PUD Quiz 1

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Questions and Answers

Which of the following is the most common infectious cause of peptic ulcer disease (PUD)?

  • Streptococcus pneumoniae
  • Escherichia coli
  • Clostridium difficile
  • Helicobacter pylori (correct)

Which of the following best explains how NSAIDs contribute to peptic ulcer formation?

  • They cause autoimmune destruction of the mucosal lining.
  • They increase gastric acid production.
  • They inhibit prostaglandin synthesis that protects the mucosa. (correct)
  • They directly infect gastric tissues.

Which of the following are risk factors for developing PUD? (Select all that apply)

  • High-fiber diet
  • NSAID use (correct)
  • Smoking (correct)
  • Crohn’s disease (correct)
  • Stress (correct)

A patient with COPD presents with epigastric pain. Which of the following should the nurse consider?

<p>PUD should be ruled out due to altered gastric secretions. (B)</p> Signup and view all the answers

Which population is more likely to experience gastric ulcers?

<p>Older adults (A)</p> Signup and view all the answers

What is the route of transmission for H. pylori?

<p>Oral–oral or fecal–oral (B)</p> Signup and view all the answers

A nurse is assessing a patient who smokes, takes ibuprofen daily, and has a history of Crohn’s disease. Which factor is least modifiable in preventing PUD?

<p>Crohn’s disease (C)</p> Signup and view all the answers

Which conditions can increase the risk of PUD by altering gastric secretion? (Select all that apply)

<p>Crohn’s disease (B), Cancer (D), COPD (E)</p> Signup and view all the answers

Which of the following symptoms is most commonly associated with a duodenal ulcer?

<p>Pain relieved by eating (C)</p> Signup and view all the answers

Which of the following descriptions best characterizes the pain of a gastric ulcer?

<p>Begins 1–2 hours after eating and is not relieved by food (C)</p> Signup and view all the answers

A nurse is assessing a patient with suspected PUD. Which of the following symptoms would support this diagnosis? (Select all that apply)

<p>Belching (A), Anemia (B), Melena (C), Bloating (D)</p> Signup and view all the answers

A patient with PUD reports black, tarry stools. What is the most appropriate nursing action?

<p>Notify the provider immediately. (B)</p> Signup and view all the answers

Which of the following terms refers to black, tarry stools seen in patients with GI bleeding?

<p>Melena (A)</p> Signup and view all the answers

During morning rounds, a nurse finds a patient with PUD pale and fatigued. Vital signs show BP 90/60, HR 110. What is the priority concern?

<p>GI bleeding (C)</p> Signup and view all the answers

Which symptoms help differentiate duodenal ulcers from gastric ulcers? (Select all that apply)

<p>Duodenal ulcers are relieved by food (A), Gastric ulcers have pain shortly after eating (D), Duodenal ulcers are more painful at night (E)</p> Signup and view all the answers

A patient presents with fatigue, bloating, and a positive fecal occult blood test. Which of the following is the most likely explanation?

<p>Peptic ulcer with bleeding (A)</p> Signup and view all the answers

The nurse reviews a client’s lab results and finds low hemoglobin and hematocrit levels. The client also reports mild abdominal discomfort. What should the nurse suspect?

<p>PUD with chronic bleeding (A)</p> Signup and view all the answers

Which class of drugs is commonly used to reduce gastric acid secretion in PUD?

<p>Proton pump inhibitors (PPIs) (A)</p> Signup and view all the answers

What is the primary purpose of using a proton pump inhibitor in a patient with PUD?

<p>Decrease acid secretion (B)</p> Signup and view all the answers

A nurse is teaching a patient newly diagnosed with H. pylori–associated PUD. Which medications would likely be included in their regimen? (Select all that apply)

<p>Omeprazole (C), Clarithromycin (D), Amoxicillin (E)</p> Signup and view all the answers

Which of the following medications is used to coat and protect the ulcer site?

<p>Sucralfate (B)</p> Signup and view all the answers

A patient with PUD is prescribed sucralfate. What is the most appropriate instruction regarding its administration?

<p>Take on an empty stomach 1 hour before meals (D)</p> Signup and view all the answers

What is the action of H2 receptor antagonists like famotidine in treating PUD?

<p>Block histamine-induced acid secretion (B)</p> Signup and view all the answers

A nurse is reviewing a patient’s medication list. Which of the following drugs should be avoided in a patient with a history of PUD?

<p>Naproxen (A)</p> Signup and view all the answers

A patient has been treated for H. pylori with triple therapy for two weeks. They now report continued pain. What is the nurse’s priority action?

<p>Notify provider for possible endoscopy (C)</p> Signup and view all the answers

A nurse is teaching a patient taking omeprazole. Which of the following should the nurse include in the teaching?

<p>Take once daily before a meal (A)</p> Signup and view all the answers

A nurse is monitoring a patient taking long-term PPIs. Which complications or side effects should be considered? (Select all that apply)

<p>Increased risk of fractures (A), Clostridioides difficile infection (D), Vitamin B12 deficiency (E)</p> Signup and view all the answers

What is the most common complication of peptic ulcer disease?

<p>Hemorrhage (A)</p> Signup and view all the answers

Which symptoms are most indicative of a bleeding peptic ulcer?

<p>Tachycardia and melena (D)</p> Signup and view all the answers

A nurse suspects a patient is experiencing a GI hemorrhage from a peptic ulcer. Which assessment findings would support this? (Select all that apply)

<p>Coffee ground emesis (A), Decreased hemoglobin (D), Hypotension (E)</p> Signup and view all the answers

A patient with known PUD suddenly reports intense abdominal pain, a rigid abdomen, and absent bowel sounds. What is the nurse’s priority action?

<p>Notify the provider immediately (A)</p> Signup and view all the answers

Which patient statement best indicates understanding of hemorrhage risk from PUD?

<p>Black stools can mean bleeding, and I should call my doctor. (A)</p> Signup and view all the answers

Which lab result supports the diagnosis of an active GI bleed in a patient with PUD?

<p>Hgb 7.9 g/dL (C)</p> Signup and view all the answers

What is the most lethal complication of peptic ulcer disease?

<p>Perforation (A)</p> Signup and view all the answers

A nurse is assessing a patient for a possible gastric outlet obstruction due to PUD. Which symptoms would support this complication? (Select all that apply)

<p>Electrolyte imbalances (A), Nausea and vomiting (B), Sensation of epigastric fullness (C)</p> Signup and view all the answers

A patient with PUD has a distended abdomen, absent bowel sounds, and low blood pressure. What is the likely complication?

<p>Ulcer perforation with peritonitis (D)</p> Signup and view all the answers

Which of the following are peritoneal signs indicating ulcer perforation?

<p>Guarding, rigidity, rebound tenderness (C)</p> Signup and view all the answers

Which of the following is a classic sign of peritonitis from ulcer perforation?

<p>Sudden, severe upper abdominal pain with a rigid abdomen (C)</p> Signup and view all the answers

A nurse is assessing a patient with suspected ulcer perforation. Which signs support the presence of peritoneal irritation?

<p>Rebound tenderness and muscle guarding (C)</p> Signup and view all the answers

Which clinical signs would indicate a progression from PUD to peritonitis? (Select all that apply)

<p>Hypotension (A), Rapid and weak pulse (C), Abdominal distension (D), Shallow, rapid respirations (E)</p> Signup and view all the answers

A client with suspected perforation is awaiting surgery. What is the nurse’s priority intervention?

<p>Keep NPO and administer prescribed IV fluids (B)</p> Signup and view all the answers

A patient with suspected PUD undergoes an EGD (esophagogastroduodenoscopy). What is the nurse's priority post-procedure assessment?

<p>Gag reflex (B)</p> Signup and view all the answers

Which diagnostic test confirms H. pylori infection by detecting its byproducts in exhaled air?

<p>C-urea breath test (C)</p> Signup and view all the answers

A patient with PUD asks how to prevent future complications. Which statement indicates a need for further education?

<p>If I feel bloated or full, I’ll just lie down and ignore it. (A)</p> Signup and view all the answers

Which nursing interventions help prevent peptic ulcer recurrence? (Select all that apply)

<p>Promoting stress reduction strategies (A), Encouraging smoking cessation (B), Instructing adherence to prescribed medications (D), Teaching to avoid aspirin/NSAIDs (E)</p> Signup and view all the answers

Flashcards

Common cause of PUD

H. pylori is the most common infectious cause of PUD, responsible for 80–90% of cases. It damages the mucosal barrier through enzymatic action.

NSAIDs contribution to PUD

NSAIDs inhibit prostaglandins that maintain mucosal integrity, increasing the risk for ulcers.

Risk factors for PUD

Smoking, stress, NSAID use, and diseases altering gastric secretions like Crohn's are all risk factors.

COPD and PUD

COPD alters gastric secretion and is a risk factor for PUD.

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Older adults and gastric ulcers

Gastric ulcers are more common in older adults, partly due to increased NSAID use and reduced mucosal protection.

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H. pylori transmission

H. pylori spreads via oral–oral or fecal-oral routes, making hygiene practices crucial in prevention.

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Duodenal ulcer symptom

Duodenal ulcer pain typically occurs 2–4 hours after eating and is relieved by food.

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Gastric ulcer symptom

Gastric ulcer pain starts 1–2 hours after meals and is typically not relieved by eating

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Melena indicates...

Black, tarry stools (melena) indicate GI bleeding, a potential complication. Immediate notification is necessary.

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What is melena?

Melena is the term for black, tarry stools caused by digested blood in the GI tract.

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PUD bleeding signs

Hypotension and tachycardia, along with pallor and fatigue, suggest active GI bleeding, a critical complication.

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Difference in ulcer pain

Duodenal ulcer pain tends to occur at night or several hours after eating and is relieved by food, while gastric ulcer pain occurs sooner after eating and is not relieved.

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PPIs reduce...

PPIs (e.g., omeprazole) significantly reduce gastric acid production, promoting ulcer healing.

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PPIs treat PUD

PPIs decrease the secretion of hydrochloric acid in the stomach, helping the ulcer to heal and preventing further damage.

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H. pylori treatment

Triple therapy for H. pylori typically includes two antibiotics (e.g., amoxicillin, clarithromycin) and a PPI like omeprazole

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Sucralfate action

Sucralfate forms a protective barrier over ulcers, especially in the stomach and duodenum, aiding healing.

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When to take sucralfate

Sucralfate should be taken on an empty stomach to bind effectively to ulcerated tissue and protect it from acid exposure.

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How H2 blockers treat PUD

H2 blockers reduce acid production by blocking histamine receptors on gastric parietal cells.

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Avoid which med?

NSAIDs like naproxen increase the risk of mucosal damage and should be avoided in patients with PUD.

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Pain after treatment

Persistent pain after treatment may indicate ulcer complications (e.g., perforation or malignancy). Further diagnostic evaluation (e.g., EGD) is warranted.

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PPI timing

PPIs like omeprazole are best taken 30 minutes before meals to maximize acid suppression.

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Long term PPI risks

Long-term PPI use is associated with decreased calcium absorption (fractures), B12 malabsorption, and increased infection risk (e.g., C. diff).

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PUD Complications

Hemorrhage is the most frequent complication of PUD and can be life-threatening if not addressed promptly.

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Suspect bleeding

Tachycardia and melena (black tarry stools) suggest GI bleeding, especially in patients with known PUD.

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Perforation causes...

Perforation causes peritoneal inflammation, resulting in sudden pain, board-like abdomen, and rigidity.

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Study Notes

Risk Factors for Peptic Ulcer Disease (PUD)

  • Helicobacter pylori (H. pylori) is the main infectious cause of PUD, responsible for 80-90% of cases
  • H. pylori damages the mucosal barrier through enzymatic action.
  • NSAIDs contributes to peptic ulcer formation by inhibiting prostaglandin synthesis, which protects the mucosa.
  • Risk factors for developing PUD include:
    • Smoking
    • Stress
    • NSAID use
    • Crohn's disease.
  • COPD alters gastric secretion and is a risk factor for PUD.
  • Older adults are more likely to experience gastric ulcers due to increased NSAID use and reduced mucosal protection.
  • H. pylori spreads via oral-oral or fecal-oral routes, practicing proper hygiene is important for prevention.
  • When assessing a patient at risk of PUD, Crohn's disease is the least modifiable factor in preventing the disease.
  • Conditions that can increase the risk of PUD by altering gastric secretion:
    • Crohn's disease
    • Cancer
    • COPD

Signs and Symptoms of Peptic Ulcer Disease (PUD)

  • Pain relieved by eating is commonly associated with a duodenal ulcer
  • Duodenal ulcer pain typically occurs 2-4 hours after eating
  • Gastric ulcer pain starts 1-2 hours after meals and is not relieved by eating, unlike duodenal ulcers.
  • The following symptoms support a PUD diagnosis:
    • Bloating
    • Belching
    • Melena (black tarry stools)
    • Anemia
  • Melena indicates GI bleeding, which is a potential complication; immediate notification is necessary.
  • Melena is the term for black, tarry stools caused by digested blood in the GI tract.
  • Hypotension and tachycardia, along with pallor and fatigue signals GI bleeding
  • Duodenal ulcers are more painful at night, gastric ulcers have pain shortly after eating, additionally duodenal ulcers is relieved by food
  • Fatigue, bloating, and a positive fecal occult blood test are most likely due to a peptic ulcer with bleeding.
  • Low hemoglobin and hematocrit levels with abdominal discomfort suggest chronic blood loss likely from PUD.
  • Hemorrhage is the most frequent complication of PUD and is life-threatening if not addressed promptly.
  • Tachycardia and melena suggest GI bleeding, especially in patients with known PUD.
  • Assessment findings for GI hemorrhage from a peptic ulcer:
    • Hypotension
    • Decreased hemoglobin
    • Coffee ground emesis
  • Intense abdominal pain, a rigid abdomen, and absent bowel sounds indicates perforation/peritonitis, a surgical emergency where immediate intervention is required.
  • A patient's understanding of hemorrhage risk from PUD: "Black stools can mean bleeding, and I should call my doctor."
  • A hemoglobin level of 7.9 suggests significant blood loss, possibly due to ulcer hemorrhage.
  • Perforation can lead to peritonitis and sepsis, making it the highest threatening PUD complication.
  • Symptoms of gastric outlet obstruction due to PUD:
    • Nausea and vomiting
    • Sensation of epigastric fullness
    • Electrolyte imbalances
  • Distension, absent bowel sounds, hypotension, and pain suggest perforation with peritonitis
  • Classic signs of peritoneal irritation that indicate ulcer perforation include rebound tenderness, muscle rigidity, and guarding.
  • Perforation causes peritoneal inflammation, resulting in sudden pain, board-like abdomen, and rigidity.
  • Hallmark signs of peritoneal inflammation include:
    • Rebound tenderness
    • Guarding
    • Rigidity.

Progression from PUD to Peritonitis

  • Clinical signs are:
    • Shallow, rapid respirations
    • Rapid and weak pulse
    • Abdominal distension
    • Hypotension
  • In suspected perforation, the nurse must maintain NPO, support circulation with IV fluids, and prepare for emergency surgery.
  • After EGD, the gag reflex must return before oral oral intake to prevent aspiration.
  • The C-urea breath test detects urease enzyme produced by H. pylori in exhaled carbon dioxide.
  • Ignoring symptoms like bloating/fullness may delay diagnosis of obstruction or bleeding.
  • Nursing interventions to help prevent peptic ulcer recurrence:
    • Encouraging smoking cessation
    • Education to avoid aspirin/NSAIDs
    • Promoting stress reduction strategies
    • Instructing adherence to prescribed medications

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