RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019
Medical Surgical Nursing
Easy
A patient's gastric analysis test reveals excess secretion of gastric acid. The nurse would suspect which of the following diagnoses?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019
Explanation
- Duodenal ulcers are strongly associated with hypersecretion of gastric acid.
- Both Basal Acid Output (BAO) and Maximal Acid Output (MAO) are typically elevated in patients with duodenal ulcers.
- The excess acid entering the duodenum from the stomach cannot be adequately neutralized by bicarbonate from the pancreas and Brunner's glands, leading to mucosal injury.
Why Other Options Were Wrong
- Option A: Patients with gastric ulcers usually have normal or decreased (hyposecretion) levels of gastric acid. The ulceration is primarily due to a weakened gastric mucosal barrier, making it susceptible to damage from even normal amounts of acid.
- Option C: Gastric cancer is typically associated with low acid (hypoacidity) or a complete absence of acid (achlorhydria). The cancerous growth can destroy the acid-producing parietal cells of the stomach.
- Option D: Chronic atrophic gastritis involves the progressive loss of gastric glandular cells, including the parietal cells that secrete acid. This leads to hypoacidity or achlorhydria, the opposite of the finding in the question.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Correlation between gastric acid secretion levels and specific gastrointestinal pathologies to guide bedside assessment, documentation, and the next nursing action.
- Nurses must monitor patients with suspected duodenal ulcers for complications like bleeding (melena, hematemesis) and perforation (sudden, severe abdominal pain, rigid abdomen), which are medical emergencies.
- Patient education is a key nursing role, focusing on lifestyle changes such as smoking cessation and avoiding alcohol, caffeine, and NSAIDs, all of which can exacerbate acid secretion or damage the GI mucosa.
- What if? If the gastric analysis had revealed achlorhydria (absence of acid), the nurse's suspicion would shift away from duodenal ulcer and towards chronic atrophic gastritis or gastric cancer, prompting different diagnostic and nursing considerations.
How to Approach the Question
- First, identify the key clinical finding in the question stem: 'excess secretion of gastric acid' (hyperchlorhydria).
- Next, systematically review each option and recall the typical acid secretion pattern associated with that diagnosis.
- Option A (Gastric ulcer): Recall that this is usually linked to normal or low acid, with a weak mucosal barrier being the main issue.
- Option B (Duodenal ulcer): Recall that this is the classic condition associated with high gastric acid output.
- Option C (Gastric cancer) & D (Chronic atrophic gastritis): Recall that both conditions involve destruction of parietal cells, leading to low or absent acid.
- Finally, match the key finding (excess acid) with the correct diagnosis (Duodenal ulcer).
Concept Tested & Keywords
- Concept Tested: Correlation between gastric acid secretion levels and specific gastrointestinal pathologies.
- Stem keywords: gastric analysis, excess secretion, gastric acid
- Lead-in keywords: suspect which
- Clinical cues: The key finding is 'excess secretion of gastric acid', which points directly to a specific type of peptic ulcer disease.
Question ID
Qcdwe3LprHaiKO7NDD91QR
Reference Book
E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 39-41
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 85-87
E6 Physiology Guyton 4SAE Part 2A p. 170-172
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