The nurse is admitting a client with a suspected duodenal ulcer. The client will most likely state that his abdominal discomfort decreases when?

1. A

   Skips a meal

2. B

   Rests in a recumbent position

3. C

   Eats a meal

4. D

   Sits upright after eating

Appeared in: DHS 2018 shift 1st

Explanation

• The hallmark symptom of a duodenal ulcer is epigastric pain that occurs when the stomach is empty, typically 2-3 hours after meals.
• Ingesting food buffers the hydrochloric acid (HCl) in the stomach.
• This neutralization of acid prevents it from irritating the ulcerated surface of the duodenum, thus providing temporary pain relief.
• This characteristic 'pain-food-relief' cycle is a key diagnostic clue for duodenal ulcers.

Why Other Options Were Wrong

• Option A: Skipping a meal would lead to an empty stomach for a prolonged period. This allows unbuffered gastric acid to pass into the duodenum, which would increase the irritation of the ulcer and worsen the pain.
• Option B: Body position, such as lying down, does not directly influence the acid-buffering mechanism that relieves duodenal ulcer pain. In some cases, lying down can worsen symptoms of gastroesophageal reflux disease (GERD), which can co-exist with peptic ulcer disease.
• Option D: While sitting upright after eating is beneficial for digestion and preventing reflux, the pain relief in a duodenal ulcer comes from the act of eating itself (the food buffering the acid), not the posture assumed afterward.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pathophysiology and clinical manifestations of duodenal ulcers to guide bedside assessment, documentation, and the next nursing action.
• A key nursing role is to educate the client about the relationship between their symptoms and food intake, which helps in managing discomfort and reinforces the importance of regular meals.
• Accurate assessment of the pain pattern (timing, relation to food, quality) is crucial for differentiating between duodenal and gastric ulcers, guiding further diagnostic workup.
• Nurses must monitor for complications of peptic ulcer disease, such as bleeding (melena, hematemesis), perforation (sudden, severe abdominal pain), and obstruction (vomiting, bloating).

How to Approach the Question

• First, identify the key condition in the question stem: 'suspected duodenal ulcer'.
• Recall the core pathophysiology of a duodenal ulcer. The pain is caused by gastric acid irritating the ulcer in the absence of a food buffer.
• Think about the timing of this irritation. It will happen when the stomach is empty, which is typically a few hours after a meal.
• Analyze the options based on this principle. Which action introduces a buffer to the stomach acid?
• Eating a meal introduces food, which neutralizes the acid. Therefore, this action will relieve the pain.
• Eliminate the other options. Skipping a meal worsens the condition, and changing body position does not address the root cause of the pain.

Concept Tested & Keywords

• Concept Tested: Pathophysiology and clinical manifestations of duodenal ulcers.
• Stem keywords: duodenal ulcer, abdominal discomfort, decreases
• Lead-in keywords: most likely
• Clinical cues: suspected duodenal ulcer

Question ID

QhsCLcFlzYKpMSxZgk6Mx6

Copy ID

Reference Book

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

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