Nursing Discharge Teaching on Peptic Ulcer Disease

Questions and Answers

What should the nurse assess after noticing one leg is pale and cooler to the touch?

Palpate the client's pedal pulses bilaterally.

Which statement indicates that the client understands the management of their sliding hiatal hernia? (Select all that apply)

I will have my blood count done in 2 weeks to check for anemia.

I will remain upright for several hours after each meal. (correct)

I will lie flat for 30 minutes after each meal.

I will sleep at night while lying on my left side to prevent reflux.

Which statement about carcinogenesis is accurate? (Select all that apply)

Tumor cells need to develop their own blood supply. (correct)

Cancer becomes a health problem once it's 1 cm in size.

An initiated cell will always become clinical cancer.

Normal hormones and proteins do not promote cancer growth.

What action should the nurse take upon reviewing a urine osmolality of 1200 mOsm/L?

Encourage the client to drink more fluids. Signup and view all the answers

What assessment finding would the nurse expect in a client with chronic pyelonephritis? (Select all that apply)

Hypertension Signup and view all the answers

What drug therapy is expected for a client with acute glomerulonephritis caused by beta streptococcus?

Antibiotics Signup and view all the answers

Which instruction should the nurse provide to a client who just completed an upper GI radiographic series with oral barium contrast?

Drink plenty of fluids over the next few days. Signup and view all the answers

What is the first action for a postoperative client who has become very restless one hour after admission to the PACU?

Assess the oxygen saturation level Signup and view all the answers

Which statement will the nurse include when teaching a client being discharged with a PICC line?

Avoid carrying your grandchild with the arm that has the central catheter. Signup and view all the answers

Which indication shows that the assistive personnel needs additional teaching regarding incontinence care?

Changing the client's incontinence brief when wet Signup and view all the answers

What skin change should the nurse monitor for in an African American client with peripheral arterial disease?

Cyanosis of the nail beds Signup and view all the answers

Which client will the nurse assess first for potential hyponatremia?

A 34-year-old who is NPO and receiving rapid intravenous D5W infusions Signup and view all the answers

What methodology is likely to be most effective in meeting a client's teaching/learning needs preoperatively?

Teaching the client and family Signup and view all the answers

What statement indicates the need for additional teaching regarding dietary changes to reduce cancer risk?

I'm so glad I don't have to give up my juicy steaks. Signup and view all the answers

What is the primary goal of preventing the entry of foreign material?

Providing maximum protection against infection Signup and view all the answers

What instruction will the nurse provide to a client at risk for venous thromboembolism on low-molecular-weight heparin?

Notify your health care provider if your stools appear tarry. Signup and view all the answers

When a client is transferred to the postanesthesia care unit (PACU), which action does the receiving nurse perform first?

Participate in a hand-off report Signup and view all the answers

What is the nurse's priority action after a client undergoes surgical repair of a fractured ankle?

Assess a full set of vital signs Signup and view all the answers

What response by the nurse best addresses why older clients are at higher risk for infection despite normal white cell counts?

White blood cells are less active in older people so they are not as efficient. Signup and view all the answers

Which medication does the nurse anticipate teaching a client prescribed for severe GERD?

Omeprazole (Prilosec) Signup and view all the answers

When a client asks if eating only preservative- and dye-free foods will decrease cancer risk, what is the nurse's best response?

Maybe; preservatives, dyes, and preparation methods may be risk factors. Signup and view all the answers

What is the most important action by the nurse for a client receiving chemotherapy through a peripheral IV line?

Assessing the IV site and blood return every hour Signup and view all the answers

Which nursing intervention does the nurse include in the plan of care for a client who has hemorrhoids?

Encourage the client to dab with moist wipes instead of wiping with toilet paper Signup and view all the answers

Which age-related change increases an older client's susceptibility to infection during chemotherapy?

Decreased immune function Signup and view all the answers

What conclusion does the nurse draw from the assessment of a bulge in a client's groin that disappears when lying down?

Reducible inguinal hernia Signup and view all the answers

Which assessment finding would alert the nurse to immediately contact the primary health provider for a client with polycystic kidney disease?

Periorbital edema Signup and view all the answers

What assessment finding requires immediate intervention from the nurse caring for a client receiving an epidural infusion for pain management?

Report of headache and stiff neck Signup and view all the answers

Which foods should a nurse encourage a vegan client with B12 deficiency to include in their diet?

Fortified cereals and tofu Signup and view all the answers

How does the nurse document a client's appendectomy incision that appears to be healing with no drainage?

Primary intention Signup and view all the answers

Which finding leads the nurse to suspect appendicitis during an abdominal assessment?

Severe, steady RLQ pain Signup and view all the answers

Which preoperative assessment finding should the nurse report to the surgeon for treatment?

Potassium level of 3.0 mEq/L Signup and view all the answers

What is the most important action for preventing infections in an older client?

Assessing vaccination records for booster shot needs Signup and view all the answers

Which preoperative assessment finding should be reported to the surgeon?

Having a sore throat Signup and view all the answers

If a client has a bluish tinge to the palms, soles, and conjunctivae, what should the nurse do next?

Assess pulse oximetry Signup and view all the answers

What action should the nurse take after noting both legs are pale pink, warm, and dry in a client on a continuous femoral nerve blockade?

Notify the surgeon or anesthesia provider immediately. Signup and view all the answers

Which drug does the nurse plan health teaching for a newly diagnosed client with osteoarthritis?

Acetaminophen Signup and view all the answers

When a client has been taking naproxen (Naprosyn) for several months, which assessment question is important for the nurse to ask?

Have you had any stomach pain or indigestion? Signup and view all the answers

What is the best response when a postmenopausal patient with recurrent bacterial urethritis asks why it is happening now?

Low estrogen levels can make the tissue more susceptible to infection. Signup and view all the answers

When assessing a client with glioblastoma, what assessment is most important?

Neurological examination Signup and view all the answers

Which assessment finding leads the nurse to check for an acquired umbilical hernia?

BMI of 41.9 Signup and view all the answers

What action should the nurse take upon reviewing a client's urinalysis with glucose present?

Perform a finger stick blood glucose assessment Signup and view all the answers

What does the term 'apoptosis' mean?

Programmed cell death Signup and view all the answers

Which type of immunity is the longest acting?

Natural active Signup and view all the answers

Which client should the nurse assess most carefully for the development of gastroesophageal reflux disease (GERD)?

Postoperative client who has a nasogastric (NG) tube Signup and view all the answers

What is the single biggest risk factor for developing cancer?

Advancing age Signup and view all the answers

When having difficulty withdrawing fluid from a client's NG tube, what is the nurse's priority action?

Obtain orders for a chest x-ray to confirm placement before starting the feeding Signup and view all the answers

During an assessment for a client with right lower quadrant abdominal pain, which lab value should the nurse prioritize?

White blood cell count, 22,000/mm3 Signup and view all the answers

When caring for a female client who is 5'7" and weighs 115 pounds, what should the nurse advise?

No. In fact, your BMI suggests that you are underweight. Signup and view all the answers

What priority instruction should the nurse include for a client with chronic venous stasis ulcers?

Apply antiembolism stockings before getting out of bed in the morning. Signup and view all the answers

What common assessment finding is associated with bladder cancer?

Painless hematuria Signup and view all the answers

After teaching a client about dehydration rehydration, which statement indicates understanding?

I will weigh myself each morning before I eat or drink. Signup and view all the answers

What is the proper sequence of palpation during an abdominal assessment for a client with suspected cholecystitis?

Palpate the upper quadrants last Signup and view all the answers

Which action demonstrates understanding of the purpose of the Rapid Response Team?

Notifying the physician of the client's change in blood pressure from 140 to 88 mm Hg systolic Signup and view all the answers

When caring for an older adult client admitted with a fractured hip who is confused and tachypneic, what should the nurse's first action be?

Administer oxygen via nasal cannula Signup and view all the answers

Upon auscultating the abdomen of a client who has just returned from abdominal surgery, what is the nurse's best action if no bowel sounds are heard?

Document the finding Signup and view all the answers

Which results from a client's urinalysis would the nurse recognize as abnormal?

Ketone bodies present Signup and view all the answers

What statement by a client prescribed acetaminophen indicates a need for further teaching?

I won't take more than 5000 mg of this drug each day. Signup and view all the answers

When assessing a client with hypokalemia who has diminished handgrip strength, what action should the nurse take first?

Assess the client's respiratory rate, rhythm, and depth Signup and view all the answers

Which statement by the client indicates that additional teaching is needed regarding H.pylori and peptic ulcer disease?

I will take my medication every day until my heartburn is gone. Signup and view all the answers

Which statement during the preoperative interview alerts the nurse to an increased risk during surgery?

I take a couple of aspirin every day for my headaches. Signup and view all the answers

For a client with a Stage II inflammatory response leg wound, which sign or symptom should the nurse assess?

Purulent drainage Signup and view all the answers

Which racial/ethnic group is at the greatest risk for kidney disease as they age?

African Americans Signup and view all the answers

What instruction is most important for an older client concerned about developing new age spots?

Monitor spots for color change. Signup and view all the answers

In the emergent care of a client with a pelvic fracture, which complication must the nurse be especially alert for?

Deep vein thrombosis Signup and view all the answers

How does being overweight contribute to reflux according to the nurse?

The weight adds extra pressure, which helps push stomach contents up. Signup and view all the answers

What response by the nurse is most appropriate for a client expressing frustration at ongoing fatigue after radiation therapy?

It is normal to be fatigued even for months afterward. Signup and view all the answers

For a client with a crush injury reporting numbness and tingling, what should the nurse's first intervention be?

Assess pedal pulses Signup and view all the answers

What action is most appropriate for a client with a platelet count of 9800/mm3?

Instruct the client to call for help to get out of bed Signup and view all the answers

After an esophagogastroduodenoscopy (EGD), which action takes priority for the nurse?

Assess the client's gag reflex Signup and view all the answers

How should the nurse manage pain for an older client with multiple fractures?

Patient-controlled analgesia (PCA) pump with morphine Signup and view all the answers

Which client's statement indicates a need for additional teaching regarding hypertension secondary to renal disease?

If I have increased urination at night, I need to drink less fluid during the day. Signup and view all the answers

What action by the nurse is most important for a client with nausea, flank pain, and muscle cramps during chemotherapy?

Request an order for serum electrolytes and uric acid Signup and view all the answers

What is the nurse's priority action for an older client with Salmonella food poisoning?

Maintain IV fluids Signup and view all the answers

When a client is getting out of bed into a chair for the first time after a hip replacement, what action is appropriate for the nurse?

Have adequate help to transfer the client. Signup and view all the answers

What is the best intervention for a client with dehydration-induced confusion?

Assess the client further for fall risk Signup and view all the answers

What intervention should the nurse prepare for a client with peptic ulcer disease who vomits a large amount of undigested food?

Insert an NG tube to low intermittent suction Signup and view all the answers

For a client with a urine specific gravity of 1.040, what action would the nurse take?

Increase the client's fluid intake Signup and view all the answers

What is the nurse's most appropriate action for a client with a chronic, nonhealing ulcer potentially needing negative-pressure wound therapy?

Request the physician write an order to consult the wound care nurse Signup and view all the answers

What information does a nurse need to know when learning the difference between normal cells and benign tumor cells?

Growing in the wrong place or time is typical of benign tumors Signup and view all the answers

What action should the nurse take first after a client is brought to the postanesthesia care unit (PACU)?

Assess the client's levels of consciousness and pain Signup and view all the answers

What is the nurse's priority action for a client started on total parenteral nutrition (TPN) who reports blurred vision and frequent urination?

Assess the client's blood sugar Signup and view all the answers

During interprofessional rounds for a client with pneumonia and dementia, which question should the nurse ask the primary healthcare provider?

May we discontinue the indwelling catheter? Signup and view all the answers

For an older client with very thin skin on the backs of the hands and arms, what is the client's priority problem?

Risk for injury Signup and view all the answers

With a complete fracture of the left radius, how is the bone described?

Fractured through the entire bone Signup and view all the answers

After a central venous access line is inserted, what action will the nurse take next?

Ensure that an x-ray is completed to confirm placement Signup and view all the answers

Which statement by a client with stress incontinence indicates a need for further teaching?

I will limit my total intake of fluids. Signup and view all the answers

For a nurse assigned to a client receiving iodine-131 treatment, which action is best?

Read the policy on handling radioactive excreta. Signup and view all the answers

Which assessment finding is of greatest concern for a client with an intraosseous catheter placed in the left leg?

The client's left lower extremity is cool to the touch Signup and view all the answers

Which adult is at greatest risk for insensible water loss?

Anxious client who has tachypnea Signup and view all the answers

What action by the nurse takes priority when caring for clients with alopecia from chemotherapy?

Teaching measures to prevent scalp injury Signup and view all the answers

Which assessment will the nurse complete first for a client with a radial artery catheter?

Skin color and capillary refill Signup and view all the answers

Which statement by a client with early polycystic kidney disease (PKD) indicates correct understanding of nutritional therapy?

I must increase my intake of dietary fiber and fluids. Signup and view all the answers

How should the nurse respond to a client who feels embarrassed discussing symptoms of pyelonephritis?

Take your time. It is okay to use words that are familiar to you. Signup and view all the answers

Which laboratory finding indicates that a client with malnutrition is not receiving adequate iron supplementation?

Hematocrit, 31% Signup and view all the answers

What condition has developed in a client two days post-accident with fractures who exhibits confusion and dyspnea?

Fat embolism Signup and view all the answers

What is the appropriate recommendation for a client with rheumatoid arthritis who wants to continue quilting?

Try a paraffin wax dip 20 minutes before you quilt. Signup and view all the answers

Which action by the nurse shows an understanding of the principle of self-determination?

Allowing a postoperative client to decide to take medication with fruit juice rather than water Signup and view all the answers

What is the nurse's priority action for a client admitted to the ED with upper GI bleeding?

Ensure the client has a patent airway Signup and view all the answers

Which action by the nurse is most appropriate when changing a dressing over a client's abdominal surgical incision?

Apply dressing using aseptic or sterile technique Signup and view all the answers

What does thin, pink-colored drainage from a client's dressing indicate?

Serosanguineous Signup and view all the answers

Study Notes

Discharge Teaching for Peptic Ulcer Disease

Client erroneously thinks treating heartburn means stopping medication.
Correct understanding requires consistent medication use regardless of symptoms.

Preoperative Risk Assessment

Daily aspirin use increases surgical complication risks.
Other factors, such as dietary habits or past smoking, present lower risks.

Inflammatory Response Stage II

Important to identify purulent drainage as a key symptom.

Racial/Ethnic Risk for Kidney Disease

African Americans face the highest risk of developing kidney-related issues.

Age Spots in Older Adults

Monitoring for color changes in spots is crucial for early detection of skin issues.

Complications in Emergent Pelvic Fracture Care

Be alert for deep vein thrombosis, a common complication post-fracture.

Obesity and Reflux

Excess weight contributes excess pressure on the stomach, leading to reflux.

Fatigue Post-Radiation Therapy

It is normal for cancer patients to experience prolonged fatigue after treatment.

Crush Injury Assessment

Initial intervention involves checking pedal pulses to assess blood flow.

Low Platelet Count Management

Clients with extremely low platelet counts should be instructed to seek assistance for mobility.

Prioritizing Post-Procedure Care

Assess the gag reflex first after an EGD to ensure safe recovery.

Pain Management in Older Adults

Patient-controlled analgesia (PCA) is preferred for managing pain effectively.

Hypertension and Fluid Intake

Clients should not restrict fluids if experiencing increased urination; this needs further education.

Chemotherapy Side Effects

Monitor serum electrolytes when clients report nausea and other systemic symptoms.

Salmonella Food Poisoning Care

Maintaining IV fluids is essential to prevent dehydration.

Post Hip Replacement Mobility

Ensure adequate assistance for client transfers after hip replacement surgery.

Dehydration and Confusion in Older Adults

Assess fall risk for confused clients potentially due to dehydration.

Management of Peptic Ulcer Symptoms

In cases of vomiting undigested food, inserting an NG tube may be necessary.

Urine Specific Gravity and Hydration

Urgent need to increase fluid intake for clients with a high urine specific gravity.

Negative-Pressure Wound Therapy

Consultation with a wound care nurse is indicated for clients with chronic ulcers.

Benign Tumors Characteristics

Benign tumors often grow inappropriately, unlike normal cells which respect tissue boundaries.

Post-Anesthesia Care Unit Monitoring

Early actions should focus on increasing IV fluids to support the recovering patient.

Total Parenteral Nutrition Complications

Assess blood sugar levels regularly in clients on TPN to monitor for potential hyperglycemia.

Urinary Catheter Management

Discuss with healthcare provider the possibility of removing unnecessary indwelling catheters.

Skin Care in Older Adults

Risk for injury is priority due to thin skin; extra care must be taken to prevent falls.

Assessment of Fractures

A complete fracture indicates the bone is broken through its entire structure.

Central Venous Access Line Follow-Up

Ensure confirmation of catheter placement via X-ray post-insertion.

Stress Incontinence Teaching

Limiting total fluid intake is misleading; appropriate education should emphasize balanced hydration.

Iodine-131 Treatment Protocols

Familiarize with handling radioactive waste to ensure safety in caring for treated clients.

Assessing Catheter Sites

Coolness in the extremity suggests possible complications and requires immediate further assessment.

Insensible Water Loss Risk Factors

Anxious clients displaying tachypnea are most prone to insensible fluid loss and require monitoring.

Alopecia Nursing Priority

Educate clients on scalp protection to prevent further injury during chemotherapy.

Radial Artery Catheter Evaluation

Skin color and capillary refill assessments should be prioritized to monitor circulation status.

Nutritional Guidance for Polycystic Kidney Disease

Increase in dietary fiber and fluid intake is vital for managing symptoms effectively.

Communication with Clients about Symptoms

Foster an open dialogue, allowing clients to express discomfort surrounding sensitive topics.

Laboratory Values and Malnutrition

A hematocrit of 31% indicates inadequate iron supplementation in malnourished clients.

Post-Injury Complications

High fever and confusion two days post-accident may indicate fat embolism as an urgent complication.

Managing Chronic Conditions

Applying paraffin wax dips before activities helps alleviate arthritis pain for clients.

Self-Determination in Patient Care

Allowing patients to make minor clinical choices respects their autonomy in healthcare.

Upper GI Bleeding Priority Actions

Ensuring the airway is patent is the immediate priority when dealing with upper GI bleeding.

Dressing Change Best Practices

Use strict aseptic technique while changing dressings to prevent infections.

Surgical Drainage Color Assessment

Documenting thin, pink drainage as serosanguineous indicates normal postoperative function.

Inflammation and Immunity Function

The primary goal of inflammation and immunity is to provide maximum protection against infections.

Instruction for Low-Molecular-Weight Heparin Patients

Awareness of symptoms such as tarry stools is crucial for clients on low-molecular-weight heparin therapy.

Post-Anesthesia Care Unit Procedures

Prioritize participating in hand-off reports for continuity of care in nursing shifts.

Post-Surgical Vital Signs Assessment

Conduct a thorough assessment of vital signs immediately after patient transfer from PACU.

Infection Risks in Older Adults

Normal white cell counts can be misleading; older adults may have decreased immune response despite normal results.### Immunology and Aging
Immunoglobulin production declines with age, affecting response to illness.
Older adults experience a reduction in white blood cell activity, leading to decreased efficiency in immune responses.

Gastroesophageal Reflux Disease (GERD)

Omeprazole (Prilosec) is a medication frequently used to treat severe GERD.
Lifestyle choices, such as diet, may influence cancer risk; preservatives and dyes could be factors.

Chemotherapy and Patient Care

Regular assessment of IV sites for blood return is crucial for patients receiving chemotherapy.
Patients receiving treatment should be educated about potential side effects and encouraged to report symptoms.

Hemorrhoid Self-Care

Moist wipes are recommended over traditional toilet paper to minimize irritation in hemorrhoid care.

Oncology and Infections

Decreased immune function in older adults heightens susceptibility to infections during chemotherapy.

Hernia Assessment

A bulge that appears when standing but disappears when lying down indicates a reducible inguinal hernia.

Polycystic Kidney Disease (PKD)

Periorbital edema in patients with PKD warrants immediate medical attention.

Epidural Infusion Monitoring

Reports of headache and stiff neck necessitate prompt intervention in patients receiving an epidural.

Nutritional Guidance for B12 Deficiency

Recommended dietary inclusions for vegetarians with B12 deficiency include fortified cereals and tofu.

Wound Healing

An incision that is approximated with no drainage is healing by primary intention.

Appendicitis Signs

Severe, steady right lower quadrant (RLQ) pain is a key indicator of appendicitis.

Preoperative Concerns

A potassium level of 3.0 mEq/L should be reported to the surgeon due to potential complications.

Infection Prevention in Older Adults

Reviewing vaccination records is essential for preventing infections in older clients.

Sore Throat Reporting

A sore throat should be reported during preoperative assessments for potential complications.

Cyanosis Assessment

In clients with a bluish tinge to palms and conjunctivae, pulse oximetry should be assessed immediately.

Postoperative Nerve Block Assessment

Lack of movement in a surgical foot with normal skin temperature calls for immediate surgical consultation.

Osteoarthritis Education

Health teaching for osteoarthritis often includes acetaminophen as a management option.

Long-term Effects of Naproxen

Assessing for stomach pain or indigestion is critical after prolonged use of naproxen.

Urinary Tract Infections in Postmenopausal Women

Low estrogen can increase susceptibility to urinary infections in postmenopausal clients.

Neurological Assessments in Glioblastoma

A comprehensive neurological examination is of utmost importance in assessing patients with glioblastoma.

Umbilical Hernia

A high BMI is a common indicator prompting investigation for umbilical hernia.

Urinalysis Findings

Presence of glucose in urinalysis requires immediate blood glucose assessment.

Apoptosis Definition

Apoptosis refers to programmed cell death, a vital process in cellular regulation.

Types of Immunity

Natural active immunity is characterized as the longest-lasting type of immunity.

Risk Factors for GERD

Postoperative patients with nasogastric tubes are at a higher risk for developing GERD.

Major Cancer Risk Factor

Advancing age is identified as the single biggest risk factor for developing cancer.

NG Tube Precautions

If an NG tube cannot withdraw fluid, confirming placement with a chest X-ray is the priority.

Abdominal Pain Assessment

Elevated white blood cell count is a critical finding requiring immediate provider contact in cases of abdominal pain.

BMI and Weight Management

A BMI indicating underweight status should prompt reassurance rather than recommendations for weight loss.

Chronic Venous Stasis Ulcers

Education should emphasize the importance of applying compression stockings to combat venous insufficiency.

Bladder Cancer Symptoms

Painless hematuria is a common symptoms associated with bladder cancer.

Fluid Management Post-Dehydration

Clients recovering from dehydration should weigh themselves daily for accurate monitoring of hydration status.

Cholecystitis Assessment

Abdominal palpation should be conducted with careful attention to the upper quadrants last.

Rapid Response Team

Notifying medical personnel of significant changes, such as a drastic drop in blood pressure, exemplifies the purpose of Rapid Response Teams.

Restlessness in PACU

Assessing oxygen saturation levels is the first step in addressing patient restlessness in the post-anesthesia care unit.

PICC Line Care

Clients should avoid heavy lifting or carrying objects with the arm where a central catheter is located.

Incontinence Management Training

Assisting personnel should be guided on effective habits to manage incontinence, ensuring proper scheduling for toileting.### Client Care and Monitoring
Encourage adequate fluid intake to prevent dehydration and promote health.
Document occurrences of incontinence to assess patterns and interventions needed.
Change incontinence briefs promptly when wet to maintain skin integrity and comfort.

Skin Assessment in Peripheral Arterial Disease

Monitor for skin changes such as cyanosis, particularly in the nail beds, indicating compromised circulation.
Assess for other signs like pitting edema or loss of toenails, though these may not be as significant in PAD.

Assessing for Hyponatremia

Prioritize assessment of clients at higher risk for hyponatremia, such as a 34-year-old NPO patient receiving rapid IV D5W infusions.
Consider fluid and electrolyte imbalances as critical factors in patient care, especially in those undergoing significant medical interventions.

Teaching and Learning Needs

Optimize patient education by involving both the client and their family in the teaching process to ensure comprehensive understanding.
Use a variety of teaching methods rather than relying exclusively on verbal or written instructions for better retention.

Dietary Guidance for Cancer Prevention

Clients should understand the importance of incorporating foods high in vitamins A and C while minimizing high-fat and processed meats.
Look for indicators of misunderstanding dietary recommendations, such as excessive enthusiasm for high-fat meats like steak, which may need further discussion on cancer risks.
Emphasize consumption of vegetables, fruits, and high-fiber grains, highlighting their role in reducing cancer risk.

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Description

This quiz assesses understanding of discharge teaching for clients with peptic ulcer disease related to H.pylori infections. It focuses on the correct patient responses and indicates when additional education is needed. Test your knowledge of effective patient education regarding dietary and medication adherence.