as

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 elimination of 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 head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

21. 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 fi ndings, 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 nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

23. 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: ■ 1. Involvement with his job will keep the client from becoming bored. ■ 2. A relaxed environment will promote ulcer healing. ■ 3. Not keeping up with his job will increase the client's stress level. ■ 4. Setting limits on the client's behavior is an important nursing responsibility.

2. 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.

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. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

25. 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.

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

22. 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? ■ 1. Bland foods. ■ 2. High-protein foods. ■ 3. Any foods that are tolerated. ■ 4. Large amounts of milk.

3. 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.

24. A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan? ■ 1. Conduct physical activity in the morning so that he can rest in the afternoon. ■ 2. Have the family agree to perform the necessary yard work at home. ■ 3. Give up jogging and substitute a less demanding hobby. ■ 4. Incorporate periods of physical and mental rest in his daily schedule.

4. 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.

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. Deficient knowledge related to unfamiliarity

15. 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 ulcer has perforated.