Peptic Ulcer Diseases (15 Questions)

1.1 Mr. Charbonneau, 64 years old, has a known history of peptic ulcer disease and was admitted for investigation of upper gastrointestinal bleeding. This morning, he underwent a diagnostic gastroscopy to identify the source of bleeding and assess the condition of his ulcer. The procedure was completed without immediate complications, and he returned to the unit with stable vital signs.

At 14:00, you assess Mr. Charbonneau and observe the following:
*He appears pale and slightly diaphoretic
*Reports sharp epigastric pain
*Has a temperature of 100°F (37.8°C)
*Suddenly experiences an episode of hematemesis (vomiting blood)

You review his medical chart and confirm he has no analgesia or anticoagulants administered post-procedure.

Question:
What do you suspect is happening, and what is your immediate intervention? *
1.2 After Mr. Charbonneau’s gastroscopy earlier this morning. He is now back on the unit in stable condition, but still drowsy. You inform the orderly that the patient will need assistance when getting out of bed.

Question:
What other priority intervention should you instruct the orderly to do? *
1.3 Mr. Charbonneau remains on the unit following his gastroscopy and biopsy. He had previously shown signs of upper GI bleeding, and now the physician has prescribed IV Sandostatin (octreotide) at 25 mcg/hour to help reduce gastrointestinal secretions and prevent further bleeding.

You are preparing the infusion. The pharmacy has provided Sandostatin at a concentration of 500 mcg/mL, diluted into a 100 mL bag of normal saline.

Question:
At what rate in mL/h will you set the IV pump to deliver the correct dose of 25 mcg/h? *
1.4 Over the past 24 hours, he has remained stable, tolerating a clear fluid diet and showing no signs of rebleeding.

He is now scheduled for discharge. His wife has arrived to take him home.

Question:
What is your priority assessment before discharge, and what signs should you teach Mr. Charbonneau and his wife to monitor at home? *
2.1 You are caring for Jean-Luc Dupont who has just had an upper Gl endoscopy. The patient's vital signs must be taken every 30 minutes for 2 hours after the procedure. You assign a Licensed Practical Nurse (LPN) to take the vital signs. One hour later, the LPN reports the patient, who was previously afebrile, has developed a temperature of 38.8°C.

Question:
What should the nurse do in response to this reported assessment data? *
2.2 Mr. Dupont’s vital signs are stable, and the side rails on his bed are raised for safety. He is awake and alert, but he tells the nurse that he is very thirsty.

Question:
What is the nurse's best action? *
3. Mme. Julie Gagnon, 35 years old, visits the clinic with recurrent dyspepsia. The physician suspects Helicobacter pylori infection and orders a Urea Breath Test.

Medical Orders:
*Urea Breath Test today.
*NPO for 4 hours.

Question:
Before the test begins, which question is most important for the nurse to ask? *
4. M. Jacques Tremblay, 58 years old, is describing his stomach pain to the nurse. He states: "I feel fine when I wake up, but about 30 minutes after I eat breakfast, I get this burning pain high up in my stomach. It hurts so much that I've stopped eating and lost weight."

Medical Orders:
*Upper GI series.

Question:
Based on the timing of the pain, which type of ulcer is suspected? *
5. Mme. Ginette Roy, 50 years old, is recovering from a Vagotomy and Pyloroplasty for severe PUD. The nurse is supervising her lunch.

Assessment:
*Tray contains: Chicken breast, mashed potatoes, green beans, chocolate pudding, and apple juice.
*Patient is sitting upright.

Medical Orders:
*Post-gastric surgery diet.

Question:
What intervention should the nurse implement to prevent Dumping Syndrome? *
6. M. Pierre Gagnon, 78 years old, is admitted for confusion and weakness. His daughter says, "He takes a lot of Aspirin for his arthritis."

Assessment:
*Hemoglobin: 75 g/L (Low).
*Stool: Dark and tarry (Melena).
*Patient reports no abdominal pain.

Medical Orders:
*Transfuse 2 units PRBCs.
*Gastroscopy.

Question:
Why did the patient not complain of pain despite having a bleeding ulcer? *
7. Mme. Claire Bouchard, 30 years old, takes high-dose NSAIDs for Rheumatoid Arthritis. The physician prescribes Misoprostol (Cytotec) to prevent ulcers.

Medical Orders:
*Misoprostol 200 mcg PO QID.

Question:
What is the nurse’s priority assessment before administering this medication? *
8. M. Robert Fortin, 55 years old, with a history of PUD, suddenly doubles over in pain.

Assessment:
*Abdomen: Rigid and tender.
*Patient reports: "My right shoulder hurts!"

Question:
What is the physiological cause of the shoulder pain? *
9. M. Sylvain Cote, 45 years old, is diagnosed with a duodenal ulcer. He smokes 1 pack of cigarettes per day. He asks, "Does smoking really matter for my stomach?"

Medical Orders:
*Smoking cessation counseling.

Question:
What is the nurse’s best explanation? *
10. Mme. Sophie Lemieux, 70 years old, with chronic kidney disease (CKD), asks the nurse which antacid she should buy for occasional heartburn.

Question:
Which instruction is crucial for a patient with renal failure? *
11. Mme. Valérie Turcotte, 60 years old, had a Total Gastrectomy 3 years ago for extensive ulcers/cancer. She presents with fatigue, a smooth red tongue (glossitis), and paresthesia in her hands.

Question:
What condition does the nurse suspect, and what is the treatment? *