A patient with a peptic ulcer is prescribed a proton pump inhibitor and advised to avoid NSAIDs. Which ration… - RRB Nsg. Superintendent-2026 (Shift -1st)

RRB Nsg. Superintendent-2026 (Shift -1st)

Pharmacology

Medium

Appeared in: RRB Nsg. Superintendent-2026 (Shift -1st)

Explanation

Proton pump inhibitors (PPIs) potently suppress gastric acid secretion, creating a less acidic environment that is optimal for the healing of the ulcerated mucosal lining.
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis, which is essential for maintaining the protective mucosal barrier of the stomach.
Avoiding NSAIDs prevents further irritation and breakdown of the mucosal barrier, while the PPI reduces the corrosive effect of stomach acid.
This combined approach synergistically promotes the healing of the existing ulcer and prevents the development of new lesions.

Option A: Peptic ulcers do not typically cause significant, generalized nutrient malabsorption. In fact, long-term use of PPIs can slightly decrease the absorption of certain nutrients like vitamin B12, calcium, and magnesium.
Option C: This is the opposite of the intended effect. PPIs are prescribed specifically to decrease stomach acid, as acid is a primary irritant that prevents ulcer healing.
Option D: While diarrhea can be a side effect of some medications or a symptom of certain gastrointestinal issues, it is not the primary target of this specific therapeutic combination for peptic ulcers. The main goal is healing the ulcer itself.

Visual 1: Diagram - Action of Proton Pump Inhibitors. A diagram showing a gastric parietal cell with the proton pump (H+/K+ ATPase) on its surface. An arrow indicating the PPI molecule would be shown blocking this pump, preventing H+ (acid) from being secreted into the stomach lumen.
Visual 2: Flowchart - NSAID-Induced Gastric Injury. A flowchart illustrating how NSAIDs block the COX-1 enzyme, leading to decreased prostaglandin production. This results in reduced mucus and bicarbonate secretion and decreased mucosal blood flow, ultimately weakening the gastric mucosal defense and leading to injury.

Clinical Relevance

Nursing practice connection: Use the key finding related to Rationale for combined PPI and NSAID avoidance in peptic ulcer management to guide bedside assessment, documentation, and the next nursing action.
Nurses play a critical role in educating patients with peptic ulcer disease to meticulously read labels and avoid all over-the-counter (OTC) products containing NSAIDs, such as ibuprofen, naproxen, and aspirin (unless prescribed for cardiovascular protection).
Patients should be advised to use acetaminophen (paracetamol) for pain relief as it does not typically irritate the stomach lining.
What if? If a patient with a history of peptic ulcers requires an anti-inflammatory for a condition like rheumatoid arthritis, the provider might prescribe a COX-2 selective inhibitor (e.g., celecoxib) or continue the NSAID along with a daily PPI or misoprostol for gastroprotection, requiring careful monitoring for GI bleeding.

How to Approach the Question

First, identify the two key components of the intervention: prescribing a proton pump inhibitor (PPI) and advising the avoidance of NSAIDs.
Recall the primary function of a PPI: to reduce the production of stomach acid.
Recall the primary adverse effect of NSAIDs on the gastrointestinal system: they damage the protective mucosal lining of the stomach.
Synthesize these two facts in the context of a peptic ulcer (a sore in the lining). The logical goal is to reduce the irritant (acid) and remove the agent that damages the protective barrier (NSAID).
Evaluate the options. The option stating that this approach promotes healing and prevents further irritation directly matches this synthesized logic.

Concept Tested & Keywords

Concept Tested: Rationale for combined PPI and NSAID avoidance in peptic ulcer management
Stem keywords: peptic ulcer, proton pump inhibitor, NSAIDs, rationale
Lead-in keywords: best explains
Clinical cues: patient with a peptic ulcer
Clinical cues: prescribed a proton pump inhibitor

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