Pancreatitis

AssessmentThe nurse is completing Jared's emergency center admission assessment. 1. To support the admitting diagnosis of acute pancreatitis, which question should the nurse ask Jared? A) "Do you currently, or have you ever, smoked cigarettes?" INCORRECT Cigarette smoking does not cause an acute exacerbation of pancreatitis. B) "How often do you drink alcohol, and when was your last drink?" CORRECT Long-term use of alcohol is commonly associated with the development of chronic pancreatitis, and alcohol ingestion is the primary cause of an acute exacerbation of pancreatitis. C) "What medications have you taken in the last 24 hours?" INCORRECT Corticosteroid use, thiazide diuretics, and oral contraceptives are associated with an increased incidence of developing chronic pancreatitis, but taking one dose of medication in the last 24 hours would not cause an acute exacerbation of pancreatitis. D) "Have you had any weight loss or gain in the last six months?" INCORRECT Weight loss is a major problem in chronic pancreatitis, but it is not a significant factor in the onset of an acute exacerbation. Jared shares with the nurse that he has been drinking alcohol every day for the last few years and that he drank a little more than usual last night at a poker party at a friend's house. He also tells the nurse that he has smoked two packs of cigarettes a day for the last 20 years. To further evaluate Jared's condition, the healthcare provider (HCP) prescribes several laboratory tests. Points Earned: 1.0/1.0 Correct Answer(s): B 2. Which laboratory data indicates that Jared is experiencing acute pancreatitis? A) Hemoglobin (Hgb) 12.9 g/dl and hematocrit (HCT) 42%. INCORRECT The hemoglobin and hematocrit are monitored to assess for bleeding, but they not are used to diagnose pancreatitis. B) White blood cell count of 10,000/mm 3 . INCORRECT The WBC count may be elevated in clients with pancreatitis, but this WBC count is within normal limits. C) Amylase of 982 U/L and lipase of 400 U/L. CORRECT Serum amylase and lipase levels can increase to an excess of three times their normal upper limits within 24 hours of an acute exacerbation of pancreatitis. Normal levels are amylase 23-85 U/L and lipase 0-60 U/L. D) Blood alcohol level of 1.0 mg. INCORRECT An elevated blood alcohol level does not support the diagnosis of acute pancreatitis. Points Earned: 0.0/1.0 Correct Answer(s): C Emergency Center Nursing Interventions The emergency center nurse starts an intravenous (IV) infusion of D 5 0.45 NS (normal saline) at 125 ml/hr with a 20 gauge angiocath in Jared's left forearm. Jared complains of severe abdominal pain rated "9" on a 0–10 numerical pain scale. Jared's abdomen is soft and non- tender, and there are bowel sounds in all 4 quadrants. 3. Which medication should the nurse expect to administer to relieve Jared's pain? A) Ondansetron (Zofran) 0.15 mg IV push diluted and administered over 15 minutes. INCORRECT Ondansetron (Zofran) is an antiemetic used to prevent nausea and vomiting associated with cancer chemotherapy and in the prevention of postoperative nausea and vomiting and is not an opioid needed for pain control. B) Ranitidine (Zantac) IV piggy back administered over 30 minutes. INCORRECT Histamine-2 antagonists are prescribed to decrease pancreatic activity by inhibiting stomach acid secretion, but Zantac will not help alleviate Jared's acute pain. C) Morphine 5 mg IV push administered diluted over 5 minutes. CORRECT Morphine is considered a first line opioid analgesic and one of the most commonly prescribed opioids for moderate to severe pain. Others include, fentanyl (Duragesic), hydromorphone (Dilaudid), methadone (Metadol), and oxycodone (Percocet). D) Promethazine (Phenergan) 25 mg IV push, diluted and administered over 1 minute. INCORRECT This is an antiemetic agent that is prescribed to treat nausea and vomiting. It is not used to relieve acute pain. Promethazine is very toxic to the vein and should be administered over at least two minutes. Points Earned: 1.0/1.0 Correct Answer(s): C The HCP writes admitting prescriptions for Jared. 4. Which diet should the nurse expect the HCP to prescribe for Jared? A) Regular diet. INCORRECT The nurse should expect the HCP to prescribe a special diet for a client with acute pancreatitis. B) Low-fat diet. INCORRECT A low-fat diet should not be prescribed for a client with acute pancreatitis. C) Clear-liquid diet. INCORRECT A clear-liquid diet should not be prescribed for a client diagnosed with acute pancreatitis. D) Nothing by mouth. CORRECT All oral intake is withheld to inhibit pancreatic stimulation and the secretion of pancreatic enzymes. Points Earned: 0.0/1.0 Correct Answer(s): D The emergency center nurse prepares to transfer Jared to the medical floor. 5. Which intervention should the nurse implement prior to transferring Jared to the floor? A) Insert a nasogastric tube and connect to low, intermittent suction. CORRECT Nasogastric suction is used to relieve nausea and vomiting, decrease painful abdominal distention and paralytic ileus, and to remove hydrocholric acid so that it does not enter the duodenum and stimulate the pancreas. B) Assist with the insertion of an esophageal balloon tamponade tube. INCORRECT This procedure is used to treat esophageal bleeding secondary to liver failure. C) Attach an urometer to a drainage bag and insert a 16-gauge Foley catheter. INCORRECT Since Jared is able to urinate on his own, there is no reason to put him through the trauma of inserting a large-bore Foley catheter. D) Schedule Jared for endoscopic retrograde cholangiopancreatography (ERCP). INCORRECT This diagnostic test is not scheduled when the client is acute execerbation. It is performed to rule out chronic pancreatitis after recovery from an acute attack and plays a role in the management of clients with acute or chronic pancreatitis. Points Earned: 1.0/1.0 Correct Answer(s): A Three hours after being admitted to the emergency center, Jared is transferred to the medical unit in stable condition. Nursing Interventions on the Medical Unit The nasogastric tube is draining green bile, and Jared reports his pain is a "4" on the 0–10 pain scale. 6. Which intervention regarding positioning should the nurse implement to help alleviate Jared's pain? A) Ensure that Jared remains in a supine position. INCORRECT Jared should not lie flat in the bed because this position will increase pressure on the diaphragm due to the distended abdomen, increasing the client's pain. B) Place 6-inch blocks under the foot of the bed. INCORRECT Elevating the foot of the bed will not help alleviate the pain experienced by a client with acute pancreatitis. C) Encourage side lying with legs drawn to chest. CORRECT The pain from pancreatitis is caused by stretching of the peritoneum secondary to edema caused by the inflamed pancreas. Sitting up, leaning forward, or lying in a fetal position helps alleviate this pain. D) No specific position will help Jared's pain. INCORRECT There are a number of different positions the client can try to help alleviate the pain. Points Earned: 1.0/1.0 Correct Answer(s): C The nurse develops a plan of care for Jared. 7. Which intervention should the nurse include in the plan of care? A) Encourage the client to ambulate in the hall. INCORRECT The client should remain on bedrest to decrease body metabolism and reduce pancreatic and gastric secretions. B) Administer oxygen via nasal cannula. CORRECT Oxygen will help decrease the workload of the respiratory system and the tissue's utilization of oxygen. C) Irrigate the nasogastic tube every four hours. INCORRECT The nasogastric should only be irrigated if the tube is clogged. D) Keep the client's room humidified and warm. INCORRECT The client should be placed in cool, comfortable room with air-conditioning to help decrease the workload of the respiratory system and tissue's utilization of oxygen. Points Earned: 0.0/1.0 Correct Answer(s): B Nutritional Needs Four days after admission, Jared is still unable to tolerate any foods or fluids, so the HCP prescribes total parenteral nutrition (TPN). 8. Which intervention should the nurse implement prior to administering TPN? A) Assess the patency of the nasogastric tube. INCORRECT TPN is not administered through a nasogastric tube. B) Restart Jared's IV with an 18-gauge angiocath. INCORRECT TPN is not administered through a peripheral IV. C) Assist the HCP with a subclavian line insertion. CORRECT Because TPN has a high glucose content which exerts osmotic pressure that is injurious to the intimal lining of peripheral veins, it is administered into the vascular system through a central venous catheter, often inserted into the subclavian vein.The HCP inserts a right subclavian line, and TPN bag #1 is administered via an IV pump at 75 ml/hr. D) Consult with a registered dietician about the formula. INCORRECT The nurse does not need to consult with a registered dietician regarding the TPN solution since the TPN was prescribed by the HCP. Points Earned: 0.0/1.0 Correct Answer(s): C 9. Which independent nursing action regarding the client's nutritional status should the nurse include when caring for Jared? A) Monitor his abdominal girth. INCORRECT The abdominal girth does not need to be monitored when a client is receiving TPN. B) Offer high-protein snacks frequently. INCORRECT Jared has a nasogastric tube. Any oral intake must be prescribed by the HCP in conjunction with clamping the nasogastric tube. C) Obtain and record a daily weight. CORRECT Short-term weight changes (over hours or days) accurately reflect the client's fluid balance which can be influenced by the pancreatitis; weight changes over days or weeks reflects the client's nutritional status. D) Change the TPN IV tubing every 72 hours. INCORRECT Because the IV tubing used for TPN is an excellent medium for bacterial growth due to the high glucose content of the solution, it is changed with every bag. Points Earned: 0.0/1.0 Correct Answer(s): C Management The nurse, with the assistance of an unlicensed nursing assistant (UAP), is assigned to care for 5 clients including Jared. 10. Which task can the nurse delegate to the UAP when caring for Jared? A) Change the subclavian site dressing. INCORRECT This is a sterile dressing change and requires the expertise of the nurse. B) Obtain a blood glucose reading. CORRECT Clients on TPN should have their blood glucose levels checked every 4–6 hours. The UAP can perform this task, but the nurse must analyze the findings to determine if any action should be taken based on the results. C) Check placement of the nasogastric tube. INCORRECT The UAP does not have the expertise to perform client assessment. D) Evaluate the 24-hour intake and output. INCORRECT UAPs can obtain and calculate the client's intake and output, but it requires the expertise of the nurse to evaluate the intake and output to determine if it is normal for the client. Points Earned: 0.0/1.0 Correct Answer(s): B The nurse is preparing to hang Jared's second bag of TPN. TPN bag # 1 has finished infusing at 75 ml/hour, but TPN bag #2 has not been delivered from the pharmacy. The unit clerk calls the pharmacy and is told that TPN Bag #2 is not ready. 11. Which action should the nurse take? A) Notify the charge nurse that the TPN bag #2 is not on the unit. INCORRECT The nurse can handle this situation without notifying the charge nurse. B) Instruct the pharmacy to bring the bag to the floor immediately. INCORRECT TPN solutions are not premixed, and they must be prepared carefully, which requires adequate time and aseptic technique. C) Administer D 20 W via the infusion pump at 75 ml/hr. CORRECT The TPN solution has high glucose content. If the solution is stopped abruptly, the client may experience rebound hypoglycemia. To prevent this, an available IV solution containing a high percentage of glucose should be infused at the same rate as the TPN solution until the next bag of TPN is ready. D) Hang D 5 W via the infusion pump at a keep-vein-open rate. INCORRECT This will not prevent complications associated with abrupt removal of the TPN solution. Points Earned: 0.0/1.0 Correct Answer(s): C Discharge Teaching After receiving TPN for three days, Jared's nasogastric tube is removed. He is started on a clear liquid diet, which he tolerates without pain. The HCP plans to remove Jared's diet restrictions gradually, decrease the TPN, and discharge Jared within the next two days. 12. Which nursing intervention has the highest priority when preparing Jared for discharge? A) Discuss the need to avoid spicy foods. INCORRECT Spicy foods increase pancreatic and gastric juices, but a discussion about spicy foods is not the most important intervention to help Jared prevent another acute pancreatic attack. B) Explain the importance of alcohol abstinence. CORRECT Alcohol intake is the number one cause of an attack of acute pancreatitis, and continued use will do further damage to the pancreas. Since Jared was consuming alcohol daily, this intervention has the highest priority. C) Refer Jared to Alcoholics Anonymous (A.A.). INCORRECT A support group to help Jared quit drinking is an appropriate intervention, but a referral is not the most important intervention. D) Instruct Jared to eat a high-carbohydrate, low-fat diet. INCORRECT This is an appropriate diet for Jared since these foods increase caloric intake without stimulating pancreatic secretions; however, instruction regarding Jared’s diet does not have the highest priority. Points Earned: 1.0/1.0 Correct Answer(s): B The nurse continues to discuss strategies to prevent further attacks with Jared and his wife. 13. Which action should the nurse include when providing discharge teaching? A) Provide the client with a written list of high-protein snack foods. INCORRECT The client should be on a high-carbohydrate, low-protein, and low-fat diet because these foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond. B) Discuss ways to deal with stressful situations and avoid stress if possible. CORRECT Stress stimulates the pancreas to secrete pancreatic enzymes. Effective management of highly stressful situations can help decrease inflammation of the pancreas. C) Encourage daily exercise and teach the proper way to perform isotonic exercises. INCORRECT Daily exercise will not help prevent acute pancreatic attacks. D) Teach Jared to limit coffee, tea, and colas to no more than two a day. INCORRECT Because coffee, tea, and colas stimulate gastric and pancreatic secretions which may precipitate pain, these drinks should be avoided all together. Jared acknowledges the discharge teaching and states, "I will try to do what I'm supposed to do, but my job is very stressful, and it is going to be very hard to quit drinking and smoking." Jared's wife is very skeptical and indicates that she does not think her husband will be compliant with any of the discharge teaching. Points Earned: 0.0/1.0 Correct Answer(s): B Diagnostic Tests Three weeks after Jared is discharged home, he is admitted to the day procedure area for an endoscopic retrograde cholangiopancreatography (ERCP). When the nurse asks Jared to sign the procedure permit, he hesitates and states, "I don't understand why I need this procedure. I am not hurting any more, so I think I want to cancel the test." 14. Which statement by the nurse provides the best response to Jared's comment? A) "The test will allow the HCP to visualize your pancreas." INCORRECT It is correct that an ERCP permits direct visualization of the pancreas, but this is not the best response by the nurse. B) "I will contact your HCP to discuss this with you." CORRECT The procedure cannot be performed unless the client has been fully informed. Jared's comments indicate that he does not fully understand the need for the procedure, and it is the HCP’s responsibility to explain the procedure to the client. After receiving further explanation by the HCP, Jared signs the procedure permit form, and the nurse completes the pre-procedure assessment. C) "You are not sure you want to have this procedure." INCORRECT This is a therapeutic response, but it is not the best response by the nurse in this situation. D) "The procedure is not done when you are hurting." INCORRECT Although the nurse provides Jared with accurate information regarding the test not being performed when the client is experiencing an acute exacerbation, this statement is not the best response in this situation. Points Earned: 1.0/1.0 Correct Answer(s): B 15. Which question should the nurse to ask Jared prior to the ERCP? A) When was the last time you had anything to eat or drink? CORRECT To reduce the risk of aspiration, clients should not have anything to eat or drink at least 8 hours prior to the procedure. B) When was the last time you had a bowel movement? INCORRECT This information is not pertinent to having an ERCP. C) Have you consumed any alcohol in the last 48 hours? INCORRECT Alcohol intake is not pertinent to having an ERCP. D) Do you have any difficulty swallowing or chewing? INCORRECT Difficulty swallowing or chewing is not pertinent to having an ERCP. Points Earned: 1.0/1.0 Correct Answer(s): A After the nurse completes the assessment, Jared undergoes the ERCP without any problems. 16. What intervention has the highest priority when caring for Jared after the procedure? A) Monitor the client's IV fluids. INCORRECT Jared will be receiving IV fluids, but monitoring fluids does not have the highest priority when providing post-procedure nursing care. B) Assess the client's pulse and blood pressure. CORRECT Because esophageal and/or duodenal perforation can occur during the procedure, monitoring the client for manifestations of hypovolemia has the highest priority. C) Check the client's abdomen for pain and tenderness. INCORRECT Assessing the abdomen is an appropriate intervention, but it does not have the highest priority when providing post-procedure nursing care. D) Evaluate the client's hemoglobin and hematocrit. INCORRECT Evaluating Jared's Hgb and HCT is an appropriate intervention, but it does not have the highest priority. Points Earned: 0.0/1.0 Correct Answer(s): B Jared does not experience any complications secondary to the ERCP and is discharged home with his wife. He has a follow-up appointment in two days with his HCP to discuss the results of the ERCP and the treatment plan. Follow-Up Appointment At Jared's follow-up visit after the ERCP, the clinic nurse asks Jared if he is complying with his discharge teaching. He tells the nurse that he doesn't drink much alcohol, and he is trying to cut down on his smoking. He adds that he has quit drinking tea and cola, but he has to have his morning coffee. He tells the nurse his stomach hasn't been hurting too much, but he reports that his stools look fatty, appear bubbly and frothy, float on top of the water, and are extremely malodorous. 17. How should the nurse respond? A) "We need to get a stool specimen and send it to the lab." INCORRECT There is no reason for the nurse to send a stool specimen to the laboratory. B) "Have you been eating any fatty foods in the last few days?" INCORRECT Fatty foods do not cause this type of stool. C) "This is common in persons with chronic pancreatitis." CORRECT Clients with chronic pancreatitis have steatorrhea (fatty, frothy, foul-smelling stools) due to a decrease in pancreatic enzyme production. D) "This happens when you drink too much alcohol." INCORRECT Alcohol intake does not cause an abnormal appearance of the stools. Points Earned: 1.0/1.0 Correct Answer(s): C Jared's HCP explains that his chronic pancreatitis is getting worse and that he needs to comply with the previous teaching as well as take additional medications. Along with pancreatic enzymes, Jared's HCP prescribes omeprazole (Prilosec). The nurse discusses the new prescriptions with Jared. 18. Which statement accurately explains the scientific rationale for the use of Prilosec? A) Prilosec decreases gastric secretions. CORRECT Prilosec is a proton-pump inhibitor (PPI) that decreases gastric secretions. Proton-pump inhibitors, such as Prilosec, reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. B) Prilosec decreases pancreatic enzyme secretion. INCORRECT Octreotide (sandostatin), a synthetic hormone, suppresses pancreatic enzyme secretion and may be used to relieve pain in chronic pancreatitis. C) Prilosec decreases the propulsion of food through the small intestine. INCORRECT Proton-pump inhibitors, such as Prilosec, do not decrease the propulsion of food through the small intestine. D) Prilosec decreases the number of stools and steatorrhea. INCORRECT Pancreatic enzymes are prescribed to reduce steatorrhea. Points Earned: 1.0/1.0 Correct Answer(s): A Medication Teaching Jared's HCP has prescribed pancrelipase (Cotazym), a pancreatic enzyme, to help reduce the fatty, frothy, foul-smelling stools. 19. How should the nurse proceed when teaching Jared about this medication? A) Instruct Jared to let the tablet dissolve in his mouth. INCORRECT The tablet should be swallowed not dissolved in the mouth. B) Advise Jared to check his stool daily for occult blood. INCORRECT There is no indication that Jared ever had blood in his stool, and Cotazym does not cause bleeding. C) Determine if Jared is allergic to any type of pork. CORRECT Because Cotazym is made from the pancreas gland of a hog, the nurse should determine if Jared is allergic to pork products. D) Explain that joint pain may occur, but will resolve over time INCORRECT Although side effects are rare when taking Cotazym as directed, if joint pain, rash, hives, respiratory difficulty, or hematuria occurs, clients should notify their HCP. Points Earned: 1.0/1.0 Correct Answer(s): C The nurse continues teaching Jared about administration of the enteric-coated pancreatic enzyme. 20. Which additional instruction regarding the use of Cotazym is important for the nurse to include? A) Take the medication with meals or snacks. CORRECT Pancrelipase enhances the digestion of starches and fats in the GI tract by supplying an exogenous source of the pancreatic enzyme. This medication promotes nutrition and decreases the number of bowel movements. B) Chew the medication 30 minutes before eating. INCORRECT Enteric-coated medication should not be crushed, chewed, or mixed with alkaline foods (milk, ice-cream). C) Spread the capsule crystals over food and chew thoroughly. INCORRECT If the pancreatic enzymes are not enteric coated, they may be spread over the food. However, if the capsules contain enteric-coated spheres, they should be taken with liquids or small amounts of soft foods, such as applesauce or gelatin that do not require chewing. D) Swallow the capsule twice a day in the morning and bedtime. INCORRECT The medication should be taken before or with meals to be most effective. Points Earned: 1.0/1.0 Correct Answer(s): A Long-Term Complications Jared and his wife did not realize how serious chronic pancreatitis can be even though they received some information when he was first diagnosed. 21. When the nurse is discussing the complications of chronic pancreatitis with Jared and his wife, which information should be included in the teaching? A) The need to report any painful urinating or dribbling. INCORRECT Painful urination and dribbling urine are not signs of potential complications of pancreatitis. These symptoms may indicate a urinary tract infection or prostate enlargement. B) The signs/symptoms of hypovolemic shock. INCORRECT This is a complication that can occur with acute necrotic pancreatitis, not chronic pancreatitis. C) The importance of checking bilirubin levels. INCORRECT Altered bilirubin levels could indicate a complication from liver dysfunction, rather than chronic pancreatitis. D) The need to monitor blood glucose levels. CORRECT Because diabetes mellitus can develop secondary to chronic pancreatitis, blood glucose levels should be monitored. Points Earned: 1.0/1.0 Correct Answer(s): D Since Jared is asking questions and seems very interested in the discussion concerning complications of chronic pancreatitis, the nurse continues to talk about interventions that Jared can implement at home. 22. Which action should the nurse encourage Jared to take? A) Rest in bed as much as possible. INCORRECT Since Jared’s last acute attack was over three weeks ago, Jared should be progressing to a normal activity level. B) Weigh weekly and report any significant weight loss. CORRECT Weight loss is a major problem for clients with chronic pancreatitis. It is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. C) Increase fluid intake to 3–4 liters of water a day. INCORRECT Increasing fluids will not help prevent complications of chronic pancreatitis. D) Decrease the amount of dietary fiber. INCORRECT Decreasing the amount of fiber in the diet will not prevent complications and may lead to constipation. Points Earned: 1.0/1.0 Correct Answer(s): B Referral to Alcoholics Anonymous (A.A.) The clinic nurse is concerned that Jared continues to smoke cigarettes, but his inability to abstain from drinking alcohol is a greater priority. The nurse encourages Jared to attend an A.A. meeting. Jared asks the nurse, "How will this meeting help me quit drinking?" 23. How should the nurse respond? A) "It is a support group that uses a 12-step recovery program to quit drinking." CORRECT A.A. is a program of total abstinence. According to A.A., sobriety is maintained through sharing experience, strength and hope at group meetings and through the suggested Twelve Steps for recovery from alcoholism. B) "If you go to these meetings instead of bars, you won’t be able to drink." INCORRECT Attending A.A. meetings does not ensure the client will not go to a bar and continue to drink. C) "A person cannot quit drinking on their own without some kind of help." INCORRECT This response does not explain how A.A. will help Jared quit drinking. D) "They discuss medications that can curb your desire to drink alcohol." INCORRECT A.A. does not encourage medication use to quit drinking alcohol. Points Earned: 1.0/1.0 Correct Answer(s): A After listening to the nurse explain Alcoholics Anonymous, Jared asks, "How much does it cost to go to these meetings?" 24. How should the nurse respond? A) "A nominal fee is charged when attending the meetings." INCORRECT A nominal fee is not charged when attending A.A. meetings. B) "A.A. meetings are supported by nonmember contributions." INCORRECT A.A. neither seeks or accepts contributions from nonmembers. C) "There are no due or fees to attend the meetings." CORRECT Although A.A. has long-held tradition of being fully self-supporting, there are no dues or fees to attend the meetings. D) "Monthly dues encourage members to attend the meetings." INCORRECT There are no monthly dues. Points Earned: 1.0/1.0 Correct Answer(s): C Therapeutic Communication The nurse is concluding the teaching session when Jared asks, "Am I going to die if I keep drinking?" 25. How should the nurse respond to Jared's question? A) "You sound as if you are afraid you may die from this disease." INCORRECT Although this reflection of the client's statement and is a therapeutic technique the nurse is assuming that Jared is afraid, so this is not the best response to Jared's question. B) "Jared, if you don't stop drinking, this disease may kill you." CORRECT Chronic pancreatitis is a serious disease that can lead to disability and death. Since the risk of premature death may be reduced if abstinence from alcohol is maintained, the nurse should give Jared a straightforward answer in response to his question. C) "I can't answer that question; no one can answer it." INCORRECT The nurse can answer Jared's question and should do so in a caring, straightforward manner. D) "Why are you concerned about that now?" INCORRECT This response is likely to make Jared defensive and could be a block to further teaching or discussion. Points Earned: 0.0/1.0 Correct Answer(s): B Jared states, "I just don't know if I will be able to stop drinking. I have been drinking every day for the last 20 years of my life." 26. Which nursing intervention will be most beneficial in helping Jared and his wife plan for the future if he is unable to modify his lifestyle? A) Encourage Jared's wife to admit him to a substance abuse unit. INCORRECT If Jared does not want to quit drinking, admission to a substance abuse unit will likely not be very helpful. B) Refer Jared for care to a home health care agency. INCORRECT Jared will not benefit from the services of a home health care agency at this time, although home health care may be beneficial in the future. C) Discuss the need to complete an Advance Directive. CORRECT If Jared does not quit drinking, he will likely die from complications of chronic pancreatitis and alcohol abuse. Completing an Advance Directive will help Jared's wife so she won't be forced to make difficult decisions later on if Jared becomes unconscious or is dying and unable to speak for himself. D) Suggest that Jared's wife attend Al-Anon meetings. INCORRECT Attendance at Al-Anon meetings may be helpful to Jared's wife, but another intervention is of greater importance. Points Earned: 0.0/1.0 Correct Answer(s): C Case Outcome Jared and his wife leave the clinic with written information about chronic pancreatitis and the telephone number of the local Alcoholics Anonymous organization. They also have the nurse's office number with instructions to call if they have any questions or concerns. Jared has a follow- up appointment in two weeks. At this time, it is unknown what will happen to Jared. Maybe with the love and support of his wife and family, he can get sober, manage his pancreatitis, and turn his life around. Continue