Chapter 78
Which instruction should the nurse give a patient who is to take bismuth subsalicylate for eradication of H. pylori? "Nausea and diarrhea are common side effects." "Do not drink alcohol while taking this medication." "The drug can cause your bowel movements to be black." "Take the medication through a straw to prevent staining of your teeth."
"The drug can cause your bowel movements to be black." Bismuth may impart a harmless black coloration to the tongue and the stool, and patients should be forewarned of this effect. Nausea and diarrhea are the most common side effects of clarithromycin [Biaxin], which also is used to treat H. pylori. Alcohol must be avoided when the patient is treated with metronidazole [Flagyl] for H. pylori infection, because it may cause a disulfiram-like reaction. Tetracycline, which is also highly active against H. pylori, can cause staining of developing teeth.
A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? Ask the healthcare provider for a reduction in dose. Encourage the patient to increase dietary fiber. Administer the drug with an aluminum hydroxide antacid. Instruct the patient to keep an accurate stool count.
Administer the drug with an aluminum hydroxide antacid. Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action. Increasing dietary fiber and keeping a stool count are appropriate actions to implement after adding an antacid to counteract the diarrhea effect.
Which of the following administration techniques would be appropriate when giving a sucralfate [Carafate] tablet to a patient with a duodenal ulcer? (Select all that apply.) Crush the tablet into a fine powder before mixing it with water. Administer the tablet with sips of water 1 hour before meals. Allow the tablet to dissolve in water before administering it. Administer the tablet with an antacid for maximum benefit. Break the tablet in half so it is easier to swallow.
Administer the tablet with sips of water 1 hour before meals. Allow the tablet to dissolve in water before administering it. Break the tablet in half so it is easier to swallow. Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form should not be crushed, and crushing it could reduce the effectiveness of the drug. Sucralfate tablets are large and difficult to swallow, but can be broken or dissolved in water prior to ingestion. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.
A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine [Zantac] and bismuth subsalicylate [Pepto-Bismol]. Which statement by the patient indicates that the teaching has been effective? "While I'm taking these medications, my bowel movements could look black." "I have a medicine at home to take when I start having some loose diarrhea stools." "I'm so glad that my allergies will be helped while I'm taking these medications." "I'll include more calcium and vitamin D in my diet to prevent osteoporosis."
"While I'm taking these medications, my bowel movements could look black." Regimens for eradicating H. pylori include using two or three antibacterials with an antisecretory agent or histamine2 receptor antagonist. Bismuth acts topically to disrupt the cell wall of H. pylori. It can cause a harmless black stool discoloration. Loose stools are an adverse effect of systemic antibacterials such as amoxicillin [Amoxil]. Ranitidine [Zantac] produces selective blockade of H2 receptors, which inhibits gastric acid secretion only, not allergy symptoms. Osteoporosis is an adverse effect of omeprazole, a PPI.
A nurse should give which nonmedication instruction to a patient who has peptic ulcers? "Reduce your intake of caffeine-containing beverages, such as coffee and colas." "Take a nonsteroidal anti-inflammatory drug once a day to help with pain." "It would be better to eat five or six small meals a day instead of three larger ones." "An ulcer diet of bland foods with milk and cream products will speed healing."
"It would be better to eat five or six small meals a day instead of three larger ones." One optimal nondrug measure, in addition to drug management, to aid patients with peptic ulcers is changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that beverages containing caffeine promote ulcer formation or that an "ulcer diet" improves healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.
A nurse monitors a patient who has peptic ulcer disease and is taking antibacterial medications. If the treatment has been effective, the patient's breath test result should reveal the absence of what? Bicarbonate H. pylori Histamine2 Prostaglandins
H. pylori Antibacterial medications should be given to patients who have confirmed infection with H. pylori, a cause of ulcers. A breath test is a noninvasive means of measuring H. pylori levels. The patient is given radiolabeled urea, which converts to carbon dioxide and ammonia if H. pylori is present. Radiolabeled carbon dioxide then can be detected in the breath. Bicarbonate, histamine2, and prostaglandins are not affected by the actions of antibacterial medications for peptic ulcers
A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? Amoxicillin [Amoxil] Cimetidine [Tagamet] Metronidazole [Flagyl] Omeprazole [Prilosec]
Cimetidine [Tagamet] Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.
The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record? Aspirin 81 mg daily Clopidogrel [Plavix] 75 mg daily Heparin 5000 units subQ every 12 hours Metoprolol 50 mg every 8 hours
Clopidogrel [Plavix] 75 mg daily For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, such as omeprazole, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided. This is due to inhibition of CYP2C19, which converts the drug to its active form. Nothing in the question indicates that the patient is at risk for GI bleeding. The other options are not cause for concern.
Instruction by the nurse regarding alcohol abstinence is essential when a patient will be discharged taking which medication? Tetracycline Metronidazole Bismuth subsalicylate Clarithromycin
Metronidazole A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore, alcohol must be avoided during treatment with this drug. Although the use of alcohol is not promoted in patients who take the other medications, it does not create an adverse reaction.
A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? Neutralized gastric acid Reduced stomach motility Increased barrier to pepsin Reduced duodenal pH
Neutralized gastric acid Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate [Carafate]. Reduced stomach motility is not an effect of milk of magnesia.
An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? +3 pitting edema Pain with urination New onset of disorientation to time and place Heart rate changes from a baseline of 70 to 80 beats per minute (bpm) to 110 to 120 bpm
New onset of disorientation to time and place Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures. The remaining options are not adverse effects of cimetidine.
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? Omeprazole [Prilosec] Famotidine [Pepcid] Misoprostol [Cytotec] Ranitidine [Zantac]
Omeprazole [Prilosec] Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.
A nurse should associate which factors with the pathophysiology of peptic ulcer disease? (Select all that apply.) Poor submucosal gastric blood flow Correct Presence of Zollinger-Ellison syndrome Correct Reduced stomach production of bicarbonate Correct Increased synthesis of prostaglandins Gastrointestinal (GI) tract colonized with Haemophilus influenzae
Poor submucosal gastric blood flow Presence of Zollinger-Ellison syndrome Reduced stomach production of bicarbonate Peptic ulcers develop when an imbalance exists between mucosal defensive factors and aggressive factors. Sufficient blood flow to cells of the GI mucosa is needed to maintain integrity. In Zollinger-Ellison syndrome, hypersecretion of acid alone causes ulcers by overcoming mucosal defenses. Bicarbonate is needed to neutralize hydrogen ions. Prostaglandins are needed to stimulate mucus and bicarbonate to maintain mucosal blood flow. Helicobacter pylori, not Haemophilus influenzae, is a bacillus that can disrupt the protective mucosal layer when colonized in the GI tract.
A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? Inhibition of an enzyme to block acid secretion Coating of the ulcer crater as a barrier to acid Selective blockade of parietal cell histamine2 receptors Disruption of the bacterial cell wall, causing lysis and death
Disruption of the bacterial cell wall, causing lysis and death Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate [Carafate]. Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.
The nurse reviews the patient's medication record and notes the following: sucralfate [Carafate] 1 gram orally four times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin [Dilantin] 200 mg orally daily at 8 AM. Which modifications, if any, should be made to the medication regimen? The medications can be administered as ordered. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate [Carafate], because this is more time efficient.
The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, all of the other options are incorrect.
