Upper & Lower GI fall 2020 ms

A client who has occasional gastric symptoms is receiving teaching on how to prevent gastroesophageal reflux disease (GERD). Which statement indicates the client understands the teaching? "Taking a nap after meals, when possible." "Eating two large meals a day, instead of three." "Sleeping flat without pillows is beneficial." "Eliminating bothersome foods will help."

"Eliminating bothersome foods will help." Explanation: Irritating foods such as spices, caffeine, and alcohol should be avoided because these will assist in decreasing gastric acidity. Eating smaller meals is recommended to avoid lower pressure in the lower esophageal sphincter. Gastric reflux of acid is more likely to occur with positioning flat and lying down after a meal, so this should be avoided.

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows. Drink three, 8 oz. glasses of regular milk daily to coat the esophagus. Avoid beer, especially in the evening. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid.

Avoid beer, especially in the evening. Elevate the head of the bed on 6- to 8-inch blocks. Elevate the upper body on pillows. Explanation: Milk should be avoided, as should eating before bed. Advise the patient not to eat or drink 2 hours before bedtime.

The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease? Taking multivitamins as prescribed and eating organic foods whenever possible Performing 15 minutes of physical activity at least three times per week Maintaining a healthy body weight Avoid taking aspirin to treat pain or fever

Avoid taking aspirin to treat pain or fever Explanation: Aspirin and other NSAIDs are implicated in chronic gastritis because of their irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection. Exercise and a healthy body weight are beneficial to overall health but do not prevent gastritis.

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes? Eliminating spicy foods. Eliminating cucumbers and other foods with seeds. Avoiding chocolate and coffee. Avoiding steamed foods.

Avoiding chocolate and coffee. Explanation: Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.

A client who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the client's condition is now stable. For the next several hours, the nurse caring for this client should assess for what signs and symptoms of recurrence? Tachycardia, hypotension, and tachypnea Tarry, foul-smelling stools Diaphoresis and sudden onset of abdominal pain Sudden thirst, unrelieved by oral fluid administration

Tachycardia, hypotension, and tachypnea Explanation: Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Clients who have had one GI bleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage. Hemorrhage is not normally associated with sudden thirst or diaphoresis.

A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. maintaining an upright position following meals avoiding foods that intensify symptoms ensuring intake of food and fluids 2 to 3 hours before bedtime sleeping in a supine position

maintaining an upright position following meals avoiding foods that intensify symptoms Explanation: Conservative measures used in the treatment of GERD are maintaining an upright position following meals, avoiding foods that intensify symptoms, elevating the head of the bed when sleeping, and avoiding the intake of food and fluids 2 to 3 hours before bedtime.

The nurse is concerned that a postoperative patient may have a paralytic ileus. What assessment data may indicate that the patient does have a paralytic ileus? Abdominal distention Absence of peristalsis Abdominal tightness Increased abdominal girth

Absence of peristalsis Explanation: Paralytic ileus and intestinal obstruction are potential postoperative complications that occur more frequently in patients undergoing intestinal or abdominal surgery. Manipulation of the abdominal organs during surgery may produce a loss of normal peristalsis for 24 to 48 hours, depending on the type and extent of surgery.

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease? Eat a low-carbohydrate diet Elevate the foot of the bed on 6- to 8-inch blocks Avoid eating or drinking 2 hours before bedtime Wear tight-fitting clothing

Avoid eating or drinking 2 hours before bedtime Explanation: The client should be advised to avoid eating or drinking 2 hours before bedtime. The client should not recline with a full stomach. The client should be instructed to avoid caffeine, beer, milk, and foods containing peppermint or spearmint, and to eat a low-fat diet. The client should be instructed to elevate the head, not the foot, of the bed on 6- to 8-inch blocks. The client should avoid tight-fitting clothes.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has? diverticulitis peptic ulcer disease appendicitis ulcerative colitis

peptic ulcer disease Explanation: Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) "It is probably your nerves." "It is a hereditary disease." "Is it possible that you are overusing aspirin." "You may have ingested some irritating foods." "It can be caused by ingestion of strong acids."

"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." Explanation: Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.

A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? Obtaining a blood sample for laboratory studies Preparing to insert a nasogastric (NG) tube Administering I.V. fluids Administering pain medication

Administering I.V. fluids Explanation: The nurse should first administer I.V. infusions containing normal saline solution and potassium to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to help diagnose bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication commonly is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.

Which of the following medications, used in the treatment of GERD, accelerate gastric emptying? Nizatidine (Axid) Metoclopramide (Reglan) Famotidine (Pepcid) Esomeprazole (Nexium)

Metoclopramide (Reglan) Explanation: Prokinetic agents which accelerate gastric emptying, used in the treatment of GERD, include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). If reflux persists, the patient may be given antacids or H2 receptor antagonists, such as famotidine (Pepcid) or nizatidine (Axid). Proton pump inhibitors (medications that decrease the release of gastric acid, such as esomeprazole (Nexium) may be used, also.

Which term refers to the symptom of gastroesophageal reflux disease (GERD), which is characterized by a burning sensation in the esophagus? Pyrosis Dysphagia Dyspepsia Odynophagia

Pyrosis Explanation: Pyrosis refers to a burning sensation in the esophagus and indicates GERD. Indigestion is termed dyspepsia. Difficulty swallowing is termed dysphagia. Pain on swallowing is termed odynophagia.

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? "I'll lie down immediately after a meal." "I'll eat three large meals every day without any food restrictions." "I'll eat frequent, small, bland meals that are high in fiber." "I'll gradually increase the amount of heavy lifting I do."

"I'll eat frequent, small, bland meals that are high in fiber." Explanation: In hiatal hernia, the upper portion of the stomach protrudes into the chest when intra-abdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend.

A client seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education? "Instead of eating three meals a day, try eating smaller amounts more often." "Drinking beverages after your meal, rather than with your meal, may bring some relief." "It's best to avoid dry foods, such as rice and chicken, because they're harder to swallow." "Many clients obtain relief by taking over-the-counter antacids 30 minutes before eating."

"Instead of eating three meals a day, try eating smaller amounts more often." Explanation: Management for a hiatal hernia includes frequent, small feedings that can pass easily through the esophagus. Avoiding beverages and particular foods or taking OTC antacids are not noted to be beneficial.

A client has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The client is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond? "The surgeon will encourage you to limit your fat intake for a few weeks after the surgery, but your body will then begin to compensate." "Your small intestine will adapt over time to the absence of your appendix." "Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery." "Your body will absorb slightly fewer nutrients from the food you eat, but you won't be aware of this."

"Your appendix doesn't play a major role, so you won't notice any difference after your recovery from surgery." Explanation: The appendix is an appendage of the cecum (not the small intestine) that has little or no physiologic function. Its absence does not affect digestion or absorption.

A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? Duodenal ulcer Gastric cancer Gastric ulcer Acute gastritis

Acute gastritis Explanation: A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.

A client was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize? Esophageal or pyloric obstruction related to scarring Gastric hyperacidity related to excessive gastrin secretion Chronic referred pain in the lower abdomen Uncontrolled proliferation of H. pylori

Esophageal or pyloric obstruction related to scarring Explanation: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of peptic ulcer disease, but would not be an expected finding for a client who has ingested a corrosive substance. Bacterial proliferation and hyperacidity would not occur.

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom? Esophageal tumor Gastroesophageal reflux disease Hiatal hernia Gastritis

Esophageal tumor Explanation: Esophageal tumor is most significant and can result in advancing cancer. Esophageal cancer is a serious condition that presents with a symptom of difficulty swallowing as the tumor grows. Hiatal hernia, gastritis, and GERD can lead to serious associated complications but less likely to be as significant as esophageal tumor/cancer.

Cancer of the esophagus is most often diagnosed by which of the following? X-ray Barium swallow Fluoroscopy Esophagogastroduodenoscopy (EGD) with biopsy and brushings

Esophagogastroduodenoscopy (EGD) with biopsy and brushings Explanation: Currently, diagnosis is confirmed most often by EGD with biopsy and brushings. The biopsy can be used to determine the presence of disease and cell differentiation. X-ray, barium swallow, and fluoroscopy are used in the diagnosis of hiatal hernia.

A client has a new order for metoclopramide. What potential side effects should the nurse educate the client about? Nausea Gastric slowing Peptic ulcer disease Extrapyramidal

Extrapyramidal Explanation: Metoclopramide (Reglan) is a prokinetic agent that accelerates gastric emptying. Because metoclopramide can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

A client has a new order for metoclopramide. The nurse identifies that this medication can be safely administered for which condition? Gastritis Peptic ulcer with melena Gastroesophageal reflux disease Diverticulitis with perforation SUBMIT ANSWER

Gastroesophageal reflux disease Explanation: Metoclopramide is a prokinetic agent that accelerates gastric emptying. It is contraindicated with hemorrhage or perforation. It is not used to treat gastritis.

A 76-year-old client presents to the ED reporting "laryngitis." The triage nurse should ask whether the client has a medical history that includes Congestive heart failure (CHF) Gastroesophageal reflux disease (GERD) Respiratory failure (RF) Chronic obstructive pulmonary disease (COPD)

Gastroesophageal reflux disease (GERD) Explanation: The nurse should ask whether the client has a medical history of GERD. Laryngitis is common in older adults and may be secondary to GERD. Older adults are more likely to have impaired esophageal peristalsis and a weaker esophageal sphincter. COPD, CHF, and RF are not associated with laryngitis in the older adult.

A client is admitted to the medical unit with a diagnosis of intestinal obstruction. When planning this client's care, which of the following nursing diagnoses should the nurse prioritize? Anxiety Related to Bowel Obstruction and Subsequent Hospitalization Impaired Skin Integrity Related to Bowel Obstruction Ineffective Tissue Perfusion Related to Bowel Ischemia Imbalanced Nutrition: Less Than Body Requirements Related to Impaired Absorption

Ineffective Tissue Perfusion Related to Bowel Ischemia Explanation: When the bowel is completely obstructed, the possibility of strangulation and tissue necrosis (i.e., tissue death) warrants surgical intervention. As such, this immediate physiologic need is a nursing priority. Nutritional support and management of anxiety are necessary, but bowel ischemia is a more immediate threat. Skin integrity is not threatened.

Which of the following is a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. Esomeprazole (Nexium) Nizatidine (Axid) Lansoprazole (Prevacid) Rabeprazole (AcipHex) Famotidine (Pepcid)

Lansoprazole (Prevacid) Rabeprazole (AcipHex) Esomeprazole (Nexium)

A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug? Calcium carbonate Omeprazole Lansoprazole Metoclopramide

Metoclopramide Explanation: Metoclopramide (Reglan) is useful in promoting gastric motility. Omeprazole and lansoprazole are proton pump inhibitors that reduce gastric acid secretion. Calcium carbonate does not affect gastric emptying.

When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? Obstruction of the appendix may increase venous drainage and cause the appendix to rupture. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. The appendix may develop gangrene and rupture, especially in a middle-aged client. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. Explanation: A client with appendicitis is at Risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? Peptic ulcer Pancreatitis Cholecystitis Appendicitis

Pancreatitis Explanation: Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.

Diagnostic imaging and physical assessment have revealed that a client with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication? Gastritis Peritonitis Acute pancreatitis Gastroesophageal reflux

Peritonitis Explanation: Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer.

The nurse advises the patient who has just been diagnosed with acute gastritis to: Take an emetic to rid the stomach of the irritating products. Restrict food and fluids for 12 hours. Refrain from food until the GI symptoms subside. Restrict all food for 72 hours to rest the stomach.

Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.

A nurse caring for a client with a newly created ileostomy assesses the client and notes that the client has had not ostomy output for the past 12 hours. The client also reports worsening nausea. What is the nurse's priority action? Facilitate a referral to the wound-ostomy-continence (WOC) nurse. Report signs and symptoms of obstruction to the health care provider. Contact the physician and obtain a swab of the stoma for culture. Encourage the client to mobilize in order to enhance motility.

Report signs and symptoms of obstruction to the health care provider. Explanation: It is important to report nausea and abdominal distention, which may indicate intestinal obstruction. This requires prompt medical intervention. Referral to the WOC nurse is not an appropriate short-term response, since medical treatment is necessary. Physical mobility will not normally resolve an obstruction. There is no need to collect a culture from the stoma, because infection is unrelated to this problem.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? Left upper quadrant Right upper quadrant Right lower quadrant Left lower quadrant

Right lower quadrant Explanation: The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

A 16-year-old presents at the emergency department reporting right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this client's nursing care, the nurse should prioritize what nursing diagnosis? Risk for Infection Related to Possible Rupture of Appendix Chronic Pain Related to Appendicitis Constipation Related to Decreased Bowel Motility and Decreased Fluid Intake Imbalanced Nutrition: Less Than Body Requirements Related to Decreased Oral Intake

Risk for Infection Related to Possible Rupture of Appendix Explanation: The client with a diagnosis of appendicitis has an acute risk of infection related to the possibility of rupture. This immediate physiologic risk is a priority over nutrition and constipation, though each of these concerns should be addressed by the nurse. The pain associated with appendicitis is acute, not chronic.

A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the client's health problem? Reports a history of social drinking on a weekly basis. Smokes one pack of cigarettes daily. Takes over-the-counter antacids frequently throughout the day. Consumes one or more protein drinks daily.

Smokes one pack of cigarettes daily. Explanation: Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralization of gastric acid and can underlie gastritis. Protein drinks do not result in gastric inflammation. Antacid use is a response to experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in clients with a history of consumption of alcohol on a daily basis.

A nurse is caring for a client hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize? Safe technique for self-suctioning Strategies for maintaining an alkaline gastric environment Strategies for avoiding irritating foods and beverages Techniques for positioning correctly to promote gastric healing

Strategies for avoiding irritating foods and beverages Explanation: Measures to help relieve pain include instructing the client to avoid foods and beverages that may be irritating to the gastric mucosa and instructing the client about the correct use of medications to relieve chronic gastritis. An alkaline gastric environment is neither possible nor desirable. There is no plausible need for self-suctioning. Positioning does not have a significant effect on the presence or absence of gastric healing.

The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? Vitamin B12 Vitamin A Vitamin E Vitamin C

Vitamin B12 Explanation: Clients with chronic gastritis from vitamin deficiency usually have evidence of malabsorption of vitamin B12 caused by the production of antibodies that interfere with the binding of vitamin B12 to intrinsic factor. However, some clients with chronic gastritis have no symptoms. Vitamins A, C, and E are not affected by gastritis.

What symptoms of perforation might the nurse observe in a client with an intestinal obstruction? Select all that apply. sudden drop in body temperature intermittent, severe pain abdominal distention sudden, sustained abdominal pain

sudden, sustained abdominal pain abdominal distention Explanation: Abdominal distention, fever, and sudden, sustained abdominal pain are the symptoms of perforation in a client with intestinal obstruction.

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? leukopenia; metabolic acidosis; elevated sodium, potassium, and chloride leukocytosis; elevated hematocrit; low sodium, potassium, and chloride leukopenia, decreased hematocrit; low sodium, potassium, and chloride leukocytosis; metabolic alkalosis; elevated sodium, potassium, and chloride

leukocytosis; elevated hematocrit; low sodium, potassium, and chloride Explanation: Tests of serum electrolytes may indicate low levels of sodium, potassium, and chloride. Metabolic alkalosis is evidenced by arterial blood gas results. A complete blood count (CBC) shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops.

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with: Crohn's disease. paralytic ileus. complete bowel obstruction. gastroenteritis.

paralytic ileus. Explanation: Bowel sounds are hypoactive or absent in a client with a paralytic ileus. Clients with Crohn's disease and gastroenteritis have hyperactive bowel sounds because of increased intestinal motility. A complete bowel obstruction causes absent bowel sounds below the obstruction and hyperactive sounds above the obstruction.

Which client requires immediate nursing intervention? The client who: presents with a rigid, board-like abdomen. presents with ribbonlike stools. complains of anorexia and periumbilical pain. complains of epigastric pain after eating.

presents with a rigid, board-like abdomen. Explanation: A rigid, board-like abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.