peptic ulcer disease practice questions
The nurse is concerned that a resident of an assisted living facility is experiencing peptic ulcer disease (PUD). Which symptom should the nurse expect to assess in this person? (Select all that apply.) A.Anemia B.Chest pain C.Weight loss D.Dysphagia E.Generalized weakness
A,B,C,D A.Anemia B.Chest pain C.Weight loss D.Dysphagia -In the older adult, the presentation of PUD is often less clear and can include anemia, vague and poorly localized discomfort including chest pain or dysphagia, and weight loss. Generalized weakness is not one of the symptoms of PUD unique to this population.
A nurse is preparing to obtain a health history from a client with peptic ulcer disease (PUD). Which factor should the nurse include in this portion of the nursing assessment? (Select all that apply.) A.Presence of nausea and vomiting B.History of chronic use of NSAIDs C.History of smoking D.History of a high-fat diet E.Complaints of heartburn
A,B,C,E A.Presence of nausea and vomiting B.History of chronic use of NSAIDs C.History of smoking E.Complaints of heartburn -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.
Which statement is INCORRECT about Histamine-receptor blockers? A. "H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric acid." B. "Ranitidine and Famotidine are two types of histamine-receptor blocker medications." C. "Antacids and H2 blockers should not be given together." D. All the statements are CORRECT.
A. "H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric acid." The answer is A. This statement is false. H2 blockers block histamine which causes the PARTIETAL (not chief) cells to decrease the secretion of hydrochloric acid.
The nurse is reviewing risk factors for peptic ulcer disease (PUD) with a group of community members. Which factor should the nurse include in the presentation? (Select all that apply.) A.Chronic alcohol abuse B.Cigarette smoking C.Unsanitary living conditions D.Chronic H. pylori infection E.Chronic use of NSAIDs
B,C,D,E B.Cigarette smoking C.Unsanitary living conditions D.Chronic H. pylori infection E.Chronic use of NSAIDs Cigarette smoking, chronic use of NSAIDs, chronic H. pylori infection, and unsanitary living conditions are all risk factors for PUD. Chronic alcohol abuse is not considered a risk factor for PUD.
A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing? A. Obstruction of pylorus B. Upper gastrointestinal bleeding C. Perforation D. Peritonitis
B. Upper gastrointestinal bleeding The answer is B. This patient is most likely experiencing an upper GI bleeding. Signs and symptoms of a possible GI bleeding with a peptic ulcer include: vomiting coffee ground emesis along with bloating, and abdominal mass
Helicobacter pylori can live in the stomach's acidic conditions because it secretes ___________ which neutralizes the acid. A. ammonia B. urease C. carbon dioxide D. bicarbonate
B. urease The answer is B. H. pylori can live in the acidic conditions of the stomach because it secretes urease which produces ammonia to neutralize the acid.
A client with a perforated duodenal ulcer has intravenous fluids and nasogastric suctioning. In which position should the nurse place this client? A.Sims position B.Semi-Fowler C.Prone D.Left side-lying
B.Semi-Fowler -Placing the client in the semi-Fowler position allows peritoneal contaminants to pool in the pelvis. The other positions are not indicated for this health problem.
Your patient is diagnosed with peptic ulcer disease due to h.pylori. This bacterium has a unique shape which allows it to penetrate the stomach mucosa. You know this bacterium is: A. Rod shaped B. Spherical shaped C. Spiral shaped D. Filamentous shaped
C. Spiral shaped -The answer is C. Helicobacter pylori (h. pylori) are spiral shaped which all them to penetrate down into the stomach lining to reside.
The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present? A. Ammonia B. Urea C. Hydrochloric acid D. Carbon dioxide
D. Carbon dioxide -The answer is D. If h. pylori are present, the bacteria will release urease which produces ammonia and carbon dioxide. For the test, the patient will ingest a urea tablet and breath samples will be analyzed for carbon dioxide levels.
In the stomach lining, the parietal cells release _________ and the chief cells release __________ which both play a role in peptic ulcer disease. A. pepsin, hydrochloric acid B. pepsinogen, pepsin C. pepsinogen, gastric acid D. hydrochloric acid, and pepsinogen
D. hydrochloric acid, and pepsinogen The answer is D. In the stomach lining, the parietal cells release HYDROCHLORIC ACID and the chief cells release PEPSINOGEN which both plays a role in peptic ulcer disease. Pepsinogen then mixes with the hydrochloric acid and turns into pepsin.
A client is being treated for peptic ulcer disease (PUD). Which action should the nurse take to reduce this client's risk of a complication? A.Encourage the client to walk the halls. B.Encourage the client to have a bedtime snack to avoid hunger pains. C.Assess the client's abdomen every 6 hours. D.Monitor stools for occult blood.
D.Monitor stools for occult blood. -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 bedrest, not activity. The nurse should discourage the client from having a bedtime snack to avoid pain associated with PUD.
The nurse is reviewing assessment data for a client hospitalized with peptic ulcer disease (PUD). Which assessment information should indicate to the nurse that the client may be experiencing an obstruction secondary to the ulcer? (Select all that apply.) A.Electrolyte imbalances B.Hematemesis C.Complaints of feeling full D.Nausea and vomiting E.Blood in the stool
A,C,D A.Electrolyte imbalances C.Complaints of feeling full D.Nausea and vomiting -Obstruction is a potential complication of PUD. Manifestations of obstruction include sensations of epigastric fullness, nausea and vomiting, and electrolyte imbalances. Hematemesis and blood in the stool may indicate hemorrhage, another potential complication of PUD.
Which intervention should be included in a client's plan of care after placement of a nasogastric tube that is inserted due to bleeding secondary to a peptic ulcer? (Select all that apply). A.Maintain tube patency and position. B.Administer antacids via tube every hour to soothe gastric mucosa. C.Initially measure and record gastric output every hour, then every 4 to 8 hours. D.Replace gastric output milliliter for milliliter with a balanced electrolyte solution. E.Use sterile technique when accessing the nasogastric tube.
A,C,D A.Maintain tube patency and position. C.Initially measure and record gastric output every hour, then every 4 to 8 hours. D.Replace gastric output milliliter for milliliter with a balanced electrolyte solution. -After placement of a nasogastric tube, the nurse should maintain tube patency and position; initially measure and record gastric output every hour, changing to every 4 to 8 hours as the client stabilizes; and replace gastric output milliliter for milliliter with a balanced electrolyte solution. Sterile technique is not required for access to the nasogastric tube. Administering antacids every hour via the tube would not be indicated.
Which pathophysiologic change contributing to the development of peptic ulcer disease occurs secondary to H. pylori infection? (Select all that apply.) A.The inflammatory response to H. pylori contributes to epithelial cell damage without producing immunity. B.Prostaglandin synthesis is interrupted, which impacts the ability to maintain the gastric mucosal barrier. C.Production of protective bicarbonate by the epithelial cells is inhibited. D.Enzymes are produced that reduce the efficacy of the mucous gel, which protects the gastric mucosa. E.Topical injury occurs due to H. pylori crossing the lipid membranes of gastric epithelial cells.
A,D A.The inflammatory response to H. pylori contributes to epithelial cell damage without producing immunity. D.Enzymes are produced that reduce the efficacy of the mucous gel, which protects the gastric mucosa. The H. pylori bacteria produce enzymes that reduce the efficacy of mucous gel in protecting the gastric mucosa. Also, the host's inflammatory response to H. pylori contributes to gastric epithelial cell damage without producing immunity to the infection. It does not inhibit production of bicarbonate. NSAID use, not H. pylori, causes topical injury and interrupts prostaglandin synthesis.
. Select all the medications a physician may order to treat a H. Pylori infection that is causing a peptic ulcer? A. Proton-Pump Inhibitors B. Antacids C. Anticholinergics D. 5-Aminosalicylates E. Antibiotics F. H2 Blockers G. Bismuth Subsalicylates
A,E,F,G A. Proton-Pump Inhibitors E. Antibiotics F. H2 Blockers G. Bismuth Subsalicylates The answers are: A, E, F, and G. All these medications can be used to treat an h. pylori infection that is causing a peptic ulcer.
A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient's description this appears to be what type of peptic ulcer? A. Duodenal B. Gastric C. Esophageal D. Refractory
A. Duodenal -The answer is A. The patient signs and symptoms describe a duodenal ulcer. Gastric ulcer tend to not cause pain in the middle of the night and epigastric pain in worst with food.
A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to advance the patient's diet to solid foods. The patient's lunch tray arrives. Which food should the patient avoid eating? A. Orange B. Milk C. White rice D. Banana
A. Orange The answer is A. When an ulcer is actively causing signs and symptoms, the patient should avoid acidic foods like tomatoes or citric fruits/juices, chocolate, alcohol, fried foods and caffeine. These foods can irritate the ulcer site. Instead the patient should consume alkalotic or bland foods like milk, white rice or bananas.
A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI? A. Pantoprazole B. Famotidine C. Magnesium Hydroxide D. Metronidazole
A. Pantoprazole The answer is A. Pantoprazole is the only PPI listed. Remember PPIs tend to end with the letters "prazole".
A client with peptic ulcer disease (PUD) asks why stomach pain occurs 2 to 3 hours after eating. Which response should the nurse make to this client? A."The pain occurs when your stomach is empty." B."The food that you ate for dinner likely contained too much fat, causing pain." C."The acid in your stomach is increased at night, causing pain." D."The food in your stomach takes longer to digest at night, which causes pain."
A."The pain occurs when your stomach is empty." Pain from PUD occurs when the stomach is empty, typically 2dash3 hours after a meal. The other responses are incorrect.
The nurse is planning care for a client with peptic ulcer disease (PUD). Which problem should the nurse identify as a priority for this client? A.Disturbed sleep pattern B.Fluid volume excess C.Anxiety D.Disturbed body image
A.Disturbed sleep pattern -Disturbed sleep pattern is a common problem 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
Thinking back to the patient in question 8, select ALL the correct statements on how to educate this patient about decreasing their symptoms: A. "It is best to eat 3 large meals a day rather than small frequent meals." B. "After eating a meal lie down for 30 minutes." C. "Eat a diet high in protein, fiber, and low in carbs." D. "Be sure to drink at least 16 oz. of milk with meals."
B,C B. "After eating a meal lie down for 30 minutes." C. "Eat a diet high in protein, fiber, and low in carbs." The answers are B and C. The patient in question 8 is exhibiting signs and symptoms of dumping syndrome. The patient should eat small but frequent meals (NOT 3 large meals a day), lie down for 30 minutes after meals, avoid sugary drinks and foods, and follow a high protein, high fiber, and low-carb diet, and avoid consuming drinks while eating but afterwards.
A patient has developed a duodenal ulcer. As the nurse, you know that which of the following plays a role in peptic ulcer formation. Select ALL that apply: A. Spicy foods B. Helicobacter pylori C. NSAIDs D. Milk E. Zollinger-Ellison Syndrome
B,C,E B. Helicobacter pylori C. NSAIDs E. Zollinger-Ellison Syndrome The answers are B, C, and E. Helicobacter pylori and NSAIDS are the most common causes for peptic ulcer formation. Zollinger-Ellison Syndrome can cause peptic ulcers but it is not as common as H. pylori or NSAIDS. Foods and stress are no longer thought to cause ulcers. Certain foods and stress can irritate ulcers or prolong healing but there is no evidence to suggest they cause them.
A client with peptic ulcer disease (PUD) asks about histamine2-receptor blockers because a friend with the same health problem is taking this type of medication. Which information should the nurse provide about this medication? (Select all that apply.) A.It binds to proteins forming a protective barrier. B.It must be continued for 8 weeks after the ulcer has healed. C.It can cause harmless darkening of stools. D.It is generally well tolerated with few side effects. E.It reduces acid secretion.
B,D,E B.It must be continued for 8 weeks after the ulcer has healed. D.It is generally well tolerated with few side effects. E.It reduces acid secretion. -Histamine2-receptor blockers are used for reducing gastric acid content in the treatment of PUD. They are generally well tolerated with few side effects and must be continued for 8 weeks after the ulcer has healed. Sucralfate, not histamine2-receptors, binds to proteins, forming a protective barrier. Bismuth compounds, not histamine2-receptors, cause harmless darkening of stools.
You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication? A. "I will take this medication at the same time I take Ranitidine." B. "I will always take this medication on an empty stomach." C. "It is best to take this medication with antacids." D. "I will take this medication once a week."
B. "I will always take this medication on an empty stomach." The answer is B. This statement is the only correct statement about how to take Carafate. It should always be taken on an empty stomach without food so it can coat the site of ulceration. This medication should NOT be taken with H2 blockers (Ranitidine) or antacids because these drugs affect the absorption of Carafate.
You're educating a group of patients at an outpatient clinic about peptic ulcer formation. Which statement is correct about how peptic ulcers form? A. "An increase in gastric acid is the sole cause of peptic ulcer formation." B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be released which signals to the parietal cells to release more pepsinogen which erodes the stomach lining further." D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form."
B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further." -The answer is B. Ulcers form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further...hence why option C is wrong. Option A is wrong because although peptic ulcers can from with increase gastric acid, this is not the sole cause of peptic ulcer formation. A breakdown in the defense mechanisms along with gastric acid leads to peptic ulcer formation. For example, h. pylori and regular NSAID usage leads to the breakdown of the stomach lining which allows stomach acid to penetrate and erode the lining. Option D is wrong because prostaglandins actually protect the stomach lining by causing the stomach cells to release mucous rich in bicarb, controls acid amounts via the parietal cells, and regulates perfusion to the stomach.
The client with peptic ulcer disease reports taking an antacid in addition to the proton pump inhibitor (PPI) prescribed by the healthcare provider. Which response should the nurse make to this client? A. "If the PPI is not working, maybe you can switch to a histamine2-receptor, as it provides faster pain relief and healing than the PPI." B."It's ok to take an antacid if it helps to relieve some of the discomfort that the PPI is not addressing." C."You really shouldn't take anything else with the PPI; please let the healthcare provider know that you are doing so." D."If the PPI is not controlling your discomfort from the ulcer, a bismuth compound such as Pepto-Bismol would work better."
B."It's ok to take an antacid if it helps to relieve some of the discomfort that the PPI is not addressing." It is acceptable to take an antacid as a supplement to provide rapid pain relief of ulcer symptoms. The statements that the client shouldn't take anything else with the PPI, that bismuth compounds work better than antacids, and that histamine2-receptors provide faster pain relief than PPIs are not accurate statements.
The nurse is reviewing the complications of peptic ulcer disease (PUD) with a group of new staff nurses. Which statement regarding peritonitis should the nurse include in the teaching? A. "Peritonitis occurs due to the obstruction of the pyloric region of the stomach and duodenum. The increased pressure from the obstruction leads to peritonitis." B."Peritonitis occurs when the ulcer penetrates through the mucosal wall, causing gastric or duodenal contents to enter the peritoneum." C."Chemical peritonitis occurs between 6 and 12 hours after perforation, when the acids from the stomach or duodenum create an inflammatory response." D."Bacterial peritonitis happens immediately after perforation as bacteria proliferate in the peritoneal cavity."
B."Peritonitis occurs when the ulcer penetrates through the mucosal wall, causing gastric or duodenal contents to enter the peritoneum." 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 patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing? A. Gastroparesis B. Fascia dehiscence C. Dumping Syndrome D. Somogyi effect
C. Dumping Syndrome The answer is C. After a gastric resection the stomach is not able to regulate the movement of food due to the removal of sections of the stomach (usually the pyloric valve and duodenum). Therefore, the food enters into the small intestine too fast before the stomach can finish digesting it. The partially digested food will act hypertonically and cause water from the blood to enter jejunum. This will cause a fluid shift leading to bowel swelling, diarrhea, and nausea etc.
A client with peptic ulcer disease (PUD) asks why an upper GI series is being done before a gastroscopy. Which response should the nurse make to this client? A."Most insurers require that an upper GI series be done first, so there really is nothing we can do." B."The upper GI series detects almost 100% of peptic ulcers, while gastroscopy often misses some, so it's best to stick with the series." C."An upper GI series is best to start with because it is less invasive and less costly." D."If you want to have an accurate diagnosis, it would probably be best to have a gastroscopy instead."
C."An upper GI series is best to start with because it is less invasive and less costly." The upper GI series does not require sedation and is less invasive and less costly. Saying that the GI series is less accurate is not necessarily a valid statement and would not be appropriate. An upper GI series can miss some small ulcers, but this does not necessarily reflect on accuracy. Statements that insurers require the upper GI series and that upper GI series detect almost 100% of ulcers are not valid statements.
The nurse is completing diet teaching for a client newly diagnosed with peptic ulcer disease (PUD). For which client statement should the nurse provide additional clarification? A."I will start taking zinc daily to help with the healing." B."I should try to eat balanced meals at regular intervals." C."I will try to decrease the amount of fiber in my diet." D."I can still enjoy spicy foods if I like."
C."I will try to decrease the amount of fiber in my diet." Fiber should be increased in the diet. Dietary restrictions are no longer necessary for management of PUD. Balanced meals at regular intervals and zinc are both recommended dietary strategies for management of PUD.
A client with peptic ulcer disease (PUD) has a history of a gastric ulcer, takes aspirin, eats spicy foods, and eats frequently to reduce stomach pain. Which suggestion should the nurse make based upon this information? A."It would be best if you limited the amount of spicy foods you eat, as they aggravate ulcers." B."You should try to take ibuprofen rather than aspirin for pain; it does not contribute to ulcer development." C."Please discuss with the healthcare provider alternative ways to address pain, as aspirin use can cause ulcers." D."Continue to eat frequently as you have been, which helps to limit the ulcer development."
C."Please discuss with the healthcare provider alternative ways to address pain, as aspirin use can cause ulcers." NSAID use is a risk factor for development of ulcers. Aspirin is the most ulcerogenic of the NSAIDs. It is best to eat balanced regular meals, not to eat based upon the symptomology of the ulcer. Restrictive diets are no longer necessary in management of PUD. Ibuprofen is also an NSAID and would not be appropriate to recommend.
The nurse notes that a client prescribed digoxin for heart failure has a new prescription for an antacid. Which information about antacids and digoxin should the nurse recall before administering these medications? A.Antacids cancel all therapeutic effects of digoxin. B.Antacids do not affect digoxin. C.Antacids interfere with the absorption of digoxin. D.Antacids absorb digoxin's therapeutic effect.
C.Antacids interfere with the absorption of digoxin. Antacids interfere with the absorption of digoxin. Antacids do not cancel all therapeutic effects of digoxin, nor do antacids absorb digoxin's therapeutic effect.
The nurse completes discharge teaching for a client recovering from complications related to peptic ulcer disease (PUD). Which information should the nurse include about over-the-counter (OTC) medications? A.Avoid all OTC vitamin and mineral supplements until the ulcer is healed. B.Avoid any OTC medications containing decongestants or antihistamines. C.Obtain healthcare provider approval for use of any OTC meds while receiving PPIs. D.Read OTC medication labels for possible aspirin content.
D.Read OTC medication labels for possible aspirin content. -Client discharge teaching should include the need to read OTC medication labels for possible aspirin content. The client does not necessarily need to obtain approval for any OTC medicines, nor do minerals, vitamins, decongestants, or antihistamines necessarily need to be avoided.
A client who smokes and routinely takes acetaminophen for pain relief is experiencing symptoms of peptic ulcer disease (PUD). Which lifestyle alteration should the nurse recommend to this client? A.Stop taking acetaminophen. B.Increase physical activity. C.Take Pepto-Bismol instead of antacids. D.Stop smoking.
D.Stop smoking. Smoking is a risk factor for PUD NSAIDs, not acetaminophen, but can increase the risk of PUD. Increasing physical activity will not decrease the risk of PUD. Antacids are more effective than Pepto-Bismol for relief of ulcer symptoms.
A client with peptic ulcer disease has been prescribed long-term NSAID therapy for osteoarthritis pain. Which action should take place before the NSAID therapy begins to address potential risk for peptic ulcer disease (PUD)? A.Upper GI series to diagnose possible existing ulcers B.Education about appropriate use of NSAIDs C.Evaluation for concomitant administration of proton pump inhibitors (PPIs) D.Testing for presence of H. pylori
D.Testing for presence of H. pylori Prior to beginning long-term therapy with NSAIDs, the client should be tested for H. pylori. Education about appropriate use may also be important but does not necessarily have to occur prior to beginning therapy. An upper GI series and concomitant administration of PPIs would not be appropriate.