Peptic Ulcer disease 114- exam 1

the nurse has been assigned to care for a client dx with peptic ulcer disease. Which assessment data require further intervention a. bowel sounds auscultated 15 times in 1 minute b. belching after eating a heavy and fatty meal late at night c. decrease in systolic BP of 20 mmhg from lying to sitting d. a decreased frequency of distress located in the epigastric region

C. A decrease of 20 mm Hg in blood pressure after changing position from lying, to sitting, to standing is orthostatic hypotension. This could indicate client is bleeding.

A client with a peptic ulcer reports epigastric pain that frequently awakens her 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 ordered. 4. Sit up for one hour when awakened at night. 5. Stay away from crowded areas.

1 2 3 4 the nurse should encourage the client to reduce stimulation that may enhance gastric secretion. the nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain such as avoiding fatigue and stop smoking. eating small frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. medications should be administered promptly to maintain optimum levels. after awakening during the night, the client should eat a small snack and return to bed, keeping the HOB elevated for an hour after eating.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?1. Ineffective coping related to fear of diagnosis of chronic illness.2. Deficient knowledge related to unfamiliarity with significant signs and symptoms.3. Constipation related to decreased gastric motility.4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2 black tarry stools are an important warning sign of bleeding in peptic ulcer disease. digested blood in the stool causes it to be black. the odor of the stool is very offensive. clients with peptic ulcer disease should be instructed to report incidence promptly

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.

2 3 the symptoms of Nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. the appropriate action is to monitor the clients vital signs and notify the physician of the symptoms. to administer an antacid hourly or wait 1 hour to assess is inappropriate. prompt intervention is essential with a hemorrhage. the nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate contact sports from his or her lifestyle.

2 Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease. Analgesics are not used to control ulcer pain; many analgesics are gastric irritants. The client's hemoglobin and hematocrit typically do not need to be monitored every 3 months, unless gastrointestinal bleeding is suspected. The client can maintain an active lifestyle and does not need to eliminate contact sports as long as they are not stress-inducing.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena.

3 4 5 vomiting and weight loss are common with gastric ulcers. the client may also have blood in the stools (melena) from gastric bleeding. clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hr after eating. eating frequently aggravates the pain. clients with duodenal ulcers are more likely to complain about pain that occurs during the night that is relieved by eating

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? 1. Before meals. 2. With meals. 3. At bedtime. 4. When pain occurs.

3. Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation? 1. the client has not been including enough fiber in his diet 2. the client needs to increase his daily exercise 3. the client is experiencing an adverse effect of the aluminum 4. the client has developed a gastrointestinal obstruction

3.It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client with peptic ulcer disease is taking ranitidine (Zantac). 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.

4 histmain 2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. antisecretory, or proton pump inhibitors, such as omeprazole help ulcers heal in 4 to 9 weeks. cytoprotective drugs such as carafate protect the ulcer surface against acid, bile and pepsid. antacids reduce acid concentration and help reduce symptoms

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. i should take my antacid before i take my other medications 2. i need to decrease my intake of fluids so that i dont dilute the effects of my 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 hrs after meals

4.Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? 1. An intestinal obstruction has developed. 2. Additional ulcers have developed. 3. The esophagus has become inflamed. 4. The ulcer has perforated.

4.The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.

which physical examination should the nurse implement first when assessing the client diagnosed with peptic ulcer disease a. auscultate the clients bowel sounds in all 4 quadrants b. palpate the abdomen area for tenderness c. per cuss the abdominal borders to identify organs d. assess the tender area progressing to non tender

A. Auscultation should be used prior to palpitation or percussion when assessing the abdomen. Manipulation of the abdomen can alter bowel sounds and give false information

the nurse is caring for an older adult male client who reports stomach pain and heartburn. which syndrome is most significant in determining whether the clients ulceration is gastric or duodenal in orgin a. pain occurs 1 1/2 to 3 hrs after a meal usually at night b. pain is worsened by the ingestion of food c. the client has a malnourished appearance d. the client is a man older than 50 years

A. Pain occurs 1 1/2 to 3 hours after a meal, usually at night.A key symptom characteristic of duodenal ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.

the client is experiencing bleeding related to peptic ulcer disease. which nursing intervention is the highest priority a. starting a large bore intravenous IV b. administering intravenous pain medication c. preparing equipment for intubation d. monitoring the clients anxiety level

A. Starting a large-bore intravenous (IV)A large-bore IV should be placed as requested, so that blood products can be administered.

the nurse is caring for a client diagnosed with rule out peptic ulcer disease. Which test confirms this diagnosis? A. Esophagogastroduodenoscopy B. Magnetic resonance imaging C. Occult blood test D. Gastric acid stimulation.

A. The esophagogastroduodenoscopy (EGD) is an invasive diagnostic test which visualizes the esophagus, stomach, and duodenum to accurately diagnose an ulcer and evaluate the effectiveness of the clients treatment.

the client with a hx of peptic ulcer disease is admitted into the intensive care unit with frank gastric bleeding. which priority intervention should the nurse implement? a. maintain a strict record of intake and output b. insert a nasogastric tube and begin saline lavage c. assist the client with keeping detailed calorie count d. provide a quiet environment to promote rest

B. Inserting a nasogastric tube and lavaging the stomach with saline is the most important intervention because this directly stops the bleeding

which expected outcome should the nurse include for a client diagnosed with peptic ulcer disease? a. the clients pain is controlled with the use of NSAIDS b. the client maintains lifestyle modifications c. the client has no signs and symptoms of hemoptysis d. the client takes antacids with each meal

B. Maintaining lifestyle changes such as following an appropriate diet and reducing stress indicate the client is complying with the medical regimen. Compliance is the goal of treatment to prevent complications.

Which problems should the nurse include in the plan of care for the client diagnosed with peptic ulcer disease to observe for physiological complications? A. Alteration in bowel elimination patterns B. Knowledge deficit in the causes of ulcers C. Inability to cope with changing family roles D. Potential for alteration in gastric emptying

D. Potential for alteration in gastric emptying is caused by edema or scarring associated with an ulcer, which may cause a feeling of "fullness", vomiting of undigested food or abdominal distention

which assessment data support to the nurse the clients diagnosis of gastric ulcer a. presence of blood in the clients stool for the past month b. reports of burning sensation moving like a wave c. sharp pain in the upper abdomen after eating a heavy meal d/ complaints of epigastric pain 30 - 60 mins after ingesting food

D. The client diagnosed with a gastric ulcer, pain usually occurs 30 to 60 minutes after eating, but not at night. In contrast,no client with a duodenal ulcer has pain during the night often relieved by eating food. Pain occurs 1-3 hours after meals.

Which oral medication should the nurse question before administering to the client with peptic ulcer disease? A. E-mycin, an antibiotic B. Prilosec, a proton pump inhibitor C. Flagyl, an anti microbial agent D. Tylenol, a nonnarcotic analgesic

a. e mycinis- irritating to stomach and its use in a client with peptic ulcer disease should be questioned

which specific data should the nurse obtain from the client suspected of having peptic ulcer disease a. history of side effects experienced from all medications b. use of non steroidal anti inflammatory drugs c. any known allergies to drugs and environmental factors d. medical histories of at least 3 generations

b Use of NSAIDs places the client at risk for peptic ulcer and hemorrhage. NSAIDs suppress the production of prostaglandin in the stomach, which is a protective mechanism to prevent damage from hydrochloric acid

The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan. "B. "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

b although these herbs may be helpful in managing PUD the client should consult his/her physician before making a change in the tx regimen

which assessment data indicate to the nurse the clients gastric ulcer has perforated a. complaints of sudden, sharp, substernal pain b. rigid, board like abdomen with rebound tenderness c. frequent clay colored liquid stool d. complaints of vague abdominal pain

b rigid boardlike abdomen with rebound tenderness is the class sign of peritonitis, which is a complication of a perforated gastric ulcer

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: a. involvement with his job will keep the client from becoming bored b. a relaxed environment will promote ulcer healing c. not keeping up with job will increase the clients stress level d. setting limits on the clients behavior is an important nursing responsibility

b .A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following? a. bland foods b. high protein foods c. any foods that are tolerated d. large amounts of milk

c .Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

the nurse is caring for a client diagnosed with hemorrhage get duodenal ulcer. which collaborative intervention should the nurse implement? SATA a. perform a complete pain assessment b. assess the clients vital signs frequently c. administer a proton pump inhibitor intravenously d. obtain permission and administer blood products e. monitor the intake of a soft bland diet

c- this is a collaborate intervention the nurse should implement. It requires an order from the HCP d. administering blood products is collaborative, requiring an order from the HCP

a client with peptic ulcer has been instructed to avoid intense physical activity and stress. which strategy should the client incorporate into the home care plan b. have the family agree to perform the necessary yard work at home c. give up jogging and substitute a less demanding hobby d. incorporate periods of physical and mental rest in his daily schedule

d .It would be most effective for the client to develop a health maintenance plan that incorporates regular periods of physical and mental rest in the daily schedule. Strategies should be identified to deal with the types of physical and mental stressors that the client needs to cope with in the home and work environments. Scheduling physical activity to occur only in the morning would not be restful or practical. There is no need for the client to avoid yard work or jogging if these activities are not stressful.

The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto- Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective? A. A decrease in alcohol intake B. Maintaining a bland diet C. A return to previous activities D. A decrease in gastric distress

d antibiotics, proton pump inhibitors and pepto bismol are administered to decrease the irritation of the ulcerative area and cure the ulcer. a decrease in gastric distress indicates the medication is effective