EAQ Peptic Ulcer Disease

EAQ Peptic Ulcer Disease 1. Which medications increase the risk of ulcer development? Select all that apply. Some correct answers were not selected Aspirin Misoprostol Bethanechol Corticosteroids Metoclopramide Aspirin and corticosteroids are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development. Misoprostol, bethanechol, and metoclopramide are used in gastroesophageal reflux disease and peptic ulcer drug therapy. pp. 905-906 2. Which drug increases production of gastric mucus? Tofranil Sucralfate Cimetidine Misoprostol Misoprostol, a synthetic prostaglandin analog prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs (NSAIDs), increases production of gastric mucus and mucosal secretion of bicarbonate. Sucralfate forms a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by NSAIDs. 3. The patient with peptic ulcer disease is taking sucralfate. Which outcome would the nurse anticipate? Healing of ulcer Reduction in acid secretion Protection of ulcer from acids Neutralization of gastric acid secretion Sucralfate acts by forming a protective layer around an ulcer that serves as a barrier against acid, bile salts, and enzymes in the stomach. Histamine blockers are used to promote ulcer healing. Proton pump inhibitors such as omeprazole reduce gastric acid secretion. Antacids increase gastric pH and neutralize gastric acid secretion. 4. Which entries in a patient’s list of current medications would indicate specific treatment for Helicobacter pylori ( H. pylori)? Select all that apply. Cimetidine Amoxicillin Famotidine Omeprazole Clarithromycin Antibiotics such as amoxicillin and clarithromycin are used to treat H. pylori infection, which is a common cause of peptic and duodenal ulcers. Cimetidine and famotidine are histamine-receptor blockers that decrease acid production. Omeprazole reduces gastric secretion. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. 5. Two days after a patient has had gastric surgery, the nurse suspects that the patient’s nasogastric tube is not in the correct position. Which action would the nurse take? Remove the tube and insert a new nasogastric tube. Notify the health care provider immediately. Monitor for evidence of local inflammation and edema. Irrigate the nasogastric tube with normal saline solution. When the nurse suspects repositioning of the nasogastric tube is needed, the health care provider should be called as soon as possible because there is a danger of either perforation of the gastric mucosa or a disruption of the suture line. The nurse should not remove or insert a new tube without the order of the primary health care provider. Irrigating the tube with normal saline solution is helpful in preventing tube clogging, but if the tube is malpositioned, the irrigation might cause additional injury. Monitoring for the symptoms of edema and inflammation delays action and will put the safety of the patient at risk. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. 6. The nurse is teaching a patient about treatment and management of peptic ulcer disease. Which statement made by the patient indicates the need for further teaching? "I should avoid eating irritating foods that worsen my ulcer." "I should take my proton pump inhibitor (PPI) therapy as prescribed." "I should take nonsteroidal antiinflammatory drugs (NSAIDs) with food." "I should report abdominal pain or discomfort to the health care provider." The patient with peptic ulcer disease should not take NSAIDs. NSAIDs decrease the production of prostaglandins, which are necessary for secretion of protective gastric mucus. For patients with peptic ulcer disease, the nurse would instruct the patient to avoid irritating substances that exacerbate the ulcer and adhere to the PPI and histamine-receptor blocker therapy as prescribed. Abdominal pain or discomfort should be reported to the health care provider because it can indicate a complication. 7. Which symptom would patients with peptic ulcer disease (PUD) commonly report? Vomiting after meals Abdominal distention after eating Intolerance of fatty and spicy foods Epigastric discomfort relieved by eating Symptoms of PUD are variable and often absent. However, discomfort, if present, may occur before meals or two to three hours after meals and at bedtime. The discomfort may be relieved by eating because the food will dilute and buffer gastric acid. Although vomiting or abdominal distention after meals may occur and there may be an intolerance of fatty and spicy foods, they are less likely to be associated with PUD than is the relief caused by eating. pp. 905-906 8. The nurse is caring for a patient with peptic ulcer disease. On a follow-up visit, the health care provider identifies spillage of gastric contents into the space between the abdominal cavity and the abdominal wall. Which complication may occur if the condition is untreated? Pernicious anemia Bile reflux gastritis Bacterial peritonitis Postprandial hypoglycemia Spillage of gastric contents into the peritoneal cavity occurs in perforation postoperation of peptic ulcer disease. If the condition is untreated, bacterial infection can occur in the abdominal cavity and result in bacterial peritonitis. Pernicious anemia is a long-term complication of partial or total gastrectomy that occurs due to loss of intrinsic factor. Bile reflux gastritis is a complication of abdominal surgery of pylorus and is characterized by epigastric distress. Postprandial hypoglycemia obstruction occurs as a complication after peptic ulcer disease surgery. 9. A patient with a peptic ulcer begins vomiting. Which type of vomitus is associated with bleeding in the stomach? Fecal Bilious "Coffee ground" Undigested food The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis. 10. Which histamine-receptor blocker is available only for oral administration? Nizatidine Ranitidine Cimetidine Famotidine Nizatidine is available only for oral administration but not for IV administration; the medication is used to promote ulcer healing. Ranitidine, cimetidine, and famotidine are histamine (H 2) blockers that can be given orally or through IV. p. 898 11. Which medication for peptic ulcer disease may cause hallucinations? Nizatidine Sucralfate Omeprazole Metoclopramide Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H 2) receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence. 12. Which medication is prescribed for the prevention of peptic ulcer caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin? Famotidine Imipramine Misoprostol Clarithromycin Because of its protective and antisecretory effects on gastric mucosa, misoprostol (a synthetic prostaglandin analog) is prescribed to prevent peptic ulcers caused by NSAIDS and aspirin. Famotidine is a histamine-receptor blocker used to heal ulcers. Imipramine is a tricyclic antidepressant prescribed for patients with peptic ulcer disease. Clarithromycin is a medication included in triple-drug therapy for treating Helicobacter pylori ( H. pylori) infection. 13. Which condition can be diagnosed by measuring fasting serum gastrin levels? Acute gastritis Pyloric obstruction Gastric outlet obstruction Zollinger-Ellison syndrome Zollinger-Ellison syndrome can be diagnosed by measuring fasting serum gastrin levels, which will determine the amount of gastrin secreted by G cells of the stomach. Acute gastritis is diagnosed by endoscopic examination with biopsy. Pyloric obstruction is diagnosed by performing an endoscopy with dilated balloons. Gastric outlet obstruction is diagnosed by performing a barium contrast study. 14. Which medication’s action reduces hydrochloric acid (HCl) secretion? Ranitidine Sucralfate Tetracycline Aluminum hydroxide gel Ranitidine, which is a histamine-receptor blocker, reduces HCl secretions by blocking histamine, a hormone responsible for HCl secretion. Sucralfate acts by forming a protective layer around the ulcer and serves as a barrier against acid, bile salts, and enzymes in the stomach. Tetracycline is an antibiotic prescribed concurrently with proton pump inhibitors. Aluminum hydroxide gel is an antacid that neutralizes gastric HCl secretion. 15. Which medications relieve gastric ulcer pain through their effects on afferent pain fiber transmission? Select all that apply. Tofranil Bismuth Doxepin Misoprostol Pantoprazole Tofranil and doxepin are tricyclic antidepressants that provide overall pain relief through their effects on afferent pain fiber transmission. Bismuth is included in quadruple-drug therapy for the treatment of Helicobacter pylori ( H. pylori) infection. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin. Pantoprazole reduces hydrochloric acid secretion. 16. The nurse is caring for a patient with suspected posterior duodenal ulcer penetration of the pancreas. Which laboratory study would diagnose the patient’s condition? Liver enzyme studies Serum amylase determination Complete blood count (CBC) test Serum gastrin level determination Serum amylase determination is done to determine pancreatic function in a patient with suspected posterior duodenal ulcer penetration of the pancreas. Liver enzyme studies are performed to detect any liver problems that may complicate ulcer healing. A CBC test may indicate anemia secondary to ulcer bleeding. Serum gastrin levels are used to determine possible gastritis. 17. Which surgical procedure involves the removal of two thirds of the stomach and anastomosis of the gastric stump to the duodenum? Vagotomy Pyloroplasty Billroth I operation Billroth II operation A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum. 18. Which treatment is likely to be planned for a patient who develops pernicious anemia after a gastrectomy? Triple-drug therapy IV therapy Quadruple-drug therapy Cobalamin replacement therapy A patient who has undergone a gastrectomy may have a long-term complication of pernicious anemia due to the loss of intrinsic factor, which is produced by parietal cells. Cobalamin replacement therapy restores the intrinsic factor and halts vitamin B 12 deficiency that occurs due to pernicious anemia. Triple-drug and quadruple-drug therapy are administered for patients with long-term Helicobacter pylori ( H. pylori) infection. IV therapy is used when a nasogastric tube is connected to the suction. 19. Which enzyme activates the immune response to Helicobacter pylori with antibody production and the release of inflammatory cytokines? Pepsin Urease Bile salts Serum amylase Urease activates the immune response with body antibody production and the release of inflammatory cytokines, resulting in mucosal edema. Pepsin is an enzyme released in the stomach that degrades food particles into peptides. Bile salts are released by liver cells, which bind with cholestyramine and cause gastric irritation. Serum amylase levels determine pancreatic function. p. 905 20. Which manifestations of peptic ulcer disease generally occur first in an older adult? Select all that apply. Indigestion Abdominal pain Abdominal sounds Frank gastric bleeding Decrease in hematocrit Frank gastric bleeding and a decrease in hematocrit are often the first clinical manifestations of peptic ulcer disease in elderly patients. Indigestion and abdominal pain are the clinical manifestations of stomach cancer. Abdominal sounds are the clinical manifestations of dumping syndrome, a complication of peptic ulcer disease surgery. 21. Which diagnostic test is best suited to help identify gastric outlet obstruction? Endoscopy Urea breath test Rapid urease testing Barium contrast study A barium contrast study is used to diagnose gastric outlet obstruction in patients with peptic ulcer disease. An endoscopy is performed to determine the degree of ulcer healing after the treatment of ulcer. A urea breath test is a noninvasive method used to detect active infection. Rapid urease testing is used to check for a Helicobacter pylori infection. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. 22. A patient reports pain in the upper abdomen after eating. The health records indicate that the patient recent underwent pyloric valve surgery. Which medication would the nurse expect the health care provider will prescribe? Fluticasone Misoprostol Cholestyramine Isosorbide dinitrate Pain in the upper abdomen after eating is known as epigastric distress. It occurs due to reflux of bile into the stomach in patients who underwent gastric surgery involving the reconstruction or removal of the pylorus. Cholestyramine is a bile acid sequestrant that binds bile in the gastrointestinal tract to prevent its reabsorption. Fluticasone is a corticosteroid used to treat eosinophilic esophagitis. Misoprostol is used to treat gastric ulcers caused by nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin. Isosorbide dinitrate is used to treat dysphagia. 23. Which dietary instructions would the nurse provide to the caregiver of a postoperative patient who has dumping syndrome? Select all that apply. "Avoid giving cheese." "Avoid giving jelly and jam." "Give the patient eggs or meat." "Avoid giving fluids with meals." "Divide the meals into three feedings." Eggs and meat contain proteins and fat, which help to rebuild body tissues and meet energy demands. Distention and fullness of the stomach can occur if fluids are consumed along with meals. Cheese contains proteins and fats and should be provided to the patient. Jelly and jam cause diarrhea and dizziness; these foods should be avoided. The meals of the patient should be divided into six small feedings to avoid overloading the stomach and intestine during mealtimes. p. 915 24. A nurse is caring for a patient diagnosed with peptic ulcer disease. Which complication would result in gastric contents spilling into the patient’s peritoneal cavity? Perforation Hemorrhage Dumping syndrome Gastric outlet obstruction With perforation, the ulcer penetrates the stomach’s serosal surface and spillage of either gastric or duodenal contents into the peritoneal or duodenal cavity will occur. A hemorrhage is a complication that occurs due to the changes in the vital signs and an increase in the amount and redness of the aspirate, often signaling massive upper gastrointestinal (GI) bleeding. Dumping syndrome is the direct result of surgical removal of a large portion of a stomach and the pyloric sphincter. Gastric outlet obstruction is a peptic ulcer complication that occurs in a patient whose ulcer is close to the pylorus. 25. A patient with severe burns is admitted in an emergency department. Which condition would the nurse suspect as a high risk for this patient? Bile reflux gastritis Dumping syndrome Zollinger-Ellison syndrome Stress-related mucosal disease Stress-related mucosal disease, or physiologic stress ulcers, is a condition observed in patients with severe burns or trauma or major surgery. Patients with coagulopathy are at a high risk for stress-related mucosal disease. Bile reflux gastritis is a complication associated with gastric surgery in which bile is refluxed into the stomach. Dumping syndrome is a postoperative complication of gastrectomy that involves weakness, sweating, dizziness, and palpitations 15 to 30 minutes after eating. Zollinger-Ellison syndrome involves severe peptic ulceration and hydrochloric acid secretion. 26. Which instructions would the nurse give when teaching a patient about prevention of peptic ulcers? Select all that apply. Avoid smoking. Consume raw, uncooked food. Use nonsteroidal antiinflammatory drugs (NSAIDs) for treatment of pain. Wash hands thoroughly with soap after using the restroom and before eating. Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider. Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori ( H. pylori) infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore it should be avoided. NSAIDs should not be taken over a long period of time because they are a potent gastric irritant. pp. 905-906, 910 27. The nurse is caring for a patient with suspected stress-related mucosal disease (SRMD). Which medication would be administered to neutralize gastric acid? Ranitidine Amoxicillin Pantoprazole Aluminum hydroxide Aluminum hydroxide helps treat SRMD by decreasing basal acid secretions and secretions stimulated by histamine. Ranitidine is a histamine-receptor blocker, which can be concurrently used with antacids to treat duodenal ulcers. Amoxicillin is included in triple-drug therapy to treat Helicobacter pylori ( H. pylori) infection. Pantoprazole is a proton pump inhibitor used concurrently with antibiotics to treat H. pylori infection. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers. 28. A patient reports gastric distress that occurs two to five hours after meals, with "burning" and "cramping" pain just below the xiphoid process. Which disorder would the nurse suspect that the patient may have? Esophagitis Gastric ulcer Duodenal ulcer Chronic gastritis The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally two to five hours after a meal. The pain is described as "burning" or "cramplike." It is most often located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis. A patient with a gastric ulcer will experience pain one to two hours after meals. 29. Following a gastrectomy performed for peptic ulcer disease, the patient is ready for discharge. Which instructions would the nurse include in discharge teaching? Take fluids along with meals. Reduce protein and fats in the diet. Divide meals into six small feedings. Use concentrated sweets like honey, jam, and jelly. To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distention or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs. 30. Which characteristic of pain is a patient with a duodenal ulcer likely to report? Cramping quality Aggravated by food Lower abdominal location Occurs immediately after eating The pain related to a duodenal ulcer is cramplike and appears two to five hours after a meal. The pain is located in the midepigastric region beneath the xiphoid process. The pain is relieved by food intake. pp. 905-906 31. Which procedure involves severing a nerve for a patient with a peptic ulcer that is unresponsive to medical management? Billroth I Billroth II Vagotomy Pyloroplasty A vagotomy is the severing of the vagus nerve either totally (truncal) or selectively (highly selective vagotomy). These procedures are done to decrease gastric acid secretion. Billroth I involves a partial gastrectomy with the removal of two thirds of the stomach and the anastomosis of the gastric stump to the duodenum. Billroth II is partial gastrectomy with the removal of two thirds of the stomach and the anastomosis of the gastric stump to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate easy passage of contents from the stomach. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer. 32. Which symptom would the nurse expect in a patient who has a gastric ulcer perforation? Pyrosis Rigid abdomen Bright-red emesis Clay-colored stools Perforation results in spillage of gastric or duodenal contents into the upper peritoneal cavity. The patient experiences sudden upper abdominal pain because the spillage causes irritation of pain receptors in the visceral and parietal layers of the peritoneum. The body then attempts to protect the area by contracting the abdominal muscles, resulting in a rigid, board-like abdomen. Pyrosis, a painful and burning sensation in the esophagus, just below the breastbone, is usually associated with regurgitation of gastric acid, also known as heartburn. Bright-red emesis may be present as a result of hemorrhage from the gastric ulcer but is not as common as the rigid, board-like abdomen. Clay-colored stools are associated with hepatic disease, such as hepatitis, not gastric ulcer perforation. p. 909 33. A patient is being discharged after receiving a diagnosis of a duodenal ulcer. Which patient statements would indicate good understanding of the nurse’s discharge teaching? Select all that apply. "I should really drink less coffee." "I will take my medications only when I’m having stomach pain." "Black, tarry stools are to be expected and are not a cause for concern." "Drinking milk will decrease the amount of acid my stomach produces." "I won’t change brands of over-the-counter (OTC) antacids without first talking to my health care provider." "This is the excuse I needed to quit smoking. Then my ulcer will heal faster." Coffee is known to be acidic and further increases hydrochloric acid production in the stomach, irritating the mucosal layer. Antacids, even if they are OTC, can have serious interactions with other drugs that may decrease absorption of the medications, making it essential that the health care provider be aware of and approve any changes to regimen. Continued smoking increases healing times in duodenal ulcers. Medication should always be taken as prescribed by the provider, as taking them intermittently increases incidence of relapse. A common home remedy for relief of ulcer pain is to drink milk, which actually increases acid production in the stomach. Black, tarry stools are not a normal finding and should therefore be reported to the health care provider. 34. The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point would the nurse provide to the patient? "You'll need to drink at least two to three glasses of milk daily." "It would likely be beneficial for you to eliminate drinking alcohol." "Many people find that a minced or pureed diet eases their symptoms of PUD." "Medications will allow you to maintain your present diet while minimizing symptoms." Alcohol increases the amount of stomach acid produced, so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. 35. Which complication would the nurse suspect due to a patient’s loss of intrinsic factor after gastrectomy? Bile reflux gastritis Pernicious anemia Dumping syndrome Postprandial hypoglycemia Pernicious anemia is a complication that occurs in a patient after undergoing a partial gastrectomy. It occurs due to loss of intrinsic factor, which is required to produce vitamin B 12. Bile reflux gastritis occurs as a complication of gastric surgery of the pylorus. Dumping syndrome occurs as a complication after surgical removal of the stomach and pylorus. Postprandial hypoglycemia is a variant of dumping syndrome that occurs due to uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine.