Peptic ulcer disease- pearson

​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.

A client with a perforated duodenal ulcer has intravenous fluids and nasogastric suctioning. In which position should the nurse place this​ client? Prone ​Semi-Fowler Left​ side-lying Sims position

​"The pain occurs when your stomach is​ empty." Pain from PUD occurs when the stomach is​ empty, typically 2-3 hours after a meal. The other responses are incorrect.

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? ​"The pain occurs when your stomach is​ empty." ​"The food that you ate for dinner likely contained too much​ fat, causing​ pain." ​"The acid in your stomach is increased at​ night, causing​ pain." ​"The food in your stomach takes longer to digest at​ night, which causes​ pain."

"This procedure is a type of x-ray that uses contrast." 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. Upper GI series uses x-ray; it is not a type of biopsy. The patient remains awake during the procedure and the contrast is swallowed, not injected via IV.

A patient is scheduled for an upper GI series to diagnose the reason for upper abdominal pain that subsides after eating. Which information should the nurse provide to the patient regarding this diagnostic test? "This procedure requires an IV." "This procedure is a type of x-ray that uses contrast." "This procedure requires sedation." "This procedure is a type of biopsy."

"Peptic ulcers can be located in the esophagus, stomach, and duodenum; however, the most common area is the duodenum." Peptic ulcers may occur in any area of the GI tract exposed to acid and pepsin secretions, including the esophagus, stomach, and duodenum. The most common site for peptic ulcers to develop is the duodenum. Alcohol and dietary intake are not implicated in the development of peptic ulcer disease.

A patient who was informed about having a peptic ulcer asks if that means the ulcer is not located in the stomach. Which response should the nurse make to this patient? "When it's referred to as a peptic ulcer instead of a gastric ulcer, it means that it is located in a site other than the stomach." "Peptic ulcer is just another term for gastric ulcer; they are generally located in the stomach." "Peptic ulcers are those that are caused by excessive alcohol use and improper diet." "Peptic ulcers can be located in the esophagus, stomach, and duodenum; however, the most common area is the duodenum."

Perforation The patient 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 that 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 patient'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 patient with a history of peptic ulcer disease (PUD) reports severe abdominal pain that radiates to the right shoulder. The patient's heart rate is 114 beats/min and blood pressure is 90/56 mmHg. The patient's skin is cool and clammy, the abdomen is hard, and bowel sounds are absent. Which complication associated with PUD should the nurse suspect? Zollinger-Ellison syndrome Perforation Gastric outlet obstruction Hemorrhage

"Have you had any blood or coffee-ground vomitus? Hematemesis is a possible sign of hemorrhage. Asking if the patient has had bright red blood in vomit or has seen a coffee-grounds appearance would assess for this potential complication. The nurse could also assess the patient for orthostatic hypotension, which is another sign of hemorrhage. The other questions assesses for common symptoms of PUD or other abdominal disorders, not potential complications.

The nurse assesses a patient with peptic ulcer disease (PUD). Which question should the nurse ask to learn if the patient is experiencing a complication of this disorder? "Have you had any upper left quadrant pain?" "Have you had any blood or coffee-ground vomitus? "Has your pain radiated to your back?" "Are you having painful defecation?"

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

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? Obtain healthcare provider approval for use of any OTC meds while receiving PPIs. Read OTC medication labels for possible aspirin content. Avoid any OTC medications containing decongestants or antihistamines. Avoid all OTC vitamin and mineral supplements until the ulcer is healed.

​"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.

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? ​"Peritonitis occurs due to the obstruction of the pyloric region of the stomach and duodenum. The increased pressure from the obstruction leads to​ peritonitis." ​"Peritonitis occurs when the ulcer penetrates through the mucosal​ wall, causing gastric or duodenal contents to enter the​ peritoneum." ​"Bacterial peritonitis happens immediately after perforation as bacteria proliferate in the peritoneal​ cavity." ​"Chemical peritonitis occurs between 6 and 12 hours after​ perforation, when the acids from the stomach or duodenum create an inflammatory​ response."

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 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? Antacids do not affect digoxin. Antacids cancel all therapeutic effects of digoxin. Antacids interfere with the absorption of digoxin. Antacids absorb​ digoxin's therapeutic effect.

Administer fluid volume and electrolyte solutions. To address the risk for deficient fluid volume, the nurse should maintain IV therapy with fluid and electrolyte replacement solutions. Monitoring serum electrolytes, BUN, and creatinine; assessing gastric drainage to estimate the amount and rapidity of hemorrhage; and inserting a nasogastric tube and maintaining its position and patency are also important but do not directly address the risk for deficient fluid volume.

The nurse plans care for a patient experiencing nausea, vomiting, and epigastric pain caused by peptic ulcer disease (PUD). Which action should the nurse take to best address this patient's risk for deficient fluid volume? Insert a nasogastric tube and maintain its position and patency. Monitor serum electrolytes, BUN, and creatinine. Administer fluid volume and electrolyte solutions. Assess gastric drainage to estimate the amount and rapidity of hemorrhage.

Histamine-receptor blockers For patients whose history includes chronic NSAID use, recommendations include adding either a histamine receptor antagonist, PPI, or misoprostol (Cytotec) with the NSAID or changing treatment to a COX-2-selective NSAID to reduce the occurrence of peptic ulcers. The other answer choices are not recommended for chronic NSAID use.

While conducting a health history, the nurse learns that an older adult patient regularly uses NSAIDs. Which medication should the nurse encourage the patient to discuss with the healthcare provider to reduce the risk of developing peptic ulcer disease (PUD)? Sucralfate Bismuth compound Histamine-receptor blockers Antacids

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.

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? Assess the​ client's abdomen every 6 hours. Monitor stools for occult blood. Encourage the client to walk the halls. Encourage the client to have a bedtime snack to avoid hunger pains.

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 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? Increase physical activity. Take​ Pepto-Bismol instead of antacids. Stop smoking. Stop taking acetaminophen.

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.

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)? Upper GI series to diagnose possible existing ulcers Evaluation for concomitant administration of proton pump inhibitors​ (PPIs) Education about appropriate use of NSAIDs Testing for presence of H. pylori

It is generally well tolerated with few side effects. It reduces acid secretion. It must be continued for 8 weeks after the ulcer has healed. 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.

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.) It is generally well tolerated with few side effects. It can cause harmless darkening of stools. It binds to proteins forming a protective barrier. It reduces acid secretion. It must be continued for 8 weeks after the ulcer has healed.

​"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.

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? ​"Most insurers require that an upper GI series be done​ first, so there really is nothing we can​ do." ​"If you want to have an accurate​ diagnosis, it would probably be best to have a gastroscopy​ instead." ​"The upper GI series detects almost​ 100% of peptic​ ulcers, while gastroscopy often misses​ some, so​ it's best to stick with the​ series." ​"An upper GI series is best to start with because it is less invasive and less​ costly."

​"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.

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? ​"Please discuss with the healthcare provider alternative ways to address​ pain, as aspirin use can cause​ ulcers." ​"It would be best if you limited the amount of spicy foods you​ eat, as they aggravate​ ulcers." ​"You should try to take ibuprofen rather than aspirin for​ pain; it does not contribute to ulcer​ development." ​"Continue to eat frequently as you have​ been, which helps to limit the ulcer​ development."

Complaints of heartburn History of smoking Presence of nausea and vomiting History of chronic use of NSAIDs 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 factor should the nurse include in this portion of the nursing​ assessment? (Select all that​ apply.) Complaints of heartburn History of a​ high-fat diet History of smoking Presence of nausea and vomiting History of chronic use of NSAIDs

"Do not skip any meals." Patients are encouraged to maintain good nutrition, consuming balanced meals at regular intervals. It is important to teach patients that bland or restrictive diets are no longer necessary. Mild alcohol intake is not harmful. Smoking is discouraged because it slows the rate of healing and increases the frequency of relapses.

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

"A bland diet is no longer recommended; it is best to eat balanced meals with increased fiber at regular intervals." Bland or restrictive diets are no longer necessary; instead, individuals with PUD are encouraged to eat regular, balanced meals and to increase fiber intake. They will not have restrictions nor will they need to avoid spicy foods. While medications will help to address some of the issues of PUD, stating that medications will help to address any issues the foods may cause is not the best answer to the patient's question.

A patient newly diagnosed with peptic ulcer disease (PUD) is concerned about managing the disease because of not being able to tolerate a bland diet. Which response should the nurse make that accurately addresses this concern? "You will be able to consume whatever you like, because the medications will help to address any issues the foods may cause." "There will be restrictions, unfortunately, but we can teach you ways to enhance the flavor of your foods safely." "A bland diet is no longer recommended; it is best to eat balanced meals with increased fiber at regular intervals." "The only foods you will really need to avoid are those that are exceedingly spicy; otherwise, you can eat normally."

Upper GI series An upper GI series is the diagnostic procedure generally chosen first because it does not require sedation and is less costly and less invasive than gastroscopy. Biopsies and the urea breath test are used to test for the presence of H. pylori.

A patient presents with suspected peptic ulcer disease (PUD). Which diagnostic test should the nurse expect to be ordered first for this patient? Upper GI series Gastroscopy Biopsy Urea breath test

"Have you had diarrhea or noticed that your stools appear oily?" Zollinger-Ellison syndrome is characterized by ulcerlike pain, diarrhea, and steatorrhea. Asking about feelings of fullness; black, tarry stools; fever; and vomiting would not elicit information concerning symptoms characteristic of this syndrome.

A patient recently diagnosed with peptic ulcer disease (PUD) is being further evaluated by the provider for suspected Zollinger-Ellison syndrome. Which question should the nurse ask to elicit information about the symptoms characteristic of this form of PUD? "Have you had any black, tarry-looking stools?" "Have you been experiencing any vomiting or fever?" "Have you had diarrhea or noticed that your stools appear oily?" "Have you been feeling really full recently?"

Antacid Antacids provide rapid relief of ulcer symptoms and are often used as needed to supplement other antiulcer medications. Misoprostol, sucralfate, and Pepto-Bismol can also be used in relation to ulcer disease, but antacids can provide the most rapid relief.

A patient taking a proton pump inhibitor for peptic ulcer disease (PUD) asks if there is anything else that can be taken to help reduce the symptoms. Which medication should the nurse recommend to help provide rapid relief of ulcer symptoms? Antacid Sucralfate Misoprostol Pepto-Bismol

"PPIs interfere with this test, so you will need to stop taking them 14 days prior to the test." In the urea breath test, radiolabeled urea is given orally. The urease produced by H. pylori bacteria converts the urea to ammonia and radiolabeled carbon dioxide, which can then be measured as the patient exhales. This test, in addition to diagnosis, can also be used to evaluate the effectiveness of treatment to eradicate H. pylori. Treatment with PPIs interferes with the urea breath test results, so these drugs should be discontinued 14 days prior to testing. Dye allergies are not an issue when performing a urea breath test. A urea breath test is done while a patient is awake. The urea breath test can be used to determine effectiveness of treatment as well as a diagnostic test.

A patient who has been taking a proton pump inhibitor (PPI) for symptoms of peptic ulcer disease (PUD) is scheduled for a urea breath test. Which information should the nurse provide to the patient prior to scheduling this diagnostic test? "PPIs interfere with this test, so you will need to stop taking them 14 days prior to the test." "This test requires anesthesia, so you will need to make sure that someone is available to drive you home." "This test cannot be done if you have any dye allergies, so please let me know if you have had issues with dyes in the past." "This test can only tell us how effective treatment has been; it cannot be used for diagnosis."

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

A patient with diarrhea and epigastric pain is diagnosed with a gastrinoma. Which additional condition should the nurse suspect in the patient? Zollinger-Ellison syndrome Gastric ulcer Sick sinus syndrome Esophageal ulcer

Abdominal rigidity and absence of bowel sounds Additional signs of perforation include a rigid, boardlike abdomen and absence of bowel sounds. Signs of shock may also be present, including diaphoresis, tachycardia, and rapid, shallow respirations. Nausea and vomiting and electrolyte imbalances are signs of obstruction. Hematemesis and occult blood in the stool are signs of hemorrhage. Steatorrhea and low sodium and potassium levels are signs of Zollinger-Ellison syndrome.

A patient with known peptic ulcer disease (PUD) experiences severe upper abdominal pain that began within the past half hour. The nurse suspects possible perforation. Which additional assessment information should the nurse identify that helps support a definitive diagnosis? Abdominal rigidity and absence of bowel sounds Nausea and vomiting and electrolyte imbalances Hematemesis and occult blood in the stool Steatorrhea and low sodium and potassium levels

"Reduce your stress as much as possible." Educating the patient regarding the prevention of PUD should include: smoking cessation (not reduction), stress reduction, and education about the use of over-the-counter NSAIDs. It is not necessary for the patient to completely eliminate alcohol. Although high-fat foods are not recommended for a healthy diet, they have not been shown to cause PUD.

A patient with peptic ulcer disease (PUD) asks what can be done to prevent the ulcers from recurring. Which statement should the nurse make to this patient? "Eliminate all high-fat foods from your diet." "Reduce your smoking." "Eliminate all alcohol intake." "Reduce your stress as much as possible."

"Your healthcare provider may order a breath test to determine the presence of H. pylori." The urea breath test is used to measure the urease produced by H. pylori bacteria. H. pylori is 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 patient with peptic ulcer disease (PUD) asks what needs to be done to determine if bacteria is causing the ulcer. Which statement should the nurse make to this patient? "Your healthcare provider may order an x-ray with contrast to visualize the H. pylori bacteria." "Your healthcare provider may order a test to analyze your stomach contents." "Your healthcare provider may order a skin test to determine the presence of H. pylori." "Your healthcare provider may order a breath test to determine the presence of H. pylori."

Replace gastric output milliliter for milliliter with a balanced electrolyte solution. Replacing gastric output milliliter for milliliter with a balanced electrolyte solution helps to maintain homeostasis. Assessing the abdomen (including bowel sounds, distention, girth, and tenderness) every 4 hours can help to monitor for signs of a perforation. Administering whole blood and packed red blood cells helps to prevent shock. Administering PPIs, H2-receptor antagonists, antacids, or mucosal protective agents as ordered help to reduce pain and promote healing.

A patient with peptic ulcer disease (PUD) is draining coffee-ground emesis through a nasogastric tube. Which action should the nurse take to help maintain homeostasis? Assess the abdomen, including bowel sounds, distention, girth, and tenderness every 4 hours. Administer PPIs, H2-receptor antagonists, antacids, or mucosal protective agents as ordered. Replace gastric output milliliter for milliliter with a balanced electrolyte solution. Administer whole blood and packed red blood cells.

Discourage the patient from eating a nighttime snack. The nurse should discourage the patient from eating a nighttime snack because this can exacerbate the patient's condition. The patient should maintain strict bedrest. The nurse should assess the patient's abdomen every 4 hours. Inserting a nasogastric tube is a collaborative nursing intervention, requiring an order from the healthcare provider. The nurse will not automatically insert a nasogastric tube for all patients with PUD.

A patient with peptic ulcer disease (PUD) is experiencing nausea, heartburn, and epigastric pain. Which nursing intervention should the nurse plan to implement? Allow the patient to have bathroom privileges. Discourage the patient from eating a nighttime snack. Listen to the patient's bowel sounds every shift. Insert a nasogastric tube upon patient admission.

It inhibits an acid-secreting enzyme to reduce gastric acid content. 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 patient with peptic ulcer disease (PUD) is prescribed a proton-pump inhibitor. Which information should the nurse recall before administering this medication? It stimulates secretion of mucus, bicarbonate, and prostaglandin. It stimulates gastric mucosal defenses. It inhibits histamine binding to the receptors on the gastric parietal cells to reduce acid secretion. It inhibits an acid-secreting enzyme to reduce gastric acid content.

"There are medications that have been found safe and appropriate for use during pregnancy to treat PUD; you can discuss them with the healthcare provider." Proton pump inhibitors have been suggested as safe and appropriate for use during pregnancy; thus, this would be the best response to the patient. The remaining responses include either inaccurate information or do not directly address the patient's question.

A pregnant patient with peptic ulcer disease (PUD) who has been experiencing hematemesis and weight loss is concerned about treatment and its potential impact on the fetus. Which response should the nurse provide to this patient? "While I understand your concerns, you cannot continue with this kind of pain and discomfort for the rest of your pregnancy." "There are medications that have been found safe and appropriate for use during pregnancy to treat PUD; you can discuss them with the healthcare provider." "You are right to be concerned, and management with diet should be enough to get things under control." "While the safety of medications to treat PUD during pregnancy has not been fully studied, it is also harmful to continue to lose weight."

Weight loss and anemia In the older adult, presentation of peptic ulcer disease (PUD) is less clear and includes vague or poorly localized discomfort, chest pain, dysphagia, weight loss, or anemia. Often, the presenting symptom may be an upper gastrointestinal hemorrhage or perforation of the stomach or duodenum.

An older adult patient continues to experience chest pain and dysphagia after having an examination that eliminated the cause as being heart disease. Which other symptom should the nurse assess that might indicate peptic ulcer disease? Altered electrolyte levels and fluid intake Vomiting and acute upper abdominal pain Diarrhea and constant hunger Weight loss and anemia

​"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 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? ​"You really​ shouldn't take anything else with the​ PPI; please let the healthcare provider know that you are doing​ so." ​"If the PPI is not controlling your discomfort from the​ ulcer, a bismuth compound such as​ Pepto-Bismol would work​ better." ​"It's ok to take an antacid if it helps to relieve some of the discomfort that the PPI is not​ addressing." ​"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."

Increase in dietary fiber A diet with increased fiber is indicated to help prevent further ulcers. A bland diet (avoiding spicy or fatty foods) is not necessary. Mild, not moderate, alcohol intake is recommended. previous

The nurse instructs a patient with peptic ulcer disease (PUD) about dietary approaches to manage the disorder. Which dietary change indicates that teaching provided to the patient was effective? Increase in dietary fiber Decrease in acidic foods Decrease in dietary fatty foods Moderate alcohol intake

Left-upper-quadrant area Abdominal pain is the classic symptom of PUD. When completing an assessment on the patient with PUD, the nurse would ask the patient about pain in the epigastric area, left-upper-quadrant pain, and radiation of pain to the back. The pain is typically described as gnawing, burning, aching, or hungerlike. The pain occurs when the stomach is empty (2-3 hours after meals and in the middle of the night) and is relieved by eating, with a classic pain-food-relief pattern. The patient may complain of heartburn or regurgitation and may vomit.

The nurse is assessing abdominal pain in a patient with peptic ulcer disease. Which body area should the nurse specifically question the patient about? Left-lower-quadrant area Right-lower-quadrant area Right-upper-quadrant area Left-upper-quadrant area

Orthostatic hypotension Orthostatic hypotension can indicate possible hemorrhage, which is a complication of PUD. During the assessment, the nurse should always assess for orthostatic hypotension. It is not necessary to assess for widening pulse pressure, pulsus paradoxus, or pulse deficit in the patient with PUD.

The nurse is completing a physical assessment of a patient with peptic ulcer disease (PUD). Which vital sign abnormality should the nurse identify that could indicate a potential complication of the disorder? Orthostatic hypotension Pulse deficit Pulsus paradoxus Widening pulse pressure

Eating During the assessment of a patient with PUD, the nurse should assess the character, severity, and timing of the discomfort, and the relationship of the discomfort to eating (not body position, activity, or bowel movements).

The nurse is completing an assessment on a patient with peptic ulcer disease (PUD). Which activity should the nurse include when assessing this patient's discomfort? Eating Bowel movements Body position Activity

​"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.

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? ​"I can still enjoy spicy foods if I​ like." ​"I will start taking zinc daily to help with the​ healing." ​"I will try to decrease the amount of fiber in my​ diet." ​"I should try to eat balanced meals at regular​ intervals."

Chest pain Weight loss Dysphagia Anemia 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.

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.) Chest pain Weight loss Dysphagia Anemia Generalized weakness

The patient will maintain adequate fluid volume For the patient with PUD who is experiencing vomiting, an appropriate outcome would be to maintain fluid volume. The patient 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 patient.

The nurse is developing a plan of care for a patient with nausea, vomiting, and epigastric pain caused by peptic ulcer disease (PUD). Which outcome should the nurse identify for this patient? The patient will maintain adequate fluid volume. The patient will have minimal bleeding. The patient will report pain as 5 or less on a standard pain scale. The patient will maintain a urine output of at least 0.1 mL/kg/hr.

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.

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? Fluid volume excess Disturbed body image Disturbed sleep pattern Anxiety

H. pylori reduces the efficacy of the mucosal gel protecting the gastric mucosa. During PUD development, H. pylori produces enzymes that reduce the efficacy of the mucosal gel. Additionally, it contributes to gastric epithelial cell damage without producing immunity to the infection. NSAIDs, not H. pylori, interrupt prostaglandin synthesis and cross the lipid membranes of gastric epithelial cells. Cigarette smoking, not H. pylori, inhibits the secretion of bicarbonate by the pancreas.

The nurse is preparing an educational seminar about the development of peptic ulcer disease. Which information should the nurse include that best characterizes the pathophysiological changes secondary to Helicobacter pylori (H. pylori) infection leading to the development of peptic ulcer disease (PUD)? Prostaglandin synthesis is interrupted by H. pylori, affecting the gastric mucosal barrier. Infection with H. pylori inhibits the secretion of bicarbonate by the pancreas, causing a marked rapid transit of gastric acid into the duodenum. H. pylori reduces the efficacy of the mucosal gel protecting the gastric mucosa. H. pylori crosses the lipid membranes of gastric epithelial cells, damaging the cells themselves.

Complaints of feeling full Nausea and vomiting Electrolyte imbalances 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.

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.) Nausea and vomiting Blood in the stool Electrolyte imbalances Complaints of feeling full Hematemesis

Chronic use of NSAIDs Cigarette smoking Unsanitary living conditions Chronic H. pylori infection 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.

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.) Chronic use of NSAIDs Chronic alcohol abuse Cigarette smoking Unsanitary living conditions Chronic H. pylori infection

45-year-old male, smoker Duodenal ulcers typically develop between the ages of 30 and 55, are more common in men than in women, and are more common in individuals who smoke. Dietary intake and alcohol abuse do not lead to PUD. NSAIDs, not acetaminophen, can cause PUD.

The nurse reviews the health histories for a group of assigned patients. Which patient should the nurse identify as having the highest risk of a duodenal ulcer? 70-year-old male, chronic acetaminophen user 52-year-old female, chronic alcohol abuser 35-year-old female with poor dietary intake 45-year-old male, smoker

Acutely ill child experiencing health disparities PUD is not common in children; however, acutely ill children should be assessed for health disparities that can increase the risk of PUD. The presence of congenital anomalies, gastrointestinal defects, and prematurity do not necessarily increase the risk of PUD.

The nurse reviews the health histories for a group of assigned pediatric patients. Which patient should the nurse consider as at the highest risk for peptic ulcer disease (PUD)? Child with known gastrointestinal defects Infant born with multiple congenital anomalies Acutely ill child experiencing health disparities Premature infant receiving tube feedings since birth

Replace gastric output milliliter for milliliter with a balanced electrolyte solution. Initially measure and record gastric output every​ hour, then every 4 to 8 hours. Maintain tube patency and position. 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 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). Administer antacids via tube every hour to soothe gastric mucosa. Replace gastric output milliliter for milliliter with a balanced electrolyte solution. Use sterile technique when accessing the nasogastric tube. Initially measure and record gastric output every​ hour, then every 4 to 8 hours. Maintain tube patency and position.

The inflammatory response to H. pylori contributes to epithelial cell damage without producing immunity. 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.

Which pathophysiologic change contributing to the development of peptic ulcer disease occurs secondary to H. pylori​ infection? (Select all that​ apply.) Topical injury occurs due to H. pylori crossing the lipid membranes of gastric epithelial cells. Production of protective bicarbonate by the epithelial cells is inhibited. The inflammatory response to H. pylori contributes to epithelial cell damage without producing immunity. Prostaglandin synthesis is​ interrupted, which impacts the ability to maintain the gastric mucosal barrier. Enzymes are produced that reduce the efficacy of the mucous​ gel, which protects the gastric mucosa.