Scenario: Client with abdominal pain and H. pylori positive. Select the 3 findings from the client's chart that increase their risk for peptic ulcer disease (PUD).

Peptic ulcer disease results from an imbalance between protective mucosal defenses and damaging factors in the gastrointestinal tract. Three well-established risk factors relevant to this scenario are smoking history, NSAID use, and Helicobacter pylori infection. Smoking impairs mucosal blood flow and prostaglandin synthesis, delays ulcer healing, and increases acid secretion, all of which promote ulcer formation. NSAIDs inhibit cyclooxygenase enzymes, reducing the synthesis of protective prostaglandins that maintain the gastric mucosal barrier and bicarbonate secretion, making the mucosa vulnerable to acid injury. H. pylori is present in this client and is the most common cause of peptic ulcer disease worldwide; the bacterium disrupts the mucosal lining and stimulates acid production. Family history may suggest a genetic predisposition but is not among the three most direct modifiable or pathophysiological risk factors typically cited for PUD. Alcohol use in moderation has weak evidence as a direct ulcer cause, though heavy use is associated with gastritis. Adalimumab is a tumor necrosis factor inhibitor used in inflammatory conditions; while it carries infection risks, it is not a primary risk factor for peptic ulcers. The three findings most directly increasing PUD risk in this client are smoking, NSAID use, and active H. pylori infection.