NURS 111 Peptic Ulcer Disease Exam. Columbia University. Complete Solution

NURS 111 Peptic Ulcer Disease Exam. Columbia University. Complete Solution.Assessment Ms. Lewis arrives at her HCP's office, and the nurse escorts her to the examination room. The nurse performs the initial assessment. During the initial interview, Ms. Lewis requests that the nurse call her Gail. 1. Which information is most significant when assessing a client suspected of having a peptic ulcer? A) Amount of stress at work and in personal life. INCORRECT In the past, stress and emotions were thought to be a major cause of ulcers, but stress rarely causes an ulcer although it probably can aggravate the symptoms. B) Frequent use of aspirin or products containing aspirin. CORRECT Long­term use of antiinflammatory medications (NSAIDs) damages the stomach lining and causes ulcers. NSAIDs inhibit the production of an enzyme (cyclooxygenase) that produces prostaglandins which help protect the stomach lining from chemical and physical injury. Gail reports that she occasionally takes aspirin or ibuprofen for low back pain and joint pains. During the interview, Gail tells the nurse that she frequently has a gnawing, burning pain in her stomach. The nurse asks Gail to explain the pain in more detail. C) History of cigarette smoking and/or current cigarette smoking. INCORRECT Nicotine delays the healing of an ulcer, but it does not cause the development of a peptic ulcer. D) Daily consumption of coffee or other caffeinated drinks. INCORRECT Although caffeine stimulates the secretion of gastric acid, ingestion of caffeine is not considered a risk factor in developing gastric ulcers. Points Earned: 1.0/1.0 Correct Answer(s): B 2. Which response by Gail supports a peptic ulcer? A) "The pain usually does not bother me at night." INCORRECT Because gastric acid production at night can cause extreme abdominal pain, individuals with ulcers may wake up during the night. B) "My pain is temporarily relieved when I drink milk." CORRECT Although antacids and milk usually provide temporary relief for the pain since they neutralize the gastric acid in the stomach, milk can make an ulcer worse because it stimulates the stomach to produce more acid and digestive juices that can aggravate an ulcer. C) "My pain seems to be worse just before I eat a meal." INCORRECT The gnawing, burning pain frequently occurs several hours following a meal after the food leaves the stomach but while acid production is still high. D) "The pain is worse in the morning when I first wake up." INCORRECT Pain upon awakening is not a symptom experienced by clients diagnosed with PUD. Points Earned: 1.0/1.0 Correct Answer(s): B Diagnostic Tests The HCP suspects that Gail has a peptic ulcer and schedules her for a Helicobacter pylori (H. pylori) breath test. The nurse explains that this is a simple and safe test used to detect an active H. pylori infection which is often the cause of PUD. The nurse discusses the pre­procedure guidelines for the test. 3. Which intervention should the nurse include? A) Advise Gail of the need to sign an informed consent form prior to the test. INCORRECT An informed consent is needed for invasive procedures. The H. pylori breath test is not invasive. B) Tell Gail to not eat or drink anything eight hours prior to the test. INCORRECT Food and drink are withheld for only one hour prior to the procedure. C) Instruct Gail not to take any antibiotics for four weeks prior to the test. CORRECT Antibiotics and oral bismuth subsalicylate (Pepto Bismol) should be withheld for four weeks so that they do not interfere with the results of the H. pylori breath test. D) Explain that a proton­pump inhibitor should be taken four hours prior to the test. INCORRECT Proton­pump inhibitors are withheld for two weeks prior to the H. pylori breath test so that they do not interfere with the results of the test. Points Earned: 1.0/1.0 Correct Answer(s): C Gail asks the nurse, "What happens during this test?" 4. Which information should the nurse provide? A) Some saliva is expectorated into a sterile specimen cup. INCORRECT This is not the correct procedure for this test. B) The lining of the mouth is swabbed with a culture tube q­tip. INCORRECT A swab is not used to perform the H. pylori breath test. C) A machine is used that requires you to breathe into it for five minutes. INCORRECT Breathing into a machine is not part of this test. D) A pleasant­tasting solution is ingested and you breathe into a balloon. CORRECT Exhaling into a balloon­like bag is performed first to obtain a baseline sample. Then a small amount of a pleasant lemon­flavored solution is ingested, and 15 minutes later another balloon breath sample is obtained. This sample is tested for an increase in carbon dioxide which indicates a positive H. pylori breath test.