Lipincott PrepU
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse?
a. place the client in high-fowlers
b. assess the client's abdomen and vital signs
c. irrigate the clients ng tube
d. notify the HCP
b. assess the client's abdomen and vital signs
Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.
_____ is the result of a lower esophageal sphincter, which allows stomach contents to move upward.
a. GERD
b. PUD
c. h.pylori
a. GERD
Perforation can lead to ________, which can lead to diminished peristalsis. Diminished peristalsis can lead to _______.
a. Peritonitis, paralytic ileus
b. hemorrhage, paralytic ileus
c. Peritonitis, hemorrhage
NIH: The intestine fails to transmit peristaltic waves, resulting in a functional obstruction, and allowing fluid and gas to collect in the intestine.
Diminished peristalsis can cause paralytic ileus.
Paralytic ileus: muscles of intestine do not allow food to pass through, blocked intestine.
Which instructions should the nurse include when performing dietary teaching for a cleint with newly diagnosed gastroesophageal reflux disease?
a. consume a diet with moderate amount of fat
b. eat a hihg carb snack before bed
c. sit up for at least 2 hours after eating
d. increase the amount of Na in the diet
c. sit up for at least 2 hours after eating
This answer is correct because clients with GERD should be taught to remain upright after eating to allow for complete digestion of food. This will help prevent the backflow of stomach contents into the esophagus which causes the burning pain within the chest and esophagus for these clients. The client should maintain a healthy weight and lose weight if overweight. The client should be taught to avoid eating late at night to prevent GERD symptoms.
Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?
a. famotidine
b. tums
c. omeprazole
d. tetracycline
c. omeprazole
Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?
a. aortic aneurysm
b. gerd
c. perforation of the peptic ulcer
d. mi
c. perforation of the peptic ulcer
Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock.
_______ infection is the most common cause of PUD.
When living with PUD a client may feel pain ______ hours ______ food.
a. h.pylori , 1-3 hours, after
b. staph, 5-6 hours, after
c. h.pylori, 2-6 hours, after
d. e.coli, 1-3 hours, after
a. h.pylori , 1-3 hours, after
A client presents complaining of gnawing/ burning sensation in the upper abdomen that is not relieved with food. The client reports recent unintentional weight loss and episodes of vomiting. What is the client most likely experiencing?
a. duodenal ulcer
b. h.pylori
c. gastric ulcer
d. stress ulcer
c. gastric ulcer
A gastric ulcer has similar symptoms of a duodenal ulcer but may or may not be relieved by food. Stress ulcers occur after an acute medical trauma, the client mentioned did not experience any medical trauma.
A client after developing PUD is wondering how they could have developed the disease. Based on the clients lifestyle which factors may have contributed ? SELECT ALL
a. excessive use of NSAIDS
b. use of antacids
c. excessive stress
d. excessive use of famotidine
a, c
Which medication reduces the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells? Select all that apply.
a. esomeprazole
b. lansoprazole
c. famotidine
d. ranitidine
e. calcium carb
a. esomeprazole
b. lansoprazole
Famotidine and ranitidine are both histamine H2 antagonists decreasing stomach acid by inhibiting the action of H2 receptors in the stomach. Calcium carbonate is an acid neutralizer that reduces the pH of the acid in the stomach and duodenum.
During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take?
a. Provide a dose of a proton pump inhibitor.
b. Provide an antiacid
c. Notify the primary health care provider
d. Provide the client with a warm beverage.
c. Notify the primary health care provider
The client with peptic ulcer disease is demonstrating signs of hemorrhage which include cool skin and tachycardia. The health care provider should be immediately notified. The client should not be given any additional medication. A warm beverage could enhance bleeding. It is inappropriate to provide any teaching while the client is experiencing an acute condition.
The nurse understand the client needs further teaching when the client states what?
a. I may take PPI's long term for treatment and prevention of ulcers
b. I will take pepto bismol (bismuth subsalicylate) after breakfast
c. I should seek emergency care if I experience pain and tenderness in combination with rigidity and distension
d. I will be NPO before my EGD
b. I will take pepto bismol (bismuth subsalicylate) after breakfast
pepto bismol (bismuth subsalicylate) should be taken on an empty stomach
A client presents in the ED complaining of pain in the abdomen that started as a diffuse pain, and has developed into a constant pain with increased intensity. The abdomen is tender and rigid. The clients VS includes a low grade temperature and tachycardia that displays progression and is becoming hypotensive.
IS THIS A MEDICAL EMERGENCY? WHAT DO YOU THINK IS HAPPENING TO THE CLIENT?
yes, this is a medical emergency, this could be life threatening, the client needs surgical intervention. The client is experiencing peritonitis.
BONUS: what is peritonitis a result of?
1.Omeprazole (Prilosec) classification is_______
2.Famotidine classification is ________
3.Pepto bismal classification is _______
4.Sucralfate (carafate) classification is ________
1. PPI
2. H2- receptor antagonist
3. bismuth subsalicylate
4. Antacid
EGD (esophagogastroduodenoscopy) is a diagnostic tool used to confirm the presence of an ulcer. The client should remain ______ for _____ hours pre procedure. The nurse should anticipate the client to be lying ______ during the procedure.
a. oriented, 12, supine
b. NPO, 12, supine
c. NPO, 8, left lateral (side lying)
d. verbal, 8, prone
c. NPO, 8, left lateral (side lying)
Left lateral position to facilitate clearance of pulmonary secretions and provide a smooth entry.
A client with peptic ulcer disease must begin medication therapy. For how long will the client follow this regimen? And how many medications?
a. 10- 14 days, Triple Medication therapy
b. 15-20 days, Triple Medication therapy
c. 10- 14 days, Two medications
d. six months, two medeications
a. 10- 14 days, Triple Medication therapy
Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol).
Peptic ulcer disease are ulcers located in ____,____, ____. Of these areas the most common area of manifestation is _______.
a. stomach, colon, small intestine, colon
b. duodenum, stomach, small intestine, duodenum
c. duodenum, stomach, small intestine, stomach
b. duodenum, stomach, small intestine, duodenum
source: Petrina's lecture
Hemorrhage occurs more often in older adults and those with _____ ulcers.
A patient vomiting bright red or coffee ground blood typically indicates bleeding where?
a. gastric ulcers, lower stomach
b. duodenum ulcers, lower stomach
c. gastric ulcers, upper gi at duodenal jejunal junction
d. somtach ulcers, esophagus
c. gastric ulcers, upper gi at duodenal jejunal junction
hemorrhage: emesis usually indicates upper gi bleeding at duodenal jejunal junction
You are a nurse in the ICU and your client has been admitted to the unit 12 hours ago. The client experienced a serious head injury after a car accident. The client has been prescribed mechanical ventilation and an NG tube. The clients family member asks why her loved one is now taking a PPI after ICU admission. What is the nurses best response?
a. The PPI helps the equipment work better
b. The PPI is being used prophylactically to prevent a stress ulcer
c. We want to prevent bleeding cause by gastric ulcers
b. The PPI is being used prophylactically to prevent a stress ulcer
Stress ulcers can occur acutely after medical trauma such as head injuries, burns, and have been seen to develop within 24 hours after ICU admission. Treatments such as the Ventilator and the placement of NG tubes cause the ulcer to develop. The PPI will work to prevent this.
______ detects IgG antibodies to h.pylori in the serum.
a. enzyme- linked immunosorbent assay
b. cbc
c. scratch test
d. upper gi endoscopy
a. enzyme- linked immunosorbent assay
ELISA
SIMPLE NURSING:
The nurse is providing discharge planning for a client with a peptic ulcer. Which statement by the client indicates more discharge teaching is required?
a. I will eat larger meals less to prevent symptoms
b. I will avoid alcohol and caffeinated drinks
c. I will tell my HCP if I experience severe stomach pain
a. I will eat larger meals less to prevent symptoms
This answer is correct because an empty stomach can exacerbate symptoms of peptic ulcers. Eating small meals more frequently, rather than big meals less often will prevent the stomach from becoming completely empty. Acidity level in the stomach does not rise as high with smaller, frequent meals due to less fluctuation in the acid level throughout the day.
1)Explain the differences between PUD/ GERD & differences in treatment
2) Explain the differences between duodenal ulcer and gastric ulcer
1) PUD is typically caused by a previous h.pylori infection. PUD is an erosion of mucosa layer. PUD can lead to major life threatening complications. PUD is treated with a combo of at least 2 antibx for 10-14 days and an acid decreasing drug like PPI/ H2 receptor/ bismuth subsalicylate (pepto).
1b) GERD is the result of a weak lower esophageal sphincter. GERD is associated with obesity, consumption of fatty& acidic foods. Management includes weight loss, adjusting HOB to be higher, diet, smaller meals, NPO before bed for atleast 3 hrs, no tobacco &A alcohol. GERD tx is similar to PUD but does not call for antibx and is not caused by h.pylori. Alkaline compounds are typically used.
2) the location of these ulcers are different, duodenal are found in the duodenum, gastric are found in the stomach. Duodenum ulcers are relieved by food, gastric are not. Gastric ulcers may cause anorexia, weight loss, vomiting.
A client presents to the emergency room with bloating & epigastric fullness. The client reports they have been nauseous and vomiting with constipation. The clients labs revealed hypokalemia. The nurse suspects the client is experiencing what?
a. Peritonitis
b. Perforation
c. hemorrhage
d. pyloric obstruction
d. pyloric obstruction
extra info from the textbook:
Analysis of gastric juice yields info about secretory activity and presence or degree of gastric retention for pyloric obstruction
1)Alternagel is _______
2) When taking antacids monitor for _______
3) If a client has kidney disease _____ should be avoided
4) If a client has heart failure or HTN _______ should be avoided
1. Alkaline compound of aluminum
2) f&e imbalances (general for all)
3) Alkaline compound of Mg hydroxide (excess mg can't be excreted via bad kidneys)
4) Alkaline compound of Na bicarbonate
TRUE or FALSE
1) smoking decreases the effectiveness of H2- receptor antagonist?
2) H2- receptor antagonist should be taken atleast 1-2 hours before alkaline compounds
3) Long term use of H2- receptor antagonists may decrease b12 levels and anemia.
1. TRUE 2. TRUE 3. TRUE