The nurse is caring for a client with diagnosis of peptic ulcer disease. Which assessment finding indicates to the nurse that the client most likely has an ulcer in the stomach rather than the duodenum?
A.
The client’s stool is positive for occult blood.
B.
The client reports abdominal discomfort an hour after each meal.
C.
The client has had four ulcers in the last 5 years.
D.
The client’s hemoglobin is 13 g/dL and hematocrit is 42%.
The Correct answer and Explanation is:
The correct answer is B. The client reports abdominal discomfort an hour after each meal.
Explanation:
Peptic ulcer disease (PUD) can involve ulcers in both the stomach (gastric ulcers) and the duodenum (duodenal ulcers), but the characteristics of pain associated with each type can help differentiate them. Gastric ulcers typically cause pain shortly after eating. Patients often report discomfort that arises within 30 minutes to an hour after meals, as the presence of food stimulates gastric acid secretion, which can irritate the ulcer.
In contrast, duodenal ulcers usually lead to pain that occurs several hours after meals or during the night, often relieved by eating or taking antacids. This difference arises from the timing of gastric acid secretion and the subsequent effects on the ulcerated areas. The discomfort from duodenal ulcers tends to be intermittent and is often described as a gnawing or burning sensation.
Option A, the client’s stool being positive for occult blood, is indicative of gastrointestinal bleeding but does not provide specific information about the ulcer’s location. Both gastric and duodenal ulcers can cause bleeding, so this finding is not diagnostic for differentiating between the two.
Option C, having multiple ulcers over the years, is not directly indicative of their location, as both types can recur.
Option D, showing hemoglobin and hematocrit values within normal limits, does not provide information specific to ulcer location either. While anemia could be a concern in ulcer patients, it is not a reliable indicator of whether the ulcer is gastric or duodenal.
Thus, the timing of the pain—an hour after meals—strongly suggests a gastric ulcer, making option B the most relevant assessment finding for this scenario.