A patient with PUD is advised to avoid NSAIDs. What is the reason for this?

Correct Answer: C

Rationale: The correct answer is C: NSAIDs are known to irritate the gastric mucosa. NSAIDs can lead to gastric mucosal injury by inhibiting prostaglandin synthesis, which plays a protective role in maintaining the integrity of the gastric mucosa. This can result in the development or exacerbation of peptic ulcers. A: NSAIDs actually inhibit prostaglandin synthesis, leading to decreased gastric acid secretion. B: NSAIDs do not delay gastric emptying; rather, they can cause dyspepsia and increase the risk of ulcers. D: NSAIDs do not interfere with proton pump inhibitors; instead, they can reduce the efficacy of these drugs in treating ulcers.

Correct Answer: B

Rationale: The correct answer is B because histamine-2 receptor antagonists (H2RAs) work by blocking the action of histamine on the H2 receptors of the stomach, which then leads to a decrease in gastric acid secretion. This helps in reducing the acidity level in the stomach, promoting ulcer healing in peptic ulcer disease (PUD). A: Neutralizing gastric acid is the action of antacids, not H2RAs. C: Coating the stomach lining is the mechanism of action of cytoprotective agents like sucralfate, not H2RAs. D: Eradicating H. pylori is a treatment approach for PUD caused by this bacterium, but H2RAs do not directly target H. pylori.

Correct Answer: D

Rationale: The correct answer is D (Both B and C). NSAIDs and aspirin are known to irritate the stomach lining and increase the risk of developing peptic ulcers. Acetaminophen, on the other hand, does not have the same effect on the stomach lining and is considered safer for patients with PUD. Therefore, advising a patient with PUD to avoid NSAIDs and aspirin is crucial to prevent exacerbation of the condition. Additionally, selecting option D is appropriate as it covers both medications that should be avoided, providing a comprehensive approach to managing PUD.

Correct Answer: C

Rationale: The correct answer is C: Perforated ulcer. The sudden, sharp, and persistent pain in the upper abdomen that worsens with movement is indicative of a perforated ulcer, where the stomach acid has eaten through the ulcer and leaked into the abdominal cavity. This can lead to severe pain and tenderness. Gastritis (choice A) typically presents with dull, aching pain. Intestinal obstruction (choice B) usually causes cramping abdominal pain with distension and vomiting. Pancreatitis (choice D) presents with severe, steady pain in the upper abdomen that may radiate to the back. Therefore, based on the sudden onset of sharp pain that worsens with movement in a patient with a history of PUD, the nurse should suspect a perforated ulcer.

Correct Answer: B

Rationale: The correct answer is B, a CT scan of the abdomen. This diagnostic test would be ordered first because it can quickly visualize the abdominal organs and help identify any potential perforations or complications associated with PUD. A CT scan is non-invasive and provides detailed images to assist in making an accurate diagnosis promptly. A: Abdominal ultrasound may not provide as detailed information as a CT scan and may not be as effective in detecting certain complications related to PUD. C: Upper GI endoscopy is more invasive and may not be the initial choice for a patient with severe abdominal pain unless there is a clear indication. D: Barium swallow is not typically used as a first-line diagnostic test for acute abdominal pain in a patient with a history of PUD.