PEPTIC ULCER DISEASE UPDATED
ACTUAL Exam Questions and CORRECT
Answers
The nurse has been assigned to provide care for four clients at the beginning of the day shift. In
what order should the nurse assess these clients?
1. The client awaiting hiatal hernia repair at 11 am.
2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests.
3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain.
4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw. -
CORRECT ANSWER - 3, 4, 2, 1
The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain
should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a
perforated ulcer, which would require immediate medical attention. It is also important for the
nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is
experiencing pain and should be assessed next. The nurse should then assess the client who is
NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before
surgery.
The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs
must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed
nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who
was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the
nurse do in response to this reported assessment data?
1. Promptly assess the client for potential perforation.
2. Tell the assistant to change thermometers and retake the temperature.
3. Plan to give the client acetaminophen (Tylenol) to lower the temperature.
4. Ask the assistant to bathe the client with tepid water. - CORRECT ANSWER - 1.
A sudden spike in temperature following an endoscopic procedure may indicate perforation of
the GI tract. The nurse should promptly conduct a further assessment of the client, looking for
further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid,
,boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers
is not an appropriate action and only further delays the appropriate action of assessing the client.
The nurse would not administer acetaminophen without further assessment of the client or
without a physician's order; a suspected perforation would require that the client be placed on
nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the
nurse is inappropriate.
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a
bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region
along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which
of the following?
1. An intestinal obstruction has developed.
2. Additional ulcers have developed.
3. The esophagus has become inflamed.
4. The ulcer has perforated. - CORRECT ANSWER - 4.
The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This
results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical
emergency requiring immediate surgical intervention because peritonitis develops quickly after
perforation. An intestinal obstruction would not cause midepigastric pain. The development of
additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms should the nurse expect to assess? Select all that apply.
1. Epigastric pain at night.
2. Relief of epigastric pain after eating.
3. Vomiting.
4. Weight loss.
5. Melena. - CORRECT ANSWER - 3, 4, 5.
Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the
stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of
a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the
,pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the
night and is frequently relieved by eating.
The nurse is caring for a client who has had a gastroscopy. Which of the following signs and
symptoms may indicate that the client is developing a complication related to the procedure?
Select all that apply.
1. The client has a sore throat.
2. The client has a temperature of 100 ° F (37.8 ° C).
3. The client appears drowsy following the procedure.
4. The client has epigastric pain.
5. The client experiences hematemesis. - CORRECT ANSWER - 2, 4, 5.
Following a gastroscopy, the nurse should monitor the client for complications, which include
perforation and the potential for aspiration. An elevated temperature, complaints of epigastric
pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and
should be reported promptly. A sore throat is a common occurrence following a gastroscopy.
Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will
be drowsy following the procedure.
A client with peptic ulcer disease tells the nurse that he has black stools, which he has not
reported to his physician. Based on this information, which nursing diagnosis would be
appropriate for this client?
1. Ineffective coping related to fear of diagnosis of chronic illness.
2. Deficient knowledge related to unfamiliarity with significant signs and symptoms.
3. Constipation related to decreased gastric motility.
4. Imbalanced nutrition: Less than body requirements related to gastric bleeding. - CORRECT
ANSWER - 2.
Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested
blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with
peptic ulcer disease should be instructed to report the incidence of black stools promptly to their
primary health care provider. The data do not support the other diagnoses.
, A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of
this drug?
1. Heal the ulcer.
2. Protect the ulcer surface from acids.
3. Reduce acid concentration.
4. Limit gastric acid secretion. - CORRECT ANSWER - 4.
Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion.
Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly
in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface
against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.
A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night.
The nurse should instruct the client to do which activities? Select all that apply.
1. Obtain adequate rest to reduce stimulation.
2. Eat small, frequent meals throughout the day.
3. Take all medications on time as ordered.
4. Sit up for one hour when awakened at night.
5. Stay away from crowded areas. - CORRECT ANSWER - 1, 2, 3, 4.
The nurse should encourage the client to reduce stimulation that may enhance gastric secretion.
The nurse can also advise the client to utilize health practices that will prevent recurrences of
ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals
helps to prevent gastric distention if not actively bleeding and decreases distension and release of
gastrin. Medications should be administered promptly to maintain optimum levels. After
awakening during the night, the client should eat a small snack and return to bed, keeping the
head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded
areas.
A client with peptic ulcer disease reports that he has been nauseated most of the day and is now
feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most
appropriate for the nurse to take? Select all that apply.
ACTUAL Exam Questions and CORRECT
Answers
The nurse has been assigned to provide care for four clients at the beginning of the day shift. In
what order should the nurse assess these clients?
1. The client awaiting hiatal hernia repair at 11 am.
2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests.
3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain.
4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw. -
CORRECT ANSWER - 3, 4, 2, 1
The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain
should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a
perforated ulcer, which would require immediate medical attention. It is also important for the
nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is
experiencing pain and should be assessed next. The nurse should then assess the client who is
NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before
surgery.
The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs
must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed
nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who
was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the
nurse do in response to this reported assessment data?
1. Promptly assess the client for potential perforation.
2. Tell the assistant to change thermometers and retake the temperature.
3. Plan to give the client acetaminophen (Tylenol) to lower the temperature.
4. Ask the assistant to bathe the client with tepid water. - CORRECT ANSWER - 1.
A sudden spike in temperature following an endoscopic procedure may indicate perforation of
the GI tract. The nurse should promptly conduct a further assessment of the client, looking for
further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid,
,boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers
is not an appropriate action and only further delays the appropriate action of assessing the client.
The nurse would not administer acetaminophen without further assessment of the client or
without a physician's order; a suspected perforation would require that the client be placed on
nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the
nurse is inappropriate.
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a
bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region
along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which
of the following?
1. An intestinal obstruction has developed.
2. Additional ulcers have developed.
3. The esophagus has become inflamed.
4. The ulcer has perforated. - CORRECT ANSWER - 4.
The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This
results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical
emergency requiring immediate surgical intervention because peritonitis develops quickly after
perforation. An intestinal obstruction would not cause midepigastric pain. The development of
additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.
When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and
symptoms should the nurse expect to assess? Select all that apply.
1. Epigastric pain at night.
2. Relief of epigastric pain after eating.
3. Vomiting.
4. Weight loss.
5. Melena. - CORRECT ANSWER - 3, 4, 5.
Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the
stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of
a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the
,pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the
night and is frequently relieved by eating.
The nurse is caring for a client who has had a gastroscopy. Which of the following signs and
symptoms may indicate that the client is developing a complication related to the procedure?
Select all that apply.
1. The client has a sore throat.
2. The client has a temperature of 100 ° F (37.8 ° C).
3. The client appears drowsy following the procedure.
4. The client has epigastric pain.
5. The client experiences hematemesis. - CORRECT ANSWER - 2, 4, 5.
Following a gastroscopy, the nurse should monitor the client for complications, which include
perforation and the potential for aspiration. An elevated temperature, complaints of epigastric
pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and
should be reported promptly. A sore throat is a common occurrence following a gastroscopy.
Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will
be drowsy following the procedure.
A client with peptic ulcer disease tells the nurse that he has black stools, which he has not
reported to his physician. Based on this information, which nursing diagnosis would be
appropriate for this client?
1. Ineffective coping related to fear of diagnosis of chronic illness.
2. Deficient knowledge related to unfamiliarity with significant signs and symptoms.
3. Constipation related to decreased gastric motility.
4. Imbalanced nutrition: Less than body requirements related to gastric bleeding. - CORRECT
ANSWER - 2.
Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested
blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with
peptic ulcer disease should be instructed to report the incidence of black stools promptly to their
primary health care provider. The data do not support the other diagnoses.
, A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of
this drug?
1. Heal the ulcer.
2. Protect the ulcer surface from acids.
3. Reduce acid concentration.
4. Limit gastric acid secretion. - CORRECT ANSWER - 4.
Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion.
Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly
in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface
against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.
A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night.
The nurse should instruct the client to do which activities? Select all that apply.
1. Obtain adequate rest to reduce stimulation.
2. Eat small, frequent meals throughout the day.
3. Take all medications on time as ordered.
4. Sit up for one hour when awakened at night.
5. Stay away from crowded areas. - CORRECT ANSWER - 1, 2, 3, 4.
The nurse should encourage the client to reduce stimulation that may enhance gastric secretion.
The nurse can also advise the client to utilize health practices that will prevent recurrences of
ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals
helps to prevent gastric distention if not actively bleeding and decreases distension and release of
gastrin. Medications should be administered promptly to maintain optimum levels. After
awakening during the night, the client should eat a small snack and return to bed, keeping the
head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded
areas.
A client with peptic ulcer disease reports that he has been nauseated most of the day and is now
feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most
appropriate for the nurse to take? Select all that apply.
