Karch Pharmacology CH57 - GI Drugs Affecting Secretions

An 86-year-old client has been prescribed ranitidine (Zantac). The nurse knows that an older adult who takes H2RAs may experience what adverse effect? Lethargy Agitation Hypertension Hyperplasia

Agitation Explanation: With H2RAs, older adults are more likely to experience adverse effects, especially confusion, agitation, and disorientation, with cimetidine. In addition, older adults often have decreased renal function, and doses need to be reduced.

A client with ulcers has asked the nurse if it would be acceptable to take bismuth subsalicylate. Before recommending an over-the-counter (OTC) formulation of bismuth subsalicylate, the nurse should conduct which client assessment? Cognition Allergy status Normal bowel pattern Immunization history

Allergy status Explanation: Because it is a salicylate, this drug can cause serious bleeding problems when used alone in clients with ulcers. People with an allergy to aspirin or other salicylates should not take bismuth subsalicylate. The client's bowel pattern, immunization history, and cognition are not central considerations.

Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which medication will likely be used in an attempt to eradicate the patient's H. pylori infection? (Select all that apply.) Ondansetron (Zofran) A PPI Antibiotics Cisapride (Propulsid) Aluminum hydroxide

Antibiotics A PPI Explanation: Classic quadruple therapy for H. pylori eradication (bismuth, a PPI, 1,500 mg of metronidazole, and 1,500 mg of tetracycline) is highly effective and is frequently the regimen of choice. A newer sequential therapy (PPI plus amoxicillin followed by a PPI plus clarithromycin plus metronidazole) has been proposed and is expected to replace legacy therapy. Both regimens include PPIs and antibiotics and exclude aluminum hydroxide, ondansetron, and cisapride.

Which of the following antacids may produce constipation and should be used cautiously in clients that have chronic constipation? Select all that apply: Magnesium oxide (Mag-Ox) Sodium bicarbonate (Bellans) Aluminum hydroxide (ALternaGEL) Calcium carbonate (Mylanta) Magnesium hydroxide (Milk of Magnesia)

Calcium carbonate (Mylanta) Aluminum hydroxide (ALternaGEL) Explanation: The aluminum and calcium containing antacids may produce constipation.

The nursing instructor is discussing the use of histamine2 receptor antagonists in the treatment of peptic ulcer disease. According to the instructor, which is a typical dosing schedule of famotidine during the first few weeks of treatment for gastric ulcer in patients with normal renal function? 20 mg bid 20 mg at bedtime 40 mg q.a.m. 10 mg bid

20 mg bid Explanation: During the first few weeks of treatment for gastric ulcer, 40 mg of famotidine is administered at bedtime each day or 20 mg is administered twice daily. Thereafter, the typical maintenance dose is 20 mg at bedtime each day. Dosage is typically reduced in patients with impaired renal function.

A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame? 30 minutes 45 minutes 15 minutes 60 minutes

30 minutes Explanation: Sucralfate has an onset of action of 30 minutes and a duration of 5 hours.

Which client is at risk for the development of an acute ulcer? select all that apply. A client with 2nd degree burns over 50% of the body A client on a mechanical ventilator for 5 days A client who is diagnosed with jaundice A client who eats spicy and acidic foods regularly A client who experienced a stroke

A client on a mechanical ventilator for 5 days A client with 2nd degree burns over 50% of the body A client who experienced a stroke A client who is diagnosed with jaundice Explanation: Acute ulcers, or "stress ulcers," are often seen in situations that involve acute physiological stress, such as trauma, burns, or prolonged illness. All the physical illnesses and related situations are risk factors for the development of a stress ulcer. Dietary habits are not considered such a factor.

A client taking metronidazole informs the nurse that the medication will be finished today and they plan on drinking alcohol at a party tonight. What response by the nurse would be most helpful to prevent complications? "Drinking within the next couple of days could cause a severe reaction." "W

"Drinking within the next couple of days could cause a severe reaction." Explanation: Consuming alcohol while using metronidazole has long been thought to have a disulfiram-like reaction with effects that can include flushing, tachycardia, diaphoresis, nausea, vomiting, or headache if alcohol ingestion occurs with use. It is important to tell the client that even a very small amount of alcohol can produce the reaction; the risk persists for up to 48 hours after completion of treatment. If a culture confirms that the infection is still present, the health care provider will likely prescribe a different antimicrobial. Alcohol consumption will not result in reinfection.

Which statement by a patient receiving pancrelipase indicates that the patient has understood his instructions? "I should take the drug with meals and snacks." "I'll take it first thing in the morning after getting up." "I must take the drug at bedtime for best results." "I should take the drug 1 hour before I eat."

"I should take the drug with meals and snacks." Explanation: Pancrelipase is given with meals and snacks so that the enzyme is available when it is needed.

A client has been prescribed omeprazole by the primary health care provider. When the nurse asks whether the medication is providing relief, the client replies, "I think it's working quite well, and I've gotten in the routine of taking it every morning before breakfast." How should the nurse respond? "That's great. If you find later that it's not working as well, you might want to try taking it at bedtime." "I'm glad it's working for you, but you'll probably find it works even better if you take it after eating." "That's good, but remember that you shouldn't take it on days when you're not having any symptoms." "I'm glad to hear that. It sounds like you're taking it exactly like it should be taken."

"I'm glad to hear that. It sounds like you're taking it exactly like it should be taken." Explanation: It is important that omeprazole be administered before food intake. Once-daily dosing is typical. The drug is not taken solely as a response to acute symptoms.

A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient? "Quitting smoking will significantly increase the chance that this drug will heal your ulcer." "You should eat several small meals each day rather than three larger meals." "Take each dose of ranitidine with an antacid of your choice." "This drug will help to eliminate the bacteria in your stomach that caused your ulcer."

"Quitting smoking will significantly increase the chance that this drug will heal your ulcer." Explanation: Smoking reverses the drug-induced inhibition of nocturnal gastric acid production and hinders ulcer healing. Cigarette smoking also is related closely to ulcer recurrence. Ranitidine should not be taken simultaneously with antacids and it does not eradicate H. pylori. It is not necessary to eat multiple small meals during the day.

In preparing a teaching plan for a patient who is to receive misoprostol, which would the nurse include as possible adverse effects? (Select all that apply.) Flatulence Dizziness Dyspepsia Excessive vaginal bleeding Dysmenorrhea Vertigo

Flatulence Excessive vaginal bleeding Dyspepsia Dysmenorrhea Explanation: Flatulence is a possible adverse effect. Excessive vaginal bleeding is a possible adverse effect of misoprostol. Dyspepsia is a possible adverse effect of misoprostol. Dysmenorrhea is a possible adverse effect of misoprostol. Dizziness is not associated with misoprostol. Vertigo is not associated with misoprostol.

The health care provider has prescribed ranitidine for a hospitalized client on a unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the client? Visual disturbances Headache Tremors Bone fracture

Headache Explanation: Adverse effects with H2RAs such as ranitidine are typically uncommon and mild with the usual doses and duration of treatment. However, effects can include diarrhea or constipation, headache, dizziness, muscle aches, and fatigue.

A client is receiving sodium bicarbonate orally. Which of the following would lead the nurse to suspect that the client is developing systemic alkalosis? (Select all that apply.) Confusion Tetany Irritability Constipation Headache

Headache Confusion Irritability Tetany Explanation: Indications of systemic alkalosis include headache, confusion, irritability, tetany, nausea, and weakness.

Ms. Law has been taking omeprazole for the last 10 years. What is the risk to the patient from long-term use of omeprazole? Increased risk of gastric cancer Erosion of the esophagus Loss of stomach acid production, resulting in metabolic alkalosis Decreased function of the lower esophageal sphincter

Increased risk of gastric cancer Explanation: Long-term PPI administration in rats has demonstrated an increased rate of gastric cancer. This finding has not been replicated in humans. PPIs do cause hypergastrinemia, which in turn causes diffuse, linear, or micronodular hyperplasia and atrophic gastritis. These changes occur most frequently in patients with Helicobacter pylori infection and markedly increased gastrin levels. Gastric hyperplasia and atrophic gastritis in combination with H. pylori infection increase the risk of gastric cancer, but there are no studies that show a direct correlation between PPI administration and gastric cancer.

The nurse should explain that metoclopramide (Reglan) decreases nausea and vomiting by which of the following actions?

Inhibiting stimulation of the vomiting center in the brain Explanation: Reglan inhibits stimulation of the vomiting center in the brain. This medication also increases the amplitude of gastric contractions and gastric motility while decreasing gastric emptying time.

Mr. Palmer is scheduled to receive ranitidine at 9:00 am this morning. What is a correct explanation of the pharmacodynamics of ranitidine? It affects pepsin secretion. It has effects on prolactin levels, gonadotropins, thyroid-stimulating hormone, growth hormone, cortisol, aldosterone, androgen and estrogen levels, and sperm count. It inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion. It has effects on fasting or postprandial serum gastrin secretion.

It inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion. Explanation: Ranitidine inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion stimulated by food, betazole, and pentagastrin. Ranitidine does not affect pepsin secretion. It has little or no effect on fasting or postprandial serum gastrin secretion. It has no effect on prolactin levels, gonadotropins, thyroid-stimulating hormone, growth hormone, cortisol, aldosterone, androgen or estrogen levels, or sperm count.

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform? Monitor the patient for concentrated urine and restlessness. Closely monitor the patient for confusion and dizziness. Monitor the patient for signs of tardive dyskinesia. Closely monitor for reports of sour taste and pain.

Closely monitor the patient for confusion and dizziness. Explanation: The nurse should closely monitor the elderly patient who has been administered cimetidine for confusion and dizziness. When the patient is receiving an antiemetic, the nurse monitors the patient frequently for continued reports of pain, sour taste, spitting blood, or coffee-ground-colored emesis. When antacids are given to the patient, the nurse should observe the patient for concentrated urine and restlessness. When the patient is administered prolonged doses of metoclopramide, the nurse reports any sign of tardive dyskinesia or extrapyramidal symptoms to the PHCP.

A group of students are reviewing the signs and symptoms of systemic alkalosis that can occur as a result of using sodium bicarbonate. The students demonstrate a need for additional teaching when they identify which as a possible manifestation? Confusion Muscle twitching Constipation Tetany

Constipation Explanation: Constipation is not considered a manifestation of systemic alkalosis. Confusion is a manifestation of systemic alkalosis. Muscle twitching is a manifestation of systemic alkalosis. Tetany is a manifestation of systemic alkalosis.

The nurse is preparing a teaching plan for a patient who is receiving sucralfate. Which would the nurse need to address? (Select all that apply.) Ensuring safety precautions Taking the drug on an empty stomach Eating a high fiber diet Using an antidiarrheal agent Limiting fluid intake Encouraging frequent mouth care

Eating a high fiber diet Ensuring safety precautions Taking the drug on an empty stomach Encouraging frequent mouth care Explanation: Constipation is the most common adverse effect. A high fiber diet is needed to prevent constipation. Dizziness and vertigo can occur with this drug; safety precautions would be important. The drug should be taken on an empty stomach, 1 hour before or 2 hours after meals to ensure therapeutic effectiveness. Frequent mouth care is important in combating dry mouth, which is associated with this drug. Constipation is the most common adverse effect. Increased fluid intake is needed to promote bowel elimination. It also helps to combat dry mouth. Diarrhea can occur, but it is not a common adverse effect and would most likely require dietary adjustments, not drug therapy.

Which of the following could a nurse expect to administer intravenously? Omeprazole Rebeprazole Dexlansoprazole Esomeprazole

Esomeprazole Explanation: Esomeprazole is available in intravenous preparations and delayed-release oral forms. Omeprazole, rabeprazole, and dexlansoprazole are available in delayed release oral forms only.

A nurse is preparing to administer a drug that reduces the secretion of gastric acid by inhibiting the action of histamine at H2 receptors in the stomach. Which medication might the nurse be preparing to administer? Select all that apply. Ranitidine Esomeprazole Famotidine Calcium carbonate Lansoprazole

Famotidine Ranitidine Explanation: Ranitidine and famotidine are drugs that reduce the secretion of gastric acid by inhibiting the action of histamine at H2 receptors in the stomach. Esomeprazole and lansoprazole are proton pump inhibitors and suppress gastric acid by inhibition of the hydrogen-potassium adenosine triphosphatase (ATPase) enzyme system of the gastric parietal cells. Calcium carbonate is an acid neutralizer that reduces the pH of the acid in the stomach and duodenum, used for symptomatic relief of peptic ulcer and stomach hyperacidity, and calcium deficiencies such as osteoporosis.

A nurse educating a client on the antacid calcium carbonate (Mylanta) should warn the client of which of the following adverse reactions? Select all that apply: Anorexia Headache Rebound hyperacidity Confusion Dehydration

Rebound hyperacidity Headache Confusion Explanation: Adverse reactions of calcium carbonate (Mylanta) include rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment.

Why might a proton pump inhibit (PPI) be preferable to an a histamine2 receptor antagonists (H2RA) for the treatment of gastroesophageal reflux disease (GERD)? Select all that apply. PPIs have fewer adverse reactions. PPIs act for a longer period of time. PPIs suppress acid more effectively. PPIs facilitate faster healing. PPIs strengthen the cardiac sphincter.

PPIs facilitate faster healing. PPIs act for a longer period of time. PPIs suppress acid more effectively. Explanation: Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases. The preferences do not include healing properties or adverse reactions.

Antacids have not been effective in managing a client's gastroesophageal reflux disease, so the health care provider is prescribing a proton pump inhibitor. Why might the health care provider prescribe a proton pump inhibitor (PPI) rather than a histamine2 receptor antagonist (H2RA)? PPIs suppress acid more strongly and for a shorter time. H2RAs do not suppress acid. PPIs suppress acid more strongly and for a longer time. PPIs are less expensive.

PPIs suppress acid more strongly and for a longer time. Explanation: Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases.

The nurse is caring for an adult client presenting with recent heartburn, which the client treated with over-the-counter omeprazole 20 mg PO daily. After reviewing the client's current list of medications, the nurse should report which medication because concurrent use may increase blood levels of omeprazole? Clarithromycin Phenytoin atorvastatin Enteric-coated aspirin

Phenytoin Clarithromycin Explanation: Clarithromycin increases effects of omeprazole and may increase blood levels of the latter. Omeprazole increases blood levels of phenytoin, a medication prescribed for seizure disorders. Neither aspirin nor atorvastatin increases the blood level of omeprazole.

The client diagnosed with peptic ulcer disease states, "I've never been a really anxious type of person, so I never thought I'd develop ulcers." The nurse has responded with health education addressing the etiology of peptic ulcer disease (PUD). What causative factors should the nurse cite? Select all that apply. Diabetes Physiologic or psychological stress Cigarette smoking Nonsteroidal anti-inflammatory drugs Infections

Physiologic or psychological stress Cigarette smoking Infections Nonsteroidal anti-inflammatory drugs Explanation: There are multiple etiologic factors implicated in PUD. These include smoking, H. pylori infection, NSAID use, and stress. Diabetes is not an identified cause of PUD.

The client diagnosed with peptic ulcer disease states, "I've never been a really anxious type of person, so I never thought I'd develop ulcers." The nurse has responded with health education addressing the etiology of peptic ulcer disease (PUD). What causative factors should the nurse cite? Select all that apply. Physiologic or psychological stress Diabetes mellitus Cigarette smoking Nonsteroidal anti-inflammatory drugs Infections

Physiologic or psychological stress Cigarette smoking Infections Nonsteroidal anti-inflammatory drugs Explanation: There are multiple etiologic factors implicated in PUD. These include smoking, H. pylori infection, NSAID use, and stress. Diabetes is not an identified cause of PUD.

Which agent would a nurse identify as inhibiting the secretion of gastrin? Proton pump inhibitors Histamine-2 antagonists Prostaglandin Antacids

Prostaglandin Explanation: Prostaglandins inhibit the secretion of gastrin and increase the secretion of the mucous lining of the stomach, providing a buffer. Histamine-2 antagonists block the release of hydrochloric acid in response to gastrin; proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach, and antacids interact with acids at the chemical level to neutralize them.

A client is diagnosed with peptic ulcer disease complicated by H. pylori. What is the rationale for adding bismuth to the client's medication regimen? Decreases gastrin secretion Provides antibacterial effects Increases pepsin activity Prevents metabolic alkalosis

Provides antibacterial effects Explanation: Health care providers use bismuth subsalicylate to coat ulcers, protecting them from stomach acid to treat H. pylori. Bismuth does not increase pepsin activity, decrease gastrin secretion, or prevent metabolic alkalosis.

A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the client's safety. What would be an appropriate nursing diagnosis? Acute Pain related to adverse drug effects, headache Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations Diarrhea related to adverse effects of drug therapy Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy

Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations Explanation: The appropriate nursing diagnosis related to safety would be Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations. Diarrhea related to adverse effects of drug therapy and Acute Pain related to adverse drug effects, headache are appropriate nursing diagnosis for a patient taking ranitidine, but are not related to safety. Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy would be appropriate for a client taking an aluminum hydroxide with magnesium hydroxide antacid (Maalox, Mylanta).

A nurse is caring for a patient who is prescribed omeprazole for a duodenal ulcer. The patient is also taking benzodiazepines for the management of a seizure disorder. Which of the following should be the effect of the interaction between these two drugs? Increased risk of respiratory depression Increased risk of bleeding Decreased absorption of the proton pump inhibitor Risk for toxic level of benzodiazepines

Risk for toxic level of benzodiazepines Explanation: When the proton pump inhibitor is administered with benzodiazepines, there will be a risk for a toxic level of benzodiazepines. When the patient is administered sucralfate with the proton pump inhibitor, there will be a decrease in absorption of the proton pump inhibitor. When the patient is administered an antacid with opioid analgesics, there will be an increased risk of respiratory depression. There will be increased risk of bleeding when the patient is taking oral anticoagulants with the proton pump inhibitor.

The following data identified during a nursing assessment and interview. When considering risks for the development of a peptic ulcer, which situation should the nurse discuss with the client? Is 15 pounds over ideal weight Has a stressful job as a air traffic controller. Eats spicy food at least twice a week. Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.

Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. Explanation: The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach. While the other situations may contribute to GI distress, NSAID used in primary risk factor for this client.

A client is receiving a liquid antacid. Which would the nurse instruct the client to do? Remove any items with strong smells or odors. Drink a full glass of water after taking the drug. Take 1 hour before meals. Shake the antacid thoroughly before using. Take sips of fluid at frequent intervals.

Shake the antacid thoroughly before using. Explanation: Liquid antacid preparations must be shaken thoroughly immediately before administration. Taking 1 hour before meals is a directive of administering a proton pump inhibitor. A full glass of water is taken after a client chews an antacid tablet thoroughly. Removing strong smells or odors is important for the client experiencing nausea. Frequent sips of fluid are appropriate if the client is experiencing nausea and vomiting.

A client diagnosed with an H. pylori-associated ulcer has been prescribed treatment that includes two antimicrobials. What does the nurse identify as the reason for using multiple antimicrobials? A single antimicrobial is generally not strong enough to eradicate the infection. Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms. One antimicrobial tends to alter the action of the adjunct medications. Two different microbes are involved, requiring two different antimicrobials.

Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms. Explanation: Effective treatment of an H. pylori-associated ulcer involves two antimicrobials—including amoxicillin, clarithromycin, metronidazole, or tetracycline—to reduce the risk of resistance. None of the other options present accurate information regarding the basis for treatment.

When educating a client prescribed a histamine-2 antagonists, which of the following should be avoided? Select all that apply. cigarettes alcohol fibrous foods caffeine acid stimulating foods

cigarettes alcohol caffeine acid stimulating foods Explanation: The instruction should include ways to decrease acid production (such as avoiding cigarettes, acid stimulating foods, alcohol, and caffeine). Fibrous foods are not considered acid stimulating.

The nurse is caring for a client who is prescribed esomeprazole. The client informs the nurse that he is also taking sucralfate. The nurse would anticipate which effect as a possibility when these two drugs are administered? increase the risk of sedation increase the risk of a hypertensive episode decrease the effectiveness of sucralfate decreased absorption of the esomeprazole

decreased absorption of the esomeprazole Explanation: The nurse should inform the client that there will be decreased absorption of the esomeprazole as an effect of the interaction between esomeprazole and sucralfate. The interaction between the two drugs will not decrease the effectiveness of sucralfate, increase the risk of a hypertensive episode, or increase the risk of sedation.

A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for: Metabolic Acidosis Metabolic Alkalosis Hypocholesteremia Hypocalcemia

metabolic alkalosis. Explanation: Overuse of antacids containing calcium carbonate can cause alkalosis and raise urine pH.

Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply: Promethazine (Phenergan) Metoclopramide (Reglan) Omeprazole (Prilosec) Lansoprazole (Prevacid) Ondansetron (Zofran)

metoclopramide Explanation: Tardive dyskinesia (nonreversible, involuntary muscle spasms), which is typically associated with conventional antipsychotics, is known to occur with long-term use (12 weeks or more) of metoclopramide. Ondansetron is used in the treatment of nausea and vomiting and works by blocking serotonin. Famotidine is used to treat esophagitis and is used cautiously in clients with diabetes. Lansoprazole is used to treat gastric and duodenal ulcers, GERD, and pathologic hypersecretory condition and prolonged treatment may decrease the body's ability to absorb vitamin B12, resulting in anemia.

How does histamine release contribute to ulcer formation? stimulates denaturing of gastrin destroys parietal cells initiates pepsin synthesis stimulates gastric acid secretion

stimulates gastric acid secretion Explanation: Vagal stimulation causes release of histamine from cells in the gastric mucosa. The histamine then acts on receptors located on the parietal cells to increase production of hydrochloric acid, which is a factor in stomach ulcer formation. Histamine is not associated with either pepsin or gastrin, and it does not destroy the parietal cells.

What type of medication might be included in the medication therapy to treat a peptic ulcer by serving as a barrier to gastric secretions? Proton Pump Inhibitors (PPIs) Sucralfate Histamine2 receptor antagonists (H2RAs) Antacids

sucralfate Explanation: Sucralfate provides a barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production. Histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) decrease gastric acid secretion.

The nurse is caring for a client diagnosed with cancer. The nurse should perform which assessment(s) for safe administration of the ondansetron? Select all that apply. Determine if the client takes any antidepressants or antipsychotic drugs for possible interactions. Monitor for adverse effects, including diarrhea, hypotension, and decreased respirations. Obtain baseline vital signs and renal profile with electrolytes at baseline to compare with later labs. Check for uncontrolled movements of mouth and tongue, or difficulty with speaking. Assess if the client has any nausea or vomiting, and if so the number of episodes and amount of vomitus.

Determine if the client takes any antidepressants or antipsychotic drugs for possible interactions. Assess if the client has any nausea or vomiting, and if so the number of episodes and amount of vomitus. Obtain baseline vital signs and renal profile with electrolytes at baseline to compare with later labs. Explanation: Ondansetron is a serotonin blocker that blocks the vomiting center. If the client also takes antidepressants called selective serotonin reuptake inhibitors (SSRIs), or other psychiatric meds that increase the serotonin level this can lead to serotonin syndrome. The syndrome leads to confusion, hallucinations, overactive reflexes, dilated pupils, muscle spasms, tachycardia, and nausea. It is important to assess if there is a presence of nausea or vomiting. The medication is prescribed to help prevent nausea and vomiting while the client is taking chemotherapy. The client will receive the med before chemo, and after the treatment is completed for the next 24 hours or longer. If vomiting occurs, assess the intake and output and skin turgor for signs of dehydration. Also watch for any symptoms of electrolyte imbalances. Baseline vital signs and renal profile with electrolytes are needed for comparison, if the client develops dehydration or electrolyte imbalances. The nurse does not need to assess the client for symptoms of tardive dyskinesia: uncontrolled movements of mouth, tongue, or difficulty speaking or swallowing. Tardive dyskinesia may be an adverse effect of long-term use of metoclopramide. The nurse does not need to assess for diarrhea, hypotension and decreased respirations, which are side effects of magnesium containing antacids.

A female client self-administers magnesium antacids. She presents to the office with symptoms of dizziness and weakness. The nurse knows that these symptoms are secondary to what common adverse effect of magnesium antacids? Hypercalcemia Diarrhea Hypocalcemia Hyperglycemia

Diarrhea Explanation: Magnesium antacids have high neutralizing capacity and may cause diarrhea and hypermagnesemia.

The nurse is scheduled to administer sucralfate 1 gram po four times daily to a pregnant client admitted with gastroesophageal reflux disease (GERD). What is the priority teaching that would be provided regarding this medication? The drug acts locally and protects the mucosa lining of the stomach. The drug may cause constipation, so eat foods high in fiber. Report any allergic reaction to your primary care provider. Take the medicine one hour before meals and at bedtime.

Take the medicine one hour before meals and at bedtime. Explanation: The priority in the situation is to make sure that the client understands the importance of taking the medicine 1 hour before meals and bedtime to provide an empty stomach for the drug to locally act upon the mucosa and protect the stomach. If the client takes the med with food or after eating, then the drug cannot help in relieving the symptoms of GERD. Sucralfate is safe for pregnancy because it is locally absorbed and not significantly absorbed through the systemic circulation. It is extremely rare for an allergic reaction, so this point is not the highest priority for teaching about the drug. The main side effect is constipation. Knowing to eat high fiber foods does not emphasize the importance of how to take the med to make sure it is effectively absorbed.

A woman is prescribed a Histamine-2 (H2) antagonists. What information should the nurse provide the client concerning the use of this class of medication if a pregnancy should occur? These medications are safe for use during pregnancy and lactation The safety of these drugs during pregnancy had not been established. Most medications in this class have been proven to cause spontaneous abortions. These drugs do not pass into breastmilk

The safety of these drugs during pregnancy had not been established. Explanation: The safety of these drugs during pregnancy and lactation has not been established, so they should be used with caution during pregnancy or lactation. Misoprostol is an abortifacient and should never be used during pregnancy.

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is: headache. irritability. dry mouth. heart palpitations.

headache. Explanation: Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the client to adjust lights or temperature and avoid noise if headaches occur and to contact the health care provider if the headache becomes intolerable. Irritability, dry mouth, and heart palpitations are not associated with this drug.

While reviewing the medication history of a client newly prescribed omeprazole, the nurse sees that the client is also taking warfarin. What potential interaction should the nurse account for when developing the plan of care for this client? rebound gastroesophageal reflux disease (GERD) venous thromboembolism hemorrhage fluid volume excess

hemorrhage Explanation: Omeprazole increases blood levels of the anticoagulant warfarin, thus creating a risk for bleeding. Such an elevation in warfarin would not increase the risk for the development of any of the other options.