An adult client presents with gnawing epigastric pain. The pain is worse when the client is hungry and abates after eating something. Which problem do these symptoms suggest?

Esophagitis.

Peptic ulcer disease (PUD).

Gastroesophageal reflux (GERD).

Chronic pancreatitis.

Answer and Explanation

The Correct Answer is B

The symptoms described, including gnawing epigastric pain that worsens when hungry and improves after eating, are classic manifestations of peptic ulcer disease (PUD). Peptic ulcers are erosions in the mucosal lining of the stomach or duodenum, often caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drugs (NSAIDs). The pain typically occurs when the stomach is empty and is relieved by food intake due to the buffering effect of food on gastric acid. This pattern of pain is known as "hunger pain" or "meal-related pain" and is characteristic of PUD.

A. Esophagitis:
Esophagitis refers to inflammation of the esophagus, often due to reflux of gastric contents into the esophagus. Symptoms may include heartburn, difficulty swallowing, and chest pain, but the pain is typically not related to hunger and food intake as described in the scenario.

C. Gastroesophageal reflux (GERD):
GERD involves the reflux of gastric contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest pain. While GERD can cause epigastric discomfort, the described pattern of pain worsening with hunger and improving after eating is more indicative of PUD.

D. Chronic pancreatitis:
Chronic pancreatitis is characterized by inflammation and irreversible damage to the pancreas, leading to persistent abdominal pain, often radiating to the back. While epigastric pain is a feature of chronic pancreatitis, the relief of pain after eating is not typically seen, making it less likely in this scenario.

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Correct Answer is C

Explanation

Answer: C. Document the presence of borborygmi.

Rationale:

A. Elevate the head of the client's bed immediately:
While elevating the head of the bed may be appropriate in certain situations, it is not the necessary immediate action in this context. The presence of loud, high-pitched bowel sounds does not indicate a need for repositioning the client. Instead, the nurse should first focus on assessing the findings before making any positional changes.

B. Use the bell of the stethoscope to auscultate again:
The bell of the stethoscope is typically used for lower frequency sounds, such as heart murmurs or certain vascular sounds. Since the nurse has already identified high-pitched bowel sounds using the diaphragm, switching to the bell is not appropriate for this situation. The diaphragm is better suited for detecting the types of sounds the nurse is hearing.

C. Document the presence of borborygmi:
Borborygmi refers to the loud, gurgling bowel sounds that can indicate increased intestinal activity. Documenting this finding is essential as it provides a clear record of the client's bowel sounds at this moment. This documentation can aid in monitoring the client's gastrointestinal function and is crucial for continuity of care.

D. Auscultate the remaining two quadrants:
While it is important to auscultate all quadrants to get a complete assessment of bowel sounds, the immediate action after hearing significant sounds in two quadrants is to document the findings. Continuing the assessment can follow, but the documentation serves as an important step in patient care and communication among the healthcare team.

A. Observe for jugular vein distention while the client is flat in bed. B. Measure the blood pressure when the client is lying and standing. C. Auscultate breath sounds while the client is supine. D. Ask the client how many pillows are used to sleep on at night.

Correct Answer is D

Explanation

A) Observe for jugular vein distention while the client is flat in bed: While jugular vein distention can indicate fluid overload or heart failure, it is not a direct assessment of orthopnea, which is the difficulty breathing while lying flat.

B) Measure the blood pressure when the client is lying and standing: This action assesses for orthostatic hypotension, which is a drop in blood pressure upon standing. While orthostatic hypotension can contribute to symptoms of dizziness or fainting upon assuming an upright position, it does not directly assess orthopnea.

C) Auscultate breath sounds while the client is supine: Auscultating breath sounds while the client is supine can provide information about lung function and the presence of abnormal breath sounds, but it does not specifically address orthopnea.

D) Ask the client how many pillows are used to sleep on at night: Orthopnea is a condition in which individuals have difficulty breathing while lying flat and may need to sleep with multiple pillows or in a more upright position to alleviate symptoms. Therefore, asking the client about the number of pillows used for sleep can provide valuable information about the presence and severity of orthopnea.

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An adult client presents with gnawing epigastric pain. The pain is worse when the client is hungry and abates after eating something. Which problem do these symptoms suggest?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After placing a client in a supine position, the nurse uses the diaphragm of the stethoscope to auscultate bowel sounds and hears a loud, high pitched almost continuous gurgling in two quadrants. Which action should the nurse implement?

Correct Answer is C

Explanation

Rationale:

During the admission assessment, a client admitted with chest pain reports having no breathing problems and no trouble sleeping at night. To obtain further data regarding possible orthopnea, which action should the nurse take?

Correct Answer is D

Explanation

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