Peptic Ulcer Disease Summer Test 5

4

A client is taking antacid for treatment of peptic ulcer. Which statement best indicates that the client understands how to correctly take the antacid? 1. I should take my antacid before I take my other meds 2. I need to decrease my intake of fluids so that i do not dilute the effect of the antacid 3. my antacid will be most effective if I take it whenever I experience stomach pains 4. It is best for me to take my antacid 1-3 hours after meals

c (Histamine2​-receptor blockers are used for reducing gastric acid content in the treatment of PUD.​ Sucralfate, bismuth​ compounds, and antacids are all used in the treatment of​ PUD; however, their function is to protect the gastric​ mucosa, not reduce gastric acid content.)

Which pharmacologic therapy is used in the treatment of peptic ulcer disease​ (PUD) for reducing gastric acid​ content? a Sucralfate b Antacids c Histamine2​-receptor blockers d Bismuth compounds

4 (Histamine 2 receptor antagonists such as ranitidine reduce gastric acid secretion. )

A client with PUD is taking ranitidine. What is the expected outcome of this drug? 1. heal the ulcer 2. protect the ulcer surface from acids 3. reduce acid concentration 4. limit gastric acid secretion

2,3,5,6 (client with upper GI bleed at risk for hypovolemic shock from blood loss. S/s related to hypovolemia: decreased urine output, tachycardia, rapid RR, and thirst. Clients skin would be cool and clammy. Client would also likely develp hypotension which would lead to a NARROWING pulse pressure.)

The nurse should assess the client who is being admitted to the hospital with upper GI bleeding for which finding? select all that apply 1. dry, flushed skin 2. decreased urine output 3. tachycardia 4. widening pulse pressure 5. rapid respirations 6. thirst

3 (to inhibit nocturnal secretion of acid.. sometimes may be given am and hs)

A client is to take one daily dose of ranitidine at home to treat peptic ulcer. The client understands proper drug administration of ranitidine when the client will take the drug: 1. before meals 2. with meals 3. at bed time 4. when pain occurs

1,2,3,4 (avoid fatigue, stop smoking, eat small freq meals, take meds, if wake at night eat a small snack and return to bed sitting up or head elevated for an hour after eating (duodenal pain) )

A client with a peptic ulcer reports epigastric pain that frequently causes the client to wake up during the night. The nurse should instruct the client to do which activities? Select all that apply 1. Obtain adequate rest to reduce stimulation 2. eat small frequent meals throughout the day 3. take all medications on time as prescribed 4. sit up for 1 hour when awakened at night 5. stay away from crowded areas

a (Rationale Antacids interfere with the absorption of digoxin. Antacids do not cancel all therapeutic effects of​ digoxin, nor do antacids absorb​ digoxin's therapeutic effect.)

A nurse is caring for a client with congestive heart failure​ (CHF) who has recently been diagnosed with peptic ulcer disease​ (PUD). The client takes digoxin to manage symptoms associated with CHF. The healthcare provider has ordered antacids for the client to help heal the gastric mucosa as a result of PUD. What is true regarding antacids and​ digoxin? a Antacids interfere with the absorption of digoxin. b Antacids cancel all therapeutic effects of digoxin. c Antacids absorb​ digoxin's therapeutic effect. d Antacids do not affect digoxin.

b,d,e (Rationale: Laser photocoagulation during an endoscopic procedure is used to cauterize bleeding vessels in the stomach or duodenum. Surgical procedures, such as a vagotomy (cutting of the vagus nerve to interrupt the production of acid in the stomach) and a subtotal gastrectomy (the surgical removal of a portion of the stomach) are now rarely required. This is due to recognition of H. pylori as a causative factor in ulcer formation and improved visualization using tubes that can be threaded orally through the esophagus to the duodenum for diagnostic and treatment purposes.)

A client is scheduled for emergency endoscopy with laser photocoagulation for a bleeding peptic ulcer. The client asks about the procedure and subsequent treatment. The nurse should tell the client that: (Select all that apply.) a "The vagus nerve will be cut to reduce acid production and irritation it causes to the mucosa." b "A tube called an endoscope will be passed into your stomach and upper intestine." c "The ulcer and tissue producing hydrochloric acid will be surgically removed by the gastroenterologist." d "A laser passed through the endoscope will seal off bleeding blood vessels to stop the bleeding." e "After the procedure, you'll be given high doses of a medication to block acid production by the stomach."

1 (rationale: The priority nursing action is VS. VS provide valuable info on the internal body system. Symptoms of shock such as low BP, a rapid weak pulse, cold clammy skin, and restlessness can be monitored. Assessing bowel function and tenderness can provide useful data but is not the priority. Documentation is a lower priority and a HCP order is required for NG tube placement)

A client presents to the ED with abd. pain and upper GI bleed. The client is sweating and appears to be in moderate distress. Which nursing action would be a priority at this time? 1. Vital signs 2. Document history of symptoms 3. Assess bowel sounds and abdominal tenderness 4. Insert a NG tube and connect to suction

D (Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive loss of these substances, such as from vomiting, can lead to metabolic alkalosis and hypokalemia.)

A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? A Metabolic acidosis with hyperkalemia B Metabolic acidosis with hypokalemia C Metabolic alkalosis with hyperkalemia D Metabolic alkalosis with hypokalemia

d (Rationale: The bacterial organism H. pylori is the major cause of peptic ulcers. Treatment includes eradicating the organism. The client is already infected, so antibiotics will not help with prevention. The stomach is not sterilized by the use of antibiotics. C. difficile is an organism in the bowel that causes diarrhea.)

A client with a duodenal ulcer asks the nurse why antibiotics are a part of the treatment plan. Which information should the nurse include in the explanation? a Antibiotics decrease the likelihood of infection. b Antibiotics are used to sterilize the stomach. c Many people have Clostridium difficile, which can lead to ulcer formation. d Most duodenal ulcers are caused by Helicobacter pylori.

a,b,e (Rationale: Cigarette smoking doubles the risk of developing peptic ulcer disease (PUD) and delays ulcer healing. Other risk factors are the frequent use of NSAIDS and concurrent use of glucocorticoids or bisphosphonates. Dietary intake and use of antihistamines are not risk factors for developing PUD. )

A client with a family history of peptic ulcer disease (PUD) asks the nurse about other risk factors for developing this condition. The nurse would identify which other known risk factors contributing to risk of PUD? (Select all that apply.) a Cigarette smoking b Use of glucocorticoids or biphosphonates c Regular use of antihistamines d Eating a high fat diet e Frequent use of non-steroidal anti-inflammatory drugs (NSAIDS)

c,d,e (Rationale: Severe upper abdominal that radiates to the shoulder may be a manifestation of perforation. Oral food and fluids are withheld to prevent vomiting and in preparation for surgery. The client is placed upright to localize drainage to the pelvic area, and the physician is notified to ensure prompt treatment. Proton-pump inhibitors are not effective for managing a perforation. Analgesics may mask symptoms of perforation. )

A client with peptic ulcer disease (PUD) suddenly complains of severe abdominal pain. The nurse should: (Select all that apply.) a administer the prescribed proton-pump inhibitor. b obtain an order for narcotics. c withhold oral food and fluids. d Place the client in Fowler's position. e Notify the physician.

2,3 ( Symptoms of nausea and dizziness in client with PUD may indicate hemorrhage and should not be ignored)

A client with peptic ulcer disease reports being nauseated most of the day and now feeling light headed and dizzy. Based on these findings, which nursing actions would be the most appropriate for the nurse to take? Select all that apply 1. administering an antacid hourly until nausea subsides 2. monitoring the clients VS 3. notifying the HCP of the clients symptoms 4. initiating o2 therapy 5 reassessing the client in an hour

c (Mr. Sanders is likely experiencing a perforation of either the duodenum or stomach. This is the most lethal complication that may occur with PUD. Symptoms of perforation include a rigid​ abdomen, severe abdominal pain which radiates to the​ shoulder, and signs of shock​ (low blood​ pressure, tachycardia, and​ cool/clammy skin). Hemorrhage would also present as a symptom of​ shock; however, the​ client's abdomen would not be rigid and boardlike as in perforation. Gastric outlet obstruction is a complication associated with​ PUD; however, symptoms are gradual with feelings of fullness.​ Zollinger-Ellison syndrome is a condition that causes​ PUD, not a complication of it.)

A nurse is caring for William​ Sanders, a​ 65-year-old male with a history of peptic ulcer disease​ (PUD), who presents to the emergency department via ambulance gurney. Mr. Sanders called first responders to his house when he developed severe upper abdominal pain that radiated to his right shoulder. Mr.​ Sanders's heart rate is 114 and blood pressure is​ 90/55. Mr.​ Sanders's nurse notes that his skin is cool and​ clammy, his abdomen is​ hard, and no bowel sounds can be auscultated. What complication associated with PUD does the nurse suspect that Mr. Sanders​ has? a Hemorrhage b Gastric outlet obstruction c Perforation ​d Zollinger-Ellison syndrome

a (Rationale The nurse would suspect that the client has​ Zollinger-Ellison syndrome because of the presence of a​ gastrinoma, which is present in this condition. The client may have a gastric or esophageal​ ulcer; however, the gastrinoma is unique to​ Zollinger-Ellison syndrome. Sick sinus syndrome is cardiac condition which does not manifest with a​ gastrinoma, diarrhea, or epigastric pain.)

A nurse is caring for a client who complains of diarrhea and epigastric pain. The client tells the nurse that he has recently been diagnosed with a gastrinoma. What additional condition does the nurse suspect the client​ has? ​a Zollinger-Ellison syndrome b Esophageal ulcer c Gastric ulcer d Sick sinus syndrome

d (Rationale The urea breath test is used to measure the urease produced by H. pylori bacteria. H. pylori are not detected with a skin test. A gastric analysis of stomach contents is ordered when the healthcare provider suspects​ Zollinger-Ellison syndrome. An upper GI uses barium as contrast for an​ x-ray to visualize the structures of the GI​ system, not to detect the presence of H. pylori.)

A nurse is caring for a client who has recently been diagnosed with peptic ulcer disease​ (PUD). The client asks the​ nurse, "My doctor told me I might have bacteria that is causing my ulcers. How will I know if I ​do? " What is the nurse​'s best​ response? a "Your healthcare provider may order a skin test to determine the presence of H. pylori. b "Your healthcare provider may order a test to analyze your stomach contents. c "Your healthcare provider may order an​ x-ray with contrast to visualize the H. pylori bacteria. d "Your healthcare provider may order a breath test to determine the presence of H. pylori.

a,d,e (Rationale Educating the client regarding the prevention of PUD should​ include: smoking​ cessation, stress​ reduction, and education about the use of OTC NSAIDs. It is not necessary for the client to completely eliminate alcohol. Although​ high-fat foods are not recommended for a healthy​ diet, they have not been shown to cause PUD.)

A nurse is caring for a client with peptic ulcer disease​ (PUD) who asks the​ nurse, "I don​'t understand how I can help to prevent my ulcers from recurring. " What is the nurse​'s best​ response? ​(Select all that​ apply.) a "Reduce your stress as much as possible. b "Eliminate all​ high-fat foods from your diet. c "Eliminate all alcohol intake. d "Be cautious with your intake of​ over-the-counter pain medications. d "Stop smoking.

a,d (Rationale A proton pump inhibitor​ (PPI) inhibits an​ acid-secreting enzyme to reduce gastric acid content. A PPI may be used in combination with two antibiotics to eliminate H. pylori. Antacids stimulate gastric mucosal defenses. A histamine2​-receptor blocker inhibits histamine binding to the receptors on the gastric parietal cells to reduce acid secretion. Sucralfate stimulates secretion of​ mucus, bicarbonate, and prostaglandin.)

A nurse is caring for a client with peptic ulcer disease​ (PUD) who is taking a proton pump inhibitor​ (PPI) for the treatment of PUD. Prior to administering this​ medication, what does the nurse need to know about a​ PPI? ​(Select all that​ apply.) a It inhibits an​ acid-secreting enzyme to reduce gastric acid content. b It inhibits histamine binding to the receptors on the gastric parietal cells to reduce acid secretion. c It stimulates secretion of​ mucus, bicarbonate, and prostaglandin. d It may be used in combination with two antibiotics to eliminate H. pylori. e It stimulates gastric mucosal defenses.

b (Rationale Pain from PUD occurs when the stomach is​ empty, typically 2dash-3 hours after a meal. The other responses are incorrect.)

A nurse is caring for a client with peptic ulcer disease​ (PUD). The client tells the​ nurse, "I don​'t understand why I have pain in the middle of the night. It​'s like my pain starts 2 -3 hours after I​ eat, not right away. Why does this ​happen? " What is the nurse​'s best​ response? a "The food in your stomach takes longer to digest at​ night, which causes pain. " b "The pain occurs when your stomach is empty. " c "The food that you ate for dinner likely contained too much​ fat, causing pain. " d "The acid in your stomach is increased at​ night, causing pain.

1,3,4,5 ( Vitamin B12 absorption, dissolving food fibers, killing microorganisms, and activating the enzyme Pepsin all occur in the stomach. Intrinsic factor is secreted in the fundus of the stomach and is essential for B12 absorption, and hydrochloric acid is needed for breaking down food fibers, killing microorganisms, and activating pepsin. B6 is water soluble and must be replaced daily and is not absorbed in the stomach or GI tract, but eliminated in urine, Bile is the substance secreted from the gallbladder to emulsify fats as they are consumed.)

A nurse is caring for a client with symptoms of epigastric pain. When teaching the action of gastric contents related to functioning of the body, which actions occur in the stomach? Select all that apply. 1. Vitamin B12 absorption 2. Emulsifying fats 3. Breaking down food fibers 4. Killing microorganisms 5. Activating the enzyme pepsin 6. Vitamin B6 absorption

a (Rationale The nurse should discourage the client from eating a nighttime snack because this can exacerbate the client​'s condition. The client should maintain strict bed rest. The nurse should assess the client​'s abdomen every 4 hours. Inserting a nasogastric tube is a collaborative nursing​ intervention, requiring the order of the healthcare provider. The nurse will not automatically insert a nasogastric tube for all clients with PUD.)

A nurse is planning care for a client who is going to be admitted to the nurse​'s unit. The client has a diagnosis of peptic ulcer disease​ (PUD) and is complaining of​ nausea, heartburn, and epigastric pain. What nursing intervention will the nurse plan to​ implement? a Discourage the client from eating a nighttime snack. b Listen to client​'s bowel sounds every shift. c Allow client to have bathroom privileges. d Insert a nasogastric tube upon client admission.

a (Rationale Peritonitis occurs due to the ulcer penetrating through the mucosal​ wall, causing gastric or duodenal contents to enter the peritoneum. Chemical peritonitis is immediate after perforation. Bacterial peritonitis occurs between 6 and 12 hours after perforation. Gastric outlet​ obstruction, not​ perforation, occurs due to the obstruction of the pyloric region of the stomach and duodenum.)

A nurse manager is teaching a group of staff nurses about the complications related to peptic ulcer disease​ (PUD). What statement regarding peritonitis will the nurse manager include in the​ teaching? a Peritonitis occurs when the ulcer penetrates through the mucosal​ wall, causing gastric or duodenal contents to enter the peritoneum. b Chemical peritonitis occurs between 6 and 12 hours after​ perforation, when the acids from the stomach or duodenum create an inflammatory response. c Bacterial peritonitis happens immediately after perforation as bacteria proliferate in the peritoneal cavity. d Peritonitis occurs due to the obstruction of the pyloric region of the stomach and duodenum. The increased pressure from the obstruction leads to peritonitis.

c,d,e (Rationale: Perforation is the most lethal complications of peptic ulcer disease (PUD), so the nurse must be ever-vigilant in monitoring for this possibility. Perforations are characterized by sudden, severe upper abdominal pain that radiates throughout the abdomen and possibly to the shoulder, a rigid and boardlike abdomen, and an absence of bowel sounds. Bradycardia and numbness in the legs is unrelated to perforation. )

The nurse is caring for a client who was admitted to the hospital with peptic ulcer disease (PUD). Which signs or symptoms are a manifestation of perforation, the most lethal complication of PUD? (Select all that apply.) a Numbness in the legs b Bradycardia c A rigid, board-like abdomen d Immediate, severe upper abdominal pain e Absent bowel sounds

2 (Ranitidine is a histamine 2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion. Antacids neutralize acid. Mucosal barrier fortifiers protect the mucosal barrier.)

The nurse is instructing a client on different types of meds to treat PUD. Which process best describes the mechanism of action of meds used to treat peptic ulcer disease such as ranitidine? 1. neutralize acid 2. reduce acid secretions 3. stimulate gastrin release 4. protect the mucosal barrier

c (Rationale The nurse should discuss the importance of stress management with the​ client, as stress can contribute to the development of peptic ulcers. The client should continue to take medications used to treat the disease even after symptoms subside. The client should be told to avoid aspirin and other​ over-the-counter NSAIDs. The nurse should instruct the client to seek medical attention if the client feels dizzy.)

The nurse is providing discharge instructions for a client with peptic ulcer disease​ (PUD). What will the nurse include in​ teaching? a Importance of using​ over-the-counter analgesics for mild pain b Importance of continuing treatment until symptoms of PUD subside c Importance of stress management techniques d Importance of rest if client feels dizzy

3

The nurse is teaching a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet should include: 1. bland foods 2. high-protein foods 3. any foods that are tolerated 4. a glass of milk with each meal

a (Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum K and serum calcium would decrease with alkalosis, not increase.)

The nurse would monitor a patient using sodium bicarbonate to treat gastric hyperacidity for signs and symptoms of: A Metabolic alkalosis B Metabolic acidosis C Hyperkalemia D Hypercalcemia

d (Gastroscopy allows visualization of the​ esophageal, gastric, and duodenal​ mucosa, and direct inspection of ulcers. The upper GI series does not require sedation. In​ Zollinger-Ellison syndrome, gastric acid levels are increased. The upper GI can detect ​80%dash-​90% of peptic ulcers via​ x-ray.)

What is true regarding the diagnostic testing used for peptic ulcer disease​ (PUD)? a The gastric analysis can detect ​80%dash-​90% of peptic ulcers via​ x-ray. b In​ Zollinger-Ellison syndrome, gastric acid levels are decreased. c The upper GI series requires sedation. d Gastroscopy allows visualization of the​ esophageal, gastric, and duodenal​ mucosa, and direct inspection of ulcers.

c (It is important to give sucralfate on an empty stomach so that it may dissolve and form a protective barrier over the gastric mucosa. The tablet form will not dissolve in water when crushed; it must be left whole and allowed to dissolve. Crushing the medication so that it will not dissolve could lead to clogging of the nasogastric tube and decreased effectiveness of the drug.)

When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important to: a Crush the tablet into a fine powder before mixing with water B Administer with a bolus tube feeding c Allow the tablet to dissolve in water before administering D Administer with an antacid for maximum benefit

3,4,5 (gastric s/s)

When obtaining a nursing history from a client with suspected gastric ulcer, which signs and symptoms should the nurse assess? select all that apply 1. epigastric pain at night 2. relief of epigastric pain after eating 3. vomiting 4. weight loss 5. anemia

c (Peptic ulcers may occur in any area of the GI tract exposed to​ acid-pepsin secretions, including the​ esophagus, stomach, and duodenum. The most common site for peptic ulcers to develop is the duodenum. Peptic ulcers do not occur in the large intestine.)

Where is the most common site for peptic ulcers to​ develop? a Large intestine b Stomach c Duodenum d Esophagus

a (Rationale: Peptic Ulcer Disease (PUD), which is an interruption of the integrity of the gastric lining predisposes the client to hemorrhage, obstruction, and perforation, thus is the highest priority nursing diagnosis. While the other nursing diagnoses will need to be addressed at some point, disruption of the integrity of the lining of the stomach receives priority. )

Which nursing diagnosis has highest priority for the client with peptic ulcer disease (PUD)? a Impaired tissue integrity: Gastrointestinal b Ineffective health maintenance c Acute pain d Nausea

a (Disturbed sleep pattern is the most appropriate nursing diagnosis for a client with peptic ulcer disease​ (PUD). Pain associated with PUD often occurs during the​ night, placing the client with PUD at risk of a disturbed sleep pattern. The other diagnoses do not specifically pertain to the client with PUD.)

Which nursing diagnosis is most appropriate for a client with peptic ulcer disease​ (PUD)? a disturbed sleep pattern b disturbed body image c anxiety d fluid volume excess

a (The most appropriate nursing intervention for a client with PUD is monitoring stools for occult blood. The nurse should assess the client​'s abdomen every 4 hours. The client should maintain bed​ rest, not activity. The nurse should discourage the client from having a bedtime snack to avoid pain associated with PUD.)

Which nursing intervention is most appropriate for a client with peptic ulcer disease​ (PUD)? a Monitor stools for occult blood. b Encourage the client to walk the halls. c Assess the client​'s abdomen every 6 hours. d Encourage the client to have a bedtime snack to avoid hunger pains.

b (A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding)

Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)? A Increased risk for infection due to immunosuppression B Potential risk for bleeding related to thrombocytopenia C Alteration in urinary elimination related to retention D Alteration in tissue perfusion related to hypertension

1 (Repeating vital sign measurements falls within the scope of the UAP's abilities. There is no indication that blood glucose level should be checked every 2 hours. Gathering certain types of equipment can be delegated. However, NG lavage is not a typical task for a UAP; if you delegate the gathering of equipment for this procedure, you will have to provide an itemized list. The UAP should not be responsible for notifying the family, even with the patient's permission. Focus: Delegation; QSEN: TC; Concept: Clinical Judgment)

Which task is appropriate to assign to a UAP? 1. Repeating measurement of vital signs every 2 hours 2. Gathering equipment for nasogastric (NG) lavage 3. Checking the blood glucose level every 2 hours 4. Notifying the family (with the patient's permission)

2,4 (The client would not eat or drink for 6-12 hrs before the procedure to ensure the upper GI tract is clear to view. Before the endoscope is inserted the client will receive a sedative that will help relaxation, be leave conscious. GI tract cleansing and clear liquid diet are interventions for a client having a lower GI tract procedure, such as a colonoscopy. Food and fluids must be withheld until the gag reflex returns after the procedure.)

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy) the nurse would be correct to implement which intervention? Select all that apply 1. administer a preparation to cleanse the GI tract such as GoLYTLELY or Fleets Phospho-Soda 2. Instruct not to eat or drink for 6-12 hours before the procedure 3. Teach only to ingest a clear liquid diet for 24 hours pre procedure 4 Inform the client of receiving a sedative before the procedure 5. Encourage the client to eat and drink immediately after the procedure

3 (A tense, rigid abdomen could signal perforation, peritonitis, and/or a worsening hemorrhage. The other findings are relevant but are less immediately urgent. Focus: Prioritization; QSEN: S; Concept: Clinical Judgment)

You are performing additional assessment and history taking for Mr. S. Which finding should you immediately report to the physician? 1. Melena stools 2. History of nonsteroidal anti-inflammatory drug use 3. Tense, rigid abdomen 4. Probable positive human immunodeficiency virus status

a (Histamine receptor blocking agents decrease gastric acid by competing with histamine for binding sites on the parietal cells.)

Histamine2-receptor antagonists: A Compete with histamine for binding sites on the parietal cells B Irreversibly bind to H+/K+ATPase C Cause a decrease in stomach pH D Decrease signs and symptoms of allergies related to histamine release

2, 3, 4, 5 (Mr. S is at risk for hypovolemic shock. Decreases in urine output or hemoglobin level and hematocrit should be monitored. Occult blood (Hemoccult) testing of emesis and stool should be performed to confirm upper and lower gastrointestinal bleeding. Semi- or high Fowler position is used to decrease risk for aspiration during vomiting and/or nasogastric tube (NG) tube insertion. A 22-gauge catheter is not the best choice for this patient. He may require a blood transfusion and/or large fluid volumes; 16- to 18-gauge catheters are better choices. Preparing the patient for surgery at this point is premature, because bleeding resolves spontaneously in most hospitalized patients. Focus: Prioritization; QSEN: S, EBP; Concept: Clinical Judgment)

Mr. S, a 50-year-old man, has driven himself to the emergency department (ED) after vomiting bright red blood twice within 6 hours. He arrives alert and oriented × 3 but appears anxious. He is able to provide only a vague history but admits to drinking "a few" last weekend. He knows that he is "supposed to stop drinking" and takes "something for his stomach," but he cannot recall the name of the medication. He reports intermittent dizziness and fatigue that has been worsening over the past 2 days. His skin is dry and pale. His abdomen is slightly distended. He reports pain (4 on a scale of 10) in the midepigastric area. Capillary refill is longer than 3 seconds, blood pressure is 140/90 mm Hg, pulse rate is 110 beats/min, respiratory rate is 24 breaths/min, and temperature is 99° F (37.2° C). Which actions are appropriate in the care of this patient? (Select all that apply.) 1. Start a peripheral IV line using a 22-gauge catheter. 2. Initiate input and output monitoring with hourly urine measurements. 3. Check emesis and stool for occult blood. 4. Monitor hemoglobin level and hematocrit every 4 hours. 5. Maintain the patient in a semi- or high Fowler position. 6. Prepare the patient for surgery.

a (Rationale: The pain of a duodenal ulcer occurs when the stomach is empty and gastric juices irritate exposed mucosa. Pain is relieved by eating in part because pancreatic juices stimulated by eating are high in bicarbonate which buffers the acid. While using an antibiotic can sometimes be irritating to the gastrointestinal system, this is not related to Peptic Ulcer Disease (PUD). A history of mild alcohol intake is also not associated with PUD. )

A client is being evaluated for a possible duodenal ulcer. The nurse monitors the client for which client history or clinical manifestation that would indicate this diagnosis? a Epigastric pain relieved by eating b History of recent antibiotic use c Abdominal distension d Occasional intake of 1-2 alcoholic drinks

c (The upper GI series uses barium as a contrast medium and can detect​ 80%-90% of peptic ulcers via​ x-ray. The other statements are incorrect.)

A nurse is caring for Mohammed​ Hassad, a​ 34-year-old man who has a​ 20-pack-year history of smoking and works as an construction worker.​ Recently, Mohammed has been complaining of hungerlike pain in his upper abdomen that occurs in the middle of the night but seems to subside once he eats. Mr.​ Hassad's healthcare provider has ordered an upper GI series to aid in diagnosing his condition. What instruction will Mr.​ Hassad's nurse provide to Mohammed regarding this diagnostic​ test? ​a "This procedure requires an​ IV." ​b "This procedure requires​ sedation." c ​"This procedure is a type of​ x-ray that uses​ contrast." ​d "This procedure is a type of​ biopsy."

d (While Mr. Carroll may have imbalanced​ nutrition: less than body requirements and disturbed sleep​ pattern, these do not take priotiry. Mr.​ Carroll's greatest concern is risk for deficient fluid volume due to vomiting. He is not at risk for impaired skin integrity.)

A nurse is planning care for Peter​ Carroll, a​ 55-year-old man who was recently diagnosed with peptic ulcer disease​ (PUD). Peter is hospitalized after several days of nausea and vomiting in addition to complaining of epigastric pain. When planning care for Mr.​ Carroll, which nursing diagnosis takes​ priority? a disturbed sleep pattern b risk for impaired skin integrity c imbalanced​ nutrition: less than body requirements d risk of deficient fluid volume

b,d,e (Duodenal ulcers typically develop between the ages of 30 and​ 55, are more common in men than in​ women, and in individuals who smoke. Dietary intake does not seem to cause PUD.)

What is true regarding duodenal​ ulcers? ​(Select all that​ apply.) a Typically develop between the ages of 55 and 70 b More common in men than in women c More common in individuals who eat poorly d Typically develop between the ages of 30 and 55 e More common in individuals who smoke

3 (Vomiting of bright red blood is a sign of active bleeding. The patient's physical assessment findings and vital sign values are indicative of physiologic compensation for blood loss. Risk for aspiration is not an immediate concern because Mr. S is currently alert and there is no reason to suspect that his gag reflex is not intact. Anxiety and noncompliance can be addressed later. Focus: Prioritization)

Mr. S, a 50-year-old man, has driven himself to the emergency department (ED) after vomiting bright red blood twice within 6 hours. He arrives alert and oriented × 3 but appears anxious. He is able to provide only a vague history but admits to drinking "a few" last weekend. He knows that he is "supposed to stop drinking" and takes "something for his stomach," but he cannot recall the name of the medication. He reports intermittent dizziness and fatigue that has been worsening over the past 2 days. His skin is dry and pale. His abdomen is slightly distended. He reports pain (4 on a scale of 10) in the midepigastric area. Capillary refill is longer than 3 seconds, blood pressure is 140/90 mm Hg, pulse rate is 110 beats/min, respiratory rate is 24 breaths/min, and temperature is 99° F (37.2° C). What is the priority nursing diagnosis for Mr. S? 1. Risk for Aspiration related to active bleeding 2. Anxiety related to the uncertainty of his health status 3. Deficient Fluid Volume related to vomiting of blood and gastric secretions 4. Noncompliance related to alcohol consumption and medication use

c

Sucralfate (Carafate) achieves a therapeutic effect by: A Neutralizing gastric acid B Enhancing gastric absorption C Forming a protective barrier around gastric mucosa D Inhibiting gastric acid secretion

2,4,5

The nurse is caring for a client who has had a gastroscopy. Which findings indicate that the client is developing a complication related to the procedure? select all that apply 1. The client has a sore throat 2. The client has a temp of 100 F 3. The client appears drowsy following the procedure 4. The client has epigastric pain 5. The client experiences hematemesis

1

The nurse is caring for a client who has just had an upper GI endoscopy. The clients VS must be taken every 30 minutes for 2 hrs after the procedure. The nurse assigns a UAP to take the VS. One hour later the UAP reports that the client who was previously afebrile has developed a temp of 101.8 F. The nurse should: 1. promptly assess the client for potential perforation 2. tell the UAP to change thermometers and retake the temp 3. plan to give the client Tylenol to lower the temp 4. ask the UAP to bathe the client in tepid water

a (The most frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as burning, heavy, sharp, or "hungry" pain that often localizes in the midepigastric area. The client with duodenal ulcer usually does not experience weight loss or N/V. These symptoms are usually more typical in the client with a gastric ulcer.)

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which of the following most frequent symptom(s) of duodenal ulcer? A Pain that is relieved by food intake B Pain that radiated down the right arm C N/V D Weight loss

d (Rationale: Triple therapy consists of two antibiotics and a protein pump inhibitor (PPI). The former are used to eradicate H. pylori infection, a common cause of peptic ulcers, and the latter to decrease gastric acid content by inhibiting an acid-secreting enzyme. Other medications used to treat PUDs serve to stimulate prostaglandin production, not inhibit it. Bicarbonate production is not stimulated by PPIs, but rather by the use of other medications, like sucralfate, bismuth, antacids, and prostaglandin analogs. )

The physician has ordered triple therapy for a client with peptic ulcer disease (PUD). In addition to the two antibiotics, a third medication used is a proton pump inhibitor (PPI) whose purpose is: a to inhibit prostaglandin production. b to neutralize the bacteria causing the infection. c to stimulate mucosal bicarbonate. d to inhibit an acid-secreting enzyme.

4 (A boardlike abdomen with shoulder pain is a symptom of a perforation, which is the most lethal complication of peptic ulcer disease. A burning sensation is a typical complaint and can be controlled with medications. Projectile vomiting can signal an obstruction. Coffee-ground emesis is typical of slower bleeding, and the client will require diagnostic testing. Focus: Prioritization)

You are caring for a client with peptic ulcer disease. Which assessment finding is the most serious? 1. Projectile vomiting 2. Burning sensation 2 hours after eating 3. Coffee-ground emesis 4. Boardlike abdomen with shoulder pain

d (Rationale For the client with PUD who is experiencing​ vomiting, an appropriate outcome would be to maintain fluid volume. The client should have a urine output of at least 0.5​ mL/kg/hr, no​ bleeding, and report a level of pain that is acceptable for the client.)

A nurse is planning care for a client with peptic ulcer disease​ (PUD) who presents with intractable nausea and vomiting and epigastric pain. What is an appropriate outcome for this​ client? a The client will report pain as 5 or less on standard pain scale. b The client will maintain a urine output of at least 0.1​ mL/kg/hr. c The client will have minimal bleeding. d The client will maintain adequate fluid volume.

a,c,d,e (Rationale Factors of the health history for a client with PUD​ include: presence of nausea and​ vomiting, complaints of​ heartburn, history of chronic use of​ NSAIDs, and history of smoking. History of a​ high-fat diet does not appear to factor into the development of PUD.)

A nurse is preparing to obtain a health history from a client with peptic ulcer disease​ (PUD). Which factors should the nurse include in this portion of the nursing​ assessment? ​(Select all that​ apply.) a Complaints of heartburn b History of a​ high-fat diet c History of chronic use of NSAIDs d Presence of nausea and vomiting e History of smoking

a (Rationale Nonpharmacologic therapy for the treatment of PUD includes education of diet and lifestyle modifications to avoid a​ flare-up of the disease. The nurse should instruct the client to eat meals at regular intervals. Mild alcohol intake is acceptable. Bland or restrictive diets are not necessary.)

A nurse is providing discharge orders for a client with peptic ulcer disease​ (PUD). What statement will the nurse include regarding client diet and lifestyle modifications for the prevention of​ PUD? a "Do not skip any meals. b "You must eliminate intake of all alcohol. " c "Restrict your diet to nonfat and​ sugar-free foods. " d "Be sure to eat a bland diet to avoid a​ flare-up of PUD.