A client is admitted with diagnosis of duodenal ulcer. During the intake history, the nurse would expect the client to report?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The classic symptom of a duodenal ulcer is epigastric pain described as a burning or gnawing sensation.
This pain typically occurs 90 minutes to 3 hours after a meal, when the stomach is empty and acidic contents pass into the duodenum.
Ingesting food or antacids buffers the acid, leading to prompt pain relief. This is a key diagnostic clue.
Pain that awakens the patient from sleep, often between midnight and 3 A.M., is also a highly discriminating symptom for duodenal ulcers.

Option B: Weight loss is not typical for duodenal ulcers. Because eating relieves their pain, these patients often maintain or even gain weight.
Option C: This describes the pain pattern of a gastric ulcer, not a duodenal ulcer. In gastric ulcers, food stimulates acid secretion, which irritates the ulcer located in the stomach, causing pain.
Option D: Vomiting is an uncommon symptom in uncomplicated duodenal ulcers.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of duodenal ulcer to guide bedside assessment, documentation, and the next nursing action.
A thorough pain assessment (timing, relation to food, quality) is a critical nursing skill for differentiating between gastric and duodenal ulcers, guiding further diagnostics and patient education.
Nurses should educate patients with duodenal ulcers to eat regular meals to prevent the stomach from becoming too empty, which can trigger pain.
What if? If a patient with a known duodenal ulcer suddenly reports severe, constant, radiating back pain that is no longer relieved by food, the nurse should suspect a penetrating ulcer (e.g., into the pancreas), which requires urgent medical evaluation.

How to Approach the Question

First, identify the key diagnosis in the question stem: 'duodenal ulcer'.
Recall the classic pathophysiology of a duodenal ulcer. The pain is caused by stomach acid irritating the ulcer in an empty stomach.
Think about the effect of food. Food acts as a buffer, neutralizing the acid and thus relieving the pain.
Evaluate each option based on this core principle.
Option A (pain relieved by eating) directly matches the expected pathophysiology.
Options B, C, and D describe symptoms more typical of a gastric ulcer (weight loss, pain worsened by food, vomiting), making them incorrect for a duodenal ulcer.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of duodenal ulcer
Stem keywords: duodenal ulcer, intake history, report
Lead-in keywords: expect the client to report
Clinical cues: The diagnosis of duodenal ulcer is the key to identifying the expected symptom pattern.

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E6 Medicine Harrison 22e Part 2 p. 426-428

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 143-145

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.