What is the purpose of including bismuth subsalicylate in the treatment regimen for PUD?

Correct Answer: B

Rationale: The correct answer is B: To create a protective barrier in the stomach. Bismuth subsalicylate forms a protective coating on the stomach lining, acting as a barrier to protect against stomach acid and irritants, promoting healing of peptic ulcers. A: To reduce acid production - While some medications like proton pump inhibitors reduce acid production, bismuth subsalicylate does not primarily function in this manner for PUD treatment. C: To increase mucus secretion - Bismuth subsalicylate does not directly increase mucus secretion, although it may indirectly support mucosal protection. D: To eradicate H. pylori - Bismuth subsalicylate does not directly target H. pylori bacteria, which is typically addressed with antibiotics in PUD treatment.

Correct Answer: B

Rationale: The correct answer is B: Avoid pregnancy while taking this medication. Misoprostol is contraindicated in pregnancy due to its potential to cause miscarriage or birth defects. It is important for the nurse to educate the patient on the risks associated with pregnancy while taking this medication. Explanation of why other choices are incorrect: A: Taking misoprostol with antacids may reduce its effectiveness as antacids can neutralize stomach acid, affecting the drug's action. C: Misoprostol should be taken with food to minimize gastrointestinal side effects, not on an empty stomach. D: Misoprostol is not a cure for PUD; it helps in treating and preventing ulcers but does not eliminate the underlying cause of the ulcer.

Correct Answer: B

Rationale: The correct answer is B: Osteoporosis. Long-term PPI use can lead to decreased calcium absorption, increasing the risk of osteoporosis. PPIs suppress stomach acid, which is essential for calcium absorption. Monitoring for bone density changes is crucial. A: Hypertension is not a common side effect of PPI use. PPIs do not directly affect blood pressure regulation. C: Hyperkalemia is not typically associated with PPI use. PPIs do not directly impact potassium levels. D: Anemia is not a common side effect of PPI use. PPIs do not directly cause decreased red blood cell production. In summary, monitoring for osteoporosis is important in patients on long-term PPI therapy due to potential calcium absorption issues.

Correct Answer: D

Rationale: The correct answer is D: CT scan of the abdomen. A CT scan is the most appropriate immediate diagnostic test for suspected perforated peptic ulcer disease (PUD). It provides detailed images to confirm the presence of perforation, assess extent of damage, and guide surgical intervention. Upper GI endoscopy (choice A) may delay diagnosis and treatment in a perforation scenario due to the risk of causing further injury. Abdominal X-ray (choice B) may show free air under the diaphragm, but CT scan is more sensitive and specific. Barium swallow (choice C) is contraindicated in suspected perforation as it can lead to barium leakage into the abdominal cavity, causing further complications.

Correct Answer: A

Rationale: The correct answer is A because peptic ulcer disease is primarily caused by the erosion of the gastrointestinal lining due to an imbalance between gastric acid and pepsin. Gastric acid and pepsin can damage the protective lining of the stomach and duodenum, leading to ulcer formation. This process is known as the acid-pepsin hypothesis. Choices B, C, and D are incorrect because they do not directly relate to the underlying cause of peptic ulcer disease. Inflammation of the esophagus due to acid reflux (choice B) is a characteristic of gastroesophageal reflux disease, not peptic ulcer disease. Overproduction of insulin leading to low blood glucose levels (choice C) is a characteristic of hypoglycemia, not peptic ulcer disease. Blockage of the pancreatic ducts leading to digestion of pancreatic tissue (choice D) is a characteristic of pancreatitis, not peptic ulcer disease.