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Diagnostic Evaluation

The diagnosis of peptic ulcer disease is based on the history, physical examination, and diagnostic tests. 

1. The history should include information about the onset, duration, frequency, location, and characteristics of the pain; any factors that worsen or relieve the pain; any associated symptoms such as nausea, vomiting, bleeding, weight loss; any history of H. pylori infection or NSAID use; any family history of peptic ulcers; and any previous treatments or medications for peptic ulcers.

2. The physical examination should include inspection and palpation of the abdomen for signs of tenderness, distension, masses, or organomegaly; auscultation for bowel sounds; percussion for signs of fluid or air; and rectal examination for signs of bleeding or anemia.

3. The diagnostic tests for peptic ulcer disease include:

  • Blood tests: Blood tests can check for anemia due to bleeding; infection by H. pylori using serology (antibody test), antigen test (stool test), or urea breath test; inflammation using erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP); and liver and kidney function using liver enzymes and creatinine.
  • Breath test: To check for H. pylori infection by measuring the amount of carbon diode in the breath after swallowing a urea solution.
  • Stool test: To check for H. pylori infection by detecting antigens or DNA in the stool sample.
  • Endoscopy: Endoscopy is the most accurate test for peptic ulcer disease. It involves inserting a thin fleble tube with a camera and a light source through the mouth into the stomach and duodenum. Endoscopy can visualize the ulcers and their size, location, shape and take biopsies for histological examination and culture.
  • Upper gastrointestinal series: To take X-rays of the upper digestive tract after drinking a contrast agent that coats the lining.

                           

Questions on Diagnostic Evaluation

Correct Answer is A

Explanation

Incorrect. Inadequate blood supply to the stomach (ischemia) is not the primary mechanism of peptic ulcers. Acid overproduction and other factors play a more significant role.

Correct Answer is A

Explanation

Incorrect. H. pylori does not primarily disrupt blood flow to the stomach. Its main impact is on the mucosal lining.

Correct Answer is B

Explanation

Incorrect. Prostaglandins do play a role in regulating blood flow, but their primary function in the stomach is mucosal protection, rather than preventing ischemia.

Correct Answer is C

Explanation

Incorrect. NSAIDs do not promote the growth of H. pylori. Their mechanism in ulcer development is related to direct damage to the stomach lining.

Correct Answer is A

Explanation

<p>Incorrect. Alcohol consumption can contribute to the risk of peptic ulcers, particularly in excessive amounts, due to its potential to irritate the stomach lining and increase acid production.</p>

Correct Answer is C

Explanation

While stress and emotional factors may exacerbate peptic ulcer symptoms, they are not the primary cause of the condition. The primary causes are H. pylori infection and the use of NSAIDs.

Correct Answer is A

Explanation

The frequency of consuming high-fiber foods is not specifically related to peptic ulcer disease. However, diet history is essential for overall health assessment.

Correct Answer is B

Explanation

Taking the PPI before bedtime may not provide the best acid suppression throughout the day. Taking it on an empty stomach before a meal is a more appropriate approach.

Correct Answer is D

Explanation

This statement is correct. An endoscopy involves inserting a fleble tube (endoscope) with a camera on the end through the mouth to examine the stomach and duodenum. It is a commonly used procedure to assess and diagnose peptic ulcer disease.

Correct Answer is B

Explanation

<p>Citrus fruits and juices are acidic and can aggravate the stomach lining in a client with peptic ulcer disease. It is best to avoid or limit their consumption.</p>

Correct Answer is A

Explanation

While stress and emotional factors may exacerbate peptic ulcer symptoms, they are not the primary cause of the condition. The primary causes are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Correct Answer is D

Explanation

This statement is correct. Long-term use of NSAIDs is a well-established risk factor for peptic ulcer disease. NSAIDs can irritate the stomach lining and increase the risk of ulcer formation.

Correct Answer is C

Explanation

Helicobacter pylori infection is not caused by excessive consumption of spicy foods. The infection is typically acquired through person-to-person transmission, such as through contaminated water or food, and is unrelated to diet choices.

Correct Answer is C

Explanation

While a high-fiber diet is generally beneficial for digestive health, it does not specifically counteract the effects of NSAIDs on the stomach lining.

Correct Answer is A

Explanation

Regular physical exercise is important for overall health, but it is not a direct risk factor for peptic ulcer disease. The nurse should focus on risk factors related to diet, medication use, and other medical conditions.

Correct Answer is A

Explanation

Diffuse abdominal pain with a low-grade fever may be seen in various conditions, but it does not specifically point to cholecystitis.

Correct Answer is C

Explanation

Elevated serum amylase is more associated with pancreatitis rather than cholecystitis. It is not directly related to the clinical manifestations described.

Correct Answer is D

Explanation

This statement is correct. High fever and chills may indicate the presence of infection and sepsis, which can be severe complications of acute cholecystitis.

Correct Answer is A

Explanation

Decreased production of pancreatic enzymes may lead to malabsorption issues and cause symptoms like diarrhea and steatorrhea. However, it is not the primary cause of indigestion and bloating after meals in chronic cholecystitis.

Correct Answer is C

Explanation

<p>Auscultation of the left upper quadrant is not relevant to assessing for Boas&#39; sign, which involves the right upper quadrant.</p>

Correct Answer is C

Explanation

ERCP is an invasive procedure used to visualize the biliary and pancreatic ducts, but it is not typically used as a first-line diagnostic test for cholecystitis.

Correct Answer is C

Explanation

Avoiding pain medications is not necessary before an abdominal ultrasound. The client can continue taking prescribed medications as usual.

Correct Answer is C

Explanation

Low serum bilirubin levels are not consistent with cholecystitis, which can cause obstructive jaundice and elevated bilirubin levels due to bile duct obstruction.

Providing detailed images of the pancreas is not the primary purpose of a HIDA scan, although it can sometimes provide some information about the pancreas if the tracer reaches the duodenum and enters the common bile duct.

<p>CT scans use X-rays, not sound waves. Sound waves are used in ultrasound imaging, not in CT scans.</p>

This statement is incorrect and indicates a need for further teaching. Alcohol can irritate the stomach lining and exacerbate peptic ulcer disease. Clients with peptic ulcers should avoid or minimize alcohol consumption.

Administering antacids at bedtime may help with overnight acid reduction, but it may not adequately address pain during meals when acid production is higher.

Antibiotics do not relax stomach muscles or alleviate abdominal pain. Pain relief is typically achieved through acid-reducing medications and other pain management strategies.

Recovering fully in 6 months may be an extended recovery period. While some clients may experience a longer recovery, it is not a standard time frame for everyone.

<p>High-fiber foods can be beneficial for overall digestive health, but they are not specifically recommended for promoting ulcer healing. In some cases, high-fiber foods may need to be avoided if they cause discomfort.</p>

Feeling fatigued and sleepy after meals is not typically associated with peptic ulcer disease or its complications.

This statement is correct. A perforated peptic ulcer can cause increased abdominal rigidity due to the inflammation and irritation of the peritoneal lining. The abdomen may feel tense and rigid upon palpation.

Avoiding alcohol is advisable while on NSAIDs as alcohol can increase the risk of gastrointestinal bleeding and worsen peptic ulcer disease.

Checking for drug interactions with other medications is essential for safe medication administration, but it is not the priority when administering PPIs intravenously to this client.

<p>Diagnosing conditions in the lower digestive tract is not the purpose of an upper gastrointestinal endoscopy. Lower digestive tract evaluations are typically done using colonoscopy or sigmoidoscopy.</p>

It is essential to avoid taking sucralfate with other medications, especially those that require an acidic environment for absorption. This is because sucralfate can decrease the absorption of certain drugs.

Providing the client with spicy foods is not advisable, as they can irritate the stomach lining and worsen symptoms for the client with peptic ulcer disease.

H2 receptor blockers are not known to affect the CBC, so monitoring the complete blood count is not the priority for this client.

Hyperactive bowel sounds are not early signs of gastrointestinal bleeding. Bowel sounds may be hyperactive or hypoactive depending on the severity of the bleeding and associated factors.

<p>Misoprostol is not used to reduce stomach acid production. Instead, it helps protect the stomach lining by increasing mucus production and promoting bicarbonate secretion.</p>

Regular use of NSAIDs can increase the risk of developing peptic ulcers and is not a preventive strategy for clients with a history of peptic ulcer disease.

This statement is correct. Antacids can interfere with the action of PPIs, and clients should avoid taking them together. If needed, antacids should be taken at least 1 hour before or after the PPI.

Caffeine-containing beverages should be limited or avoided, as caffeine can stimulate gastric acid secretion and may worsen symptoms for clients with peptic ulcers.

Taking over-the-counter antacids regularly is not a preventive strategy for H. pylori reinfection. Antacids do not target the bacterium and are not effective in eradicating H. pylori.

<p>Sucralfate does not typically cause drowsiness, so taking it before bedtime is not necessary for this medication. It should be taken at regular intervals during the day as prescribed.</p>
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