What is the action of histamine-2 receptor antagonists (H2RAs) in the treatment of PUD?

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: 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.

Correct Answer: C

Rationale: The correct answer is C: Eradicate H. pylori and reduce acid secretion. This combination therapy is commonly used to treat peptic ulcer disease caused by H. pylori infection. Amoxicillin and clarithromycin target and eradicate the H. pylori bacteria, while the PPI helps reduce acid secretion to promote ulcer healing. Choice A is incorrect because the regimen is focused on treating existing ulcers rather than preventing new ones. Choice B is incorrect because the primary goal of the therapy is not just pain relief but rather treating the underlying cause of the ulcers. Choice D is incorrect because the therapy does not directly promote healing by increasing mucus production but rather by targeting H. pylori and reducing acid secretion.

Correct Answer: B

Rationale: The correct answer is B: Notify the physician immediately. This is the priority action because the patient is showing signs of a perforated peptic ulcer, a medical emergency that requires immediate surgical intervention to prevent complications like sepsis. Contacting the physician promptly allows for quick decision-making and coordination of emergency surgery. Administering pain medication (A) can mask symptoms and delay proper diagnosis and treatment. Emergency surgery (C) is necessary, but physician notification should come first. Inserting a nasogastric tube (D) may be indicated later for decompression, but it is not the immediate priority in this critical situation.