Peptic Ulcer Disease (Duodenal and Gastric) NCLEX

Which physical examination should the nurse implement first when assessing the client diagnosed with peptic ulcer disease? 1. Auscultate the client's bowel sounds in all four quadrants. 2. Palpate the abdominal area for tenderness. 3. Percuss the abdominal borders to identify organs. 4. Assess the tender area progressing to nontender.

1. Auscultation should be used prior to palpation or percussion when assess- ing the abdomen. Manipulation of the abdomen can alter bowel sounds and give false information.

Which oral medication should the nurse question before administering to the client with peptic ulcer disease? 1. E-mycin, an antibiotic. 2. Prilosec, a proton pump inhibitor. 3. Flagyl, an antimicrobial agent. 4. Tylenol, a nonnarcotic analgesic.

1. E-mycin is irritating to the stomach, and its use in a client with peptic ulcer disease should be questioned.

The nurse is caring for a client diagnosed with rule-out peptic ulcer disease. Which test confirms this diagnosis? 1. Esophagogastroduodenoscopy. 2. Magnetic resonance imaging (MRI). 3. Occult blood test. 4. Gastric acid stimulation.

1. The esophagogastroduodenoscopy (EGD) is an invasive diagnostic test that visualizes the esophagus, stomach, and duodenum to accurately diagnose an ulcer and evaluate the effectiveness of the client's treatment. TEST-TAKING HINT: If the test taker has no idea what the correct answer is, knowledge of anatomy can help identify the answer. A peptic ulcer is an ulcer in the stomach, and in option "1" the word "esophagogastroduo- denoscopy" has "gastro," which refers to the stomach. Therefore, this would be the best option to select as the correct answer.

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 midepigas- tric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.

15. A client is admitted to the hospital after vom- iting bright red blood and is diagnosed with a bleed- ing duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifesta- tions 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

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 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to com- plain about pain that occurs during the night and is frequently relieved by eating.

16. When obtaining a nursing history on a cli- ent 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.

2, 4, 5. Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occur- rence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

17. The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symp- toms may indicate that the client is developing a com- plication related to the procedure? Select all that apply. 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 findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. The client has a sore throat. 2. The client has a temperature of 100° F (37.8° C). 3. The client appears drowsy following the pro- cedure. 4. The client has epigastric pain. 5. The client experiences hematemesis

Which assessment data indicate to the nurse the client's gastric ulcer has perforated? 1. Complaints of sudden, sharp, substernal pain. 2. Rigid, boardlike abdomen with rebound tenderness. 3. Frequent, clay-colored, liquid stool. 4. Complaints of vague abdominal pain in the 36. right upper quadrant.

2. A rigid, boardlike abdomen with rebound tenderness is the classic sign/symptom of peritonitis, which is a complication of a perforated gastric ulcer.

The client with a history of peptic ulcer disease is admitted into the intensive care department with frank gastric bleeding. Which priority intervention should the nurse implement? 1. Maintain a strict record of intake and output. 2. Insert a nasogastric (N/G) tube and begin saline lavage. 3. Assist the client with keeping a detailed calorie count. 4. Provide a quiet environment to promote rest.

2. Inserting a nasogastric tube and lavaging the stomach with saline is the most im- portant intervention because this directly stops the bleeding.

Which expected outcome should the nurse include for a client diagnosed with peptic ulcer disease? 1. The client's pain is controlled with the use of NSAIDs. 2. The client maintains lifestyle modifications. 3. The client has no signs and symptoms of hemoptysis. 4. The client takes antacids with each meal.

2. Maintaining lifestyle changes such as fol- lowing an appropriate diet and reducing stress indicate the client is complying with the medical regimen. Compliance is the goal of treatment to prevent complications. TEST-TAKING HINT: Expected outcomes are positive completion of goals; maintaining lifestyle modifications would be an appro- priate goal for any client with any chronic illness.

Which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease? 1. History of side effects experienced from all medications. 2. Use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Any known allergies to drugs and environmental factors. 4. Medical histories of at least three (3) generations.

2. Use of NSAIDs places the client at risk for peptic ulcer disease and hemorrhage. NSAIDs suppress the production of prostaglandin in the stomach, which is a protective mechanism to prevent damage from hydrochloric acid. TEST-TAKING HINT: The words "specific data" indicate there will be appropriate data in one (1) or more of the answer options but only one (1) is specific to peptic ulcer disease.

The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data require further intervention? 1. Bowel sounds auscultated 15 times in one (1) minute. 2. Belching after eating a heavy and fatty meal late at night. 3. A decrease in systolic blood pressure (BP) of 20 mm Hg from lying to sitting. 4. A decreased frequency of distress located in the epigastric region.

3. A decrease of 20mmHg in blood pressure after changing position from lying, to sit- ting, to standing is orthostatic hypotension. This could indicate the client is bleeding.

The nurse is caring for a client diagnosed with hemorrhaging duodenal ulcer. Which collaborative interventions should the nurse implement? Select all that apply. 1. Perform a complete pain assessment. 2. Assess the client's vital signs frequently. 3. Administer a proton pump inhibitor intravenously. 4. Obtain permission and administer blood products. 5. Monitor the intake of a soft, bland diet.

3. This is a collaborative intervention the nurse should implement. It requires an order from the HCP. 4. Administering blood products is collaborative , requiring an order from the HCP. TEST-TAKING HINT: Descriptive words such as "collaborative" or "independent" can be the deciding factor when determining if an an- swer option is correct or incorrect. These are key words the test taker should identify.

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? 1. A decrease in alcohol intake. 2. Maintaining a bland diet. 3. A return to previous activities. 4. A decrease in gastric distress.

4. 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 dis- tress indicates the medication is effective.

Which assessment data supports the client's diagnosis of gastric ulcer to the nurse? 1. Presence of blood in the client's stool for the past month. 2. Reports of a burning sensation moving like a wave. 3. Sharp pain in the upper abdomen after eating a heavy meal. 4. Complaints of epigastric pain 30 to 60 minutes after ingesting food.

4. In a client diagnosed with a gastric ulcer, pain usually occurs 30 to 60 minutes after eating but not at night. In contrast, a cli- ent with a duodenal ulcer has pain during the night often relieved by eating food. Pain occurs one (1) to three (3) hours after meals. TEST-TAKING HINT: This question asks the test taker to identify assessment data spe- cific to the disease process. Many diseases have similar symptoms, but the timing of symptoms or their location may help rule out some diseases and provide the health-care provider with a key to diagnose a specific disease—in this case, peptic ulcer disease. Nurses are usually the major source for information to the health-care team.

Which problems should the nurse include in the plan of care for the client diagnosed with peptic ulcer disease to observe for physiological complications? 1. Alteration in bowel elimination patterns. 2. Knowledge deficit in the causes of ulcers. 3. Inability to cope with changing family roles. 4. Potential for alteration in gastric emptying.

4. 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. TEST-TAKING HINT: This question asks the test taker to identify a physiological problem identifying a complication of the disease pro- cess.Therefore,options"2"and"3"could be eliminated because they do not address physiological problems.

3. It is most likely that the client is experi- encing 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 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 hydroxide. 4. The client has developed a gastrointestinal obstruction.

4. Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an ant- acid 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 admin- istered 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 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 don't 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 to 3hours after meals."

3. Ranitidine blocks secretion of hydrochlo- ric 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 is to take one daily dose of raniti- dine (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.

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 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 neces- sary yard work at home. ■ 3. Give up jogging and substitute a less demand- ing hobby. ■ 4. Incorporate periods of physical and mental rest in his daily schedule.

1, 2, 3, 4. The nurse should encourage the cli- ent 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 elimina- tion of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleed- ing 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.

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.

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 concentra- tion and help reduce symptoms.

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.

2, 3. The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indica- tive 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 admin- ister an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt interven- tion is essential in a client who is potentially expe- riencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

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 symp- toms. 4. Initiating oxygen therapy. Reassessing the client in an hour.

2. Black, tarry stools are an important warn- ing 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 the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.

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 informa- tion, 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 require- ments related to gastric bleeding.

2. A relaxed environment is an essential component of ulcer healing. Nurses can help cli- ents 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 com- ponent of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

The nurse finds a client who has been diag- nosed 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.

3421 The client with peptic ulcer disease who is experi- encing a sudden onset of acute stomach pain should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. It is also important for the nurse to thor- oughly assess the nature of the client's pain. The client with the fractured jaw is experiencing pain and should be assessed next. The nurse should then assess the client who is NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before surgery.

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order should the nurse assess these clients? 1. A client awaiting surgery for a hiatal hernia repair at 11 a.m. 2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests. 3. A client with peptic ulcer disease experienc- ing a sudden onset of acute stomach pain. 4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

1. A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers is not an appropri- ate action and only further delays the appropriate action of assessing the client. The nurse would not administer acetaminophen without further assess- ment of the client or without a physician's order; a suspected perforation would require that the client be placed on nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the nurse is inappropriate.

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unli- censed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8° F (38.8° C). What should the nurse do in response to this reported assessment data? Promptly assess the client for potential perfo- ration. Tell the assistant to change thermometers and retake the temperature Plan to give the client acetaminophen (Tylenol) to lower the temperature. Ask the assistant to bathe the client with tepid water.

3. Diet therapy for ulcer disease is a con- troversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can toler- ate. 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 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 follow- ing? ■ 1. Bland foods. ■ 2. High-protein foods. ■ 3. Any foods that are tolerated. ■ 4. Large amounts of milk.

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.

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 hemo- globin and hematocrit every 3 months. 4. Eliminate contact sports from his or her life- style.