A patient who takes warfarin (Coumadin) is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. Dipstick urinalysis is normal. The patient does not have any signs of bleeding and does not complain of pain. The nurse will anticipate an order for:

Choice A reason:
Pulmonary embolism is not a typical complication of a peptic ulcer. While serious, pulmonary embolism is unrelated to the gastrointestinal tract and would not arise from ulceration of the stomach or duodenum. It is therefore not the correct answer to the question posed.
Choice B reason:
Bleeding is the primary clinical manifestation of greatest concern with a peptic ulcer. Ulcers can erode into blood vessels, leading to gastrointestinal hemorrhage, which may present as hematemesis (vomiting blood) or melena (black, tarry stools). Severe bleeding can result in hypovolemic shock and requires immediate medical intervention, such as endoscopic hemostasis, blood transfusions, or surgery. This makes bleeding the most critical concern among the options listed.
Choice C reason:
Bowel obstruction can occur as a complication of peptic ulcer disease but is less common compared to bleeding. It arises from scarring or swelling near the pylorus, leading to gastric outlet obstruction. While serious, it is not the most frequent or immediate concern in the context of peptic ulcers.
Choice D reason:
Hepatomegaly, or enlargement of the liver, is unrelated to peptic ulcer disease. This symptom is typically associated with liver conditions such as cirrhosis, hepatitis, or cancer, and does not result from ulcer pathology.

Choice A reason:
Alcohol abuse is the leading cause of chronic pancreatitis in many cases. Chronic alcohol consumption leads to repeated episodes of pancreatic inflammation, resulting in fibrosis, loss of pancreatic function, and structural damage. Alcohol directly stimulates pancreatic secretions and contributes to the formation of protein plugs that obstruct pancreatic ducts, exacerbating the condition.
Choice B reason:
Bulimia is not a known contributing factor for chronic pancreatitis. While eating disorders can have gastrointestinal manifestations, they do not directly lead to the chronic inflammatory process seen in pancreatitis.
Choice C reason:
A history of gallstones is a recognized contributing factor to chronic pancreatitis. Gallstones can intermittently block the pancreatic duct, leading to inflammation and damage over time. While gallstones are more commonly associated with acute pancreatitis, they also play a role in the chronic form if untreated or recurrent.
Choice D reason:
Bacterial infection is not a primary contributing factor to chronic pancreatitis. While infections can complicate pancreatic conditions, they do not typically initiate the chronic inflammatory process. Chronic pancreatitis is more often caused by mechanical, toxic, or genetic factors rather than infectious agents.