What interventions should the nurse perform when caring for a patient on TPN? Select all that apply.

A: Daily weights

B: Monitor intake and output

C: Monitor infusion rate

D: Change tubing weekly

E: Monitor glucose and electrolytes

Answer 1

1. In the given data, patient just received a fluid resuscitation and blood pressure is 84/53 mm Hg and heart rate is 121 bpm. The patient experience  hypotension and tachycardia.

Option A is irrelevant as administering diuretics will reduce body fluid volume and further reduce the blood pressure.

Option B is irrelevant as antihypertensive medications used to reduce blood pressure which is dangerous for this patient condition as the patient has low BP.

Option C is relevant because the patient has hypotension with tachycardia which indicate due to less blood volume in the body, the heart is pumping more to adjust the body needs.

Option D is irrelevant as potassium chloride in this condition is not necessary at this moment. it should be indicated if the electrolyte values are deranged.

Thus the answer is, C : Assess for hypovolemic shock

2. As per the given data, the patient has a history of IV drug use and chronic kidney disease requiring dialysis. He presents today with jaundice and arthralgia.

The history reveal that he has a chance of getting hepatitis B or hepatitis C as both of the infections are transmitted through IV drug uses ( by exchanging same needles among drug users) and during dialysis. When we go through the symptoms of both hepatitis B and C we can observe that jaundice is observed in both cases but arthralgia ( joint pain ) is seen only in patients with Hepatitis C. Thus option B: Hepatitis B can be excluded. Hepatitis A and E are transmited through contaminated food and water and they are not relevant to the given history. Thus, option A: Hepatitis E and D: Hepatitis A can be excluded.

Thus the answer is , C: Hepatitis C.

3. When a patient is on Total parentral nutrition therapy, it is important to monitor daily weight, intake output, infusion rate, glucose and electrolyte.

Daily weight monitoring is important because the sudden weight gain indicate fluid over load.

Intake output monitoring is necessary as it helps to identify the fluid overload and cardiovascular function.

Monitoring of infusion rate is important as rapid infusion will cause fluid overload. Monitoring and reporting the rate of infusion whether the rate is appropriate for the patient will reduce complication related to fluid overload.

Monitoring glucose and electrolyte is very important as the TPN infusion can cause hyperglycemia and electrolyte imbalances.

The recomendation to change the tubing is every 24 hours not weekly.

Thus the answer are A: Daily weights, B: Monitor intake and output, C: Monitor infusion rate, E: Monitor glucose and electrolytes.