NUR 316 | Chapter 57: Drugs Affecting GI Secretions

Ranitidine and cimetidine are both H2RAs used in the treatment of peptic ulcer disease. Of the two, ranitidine is preferred in critically ill clients because it is less likely to:

Interfere with the metabolism of other drugs.

Ranitidine is a histamine2 receptor antagonist (H2RA) prescribed for treatment of peptic ulcer disease and gastric reflux. Dosage of ranitidine must be reduced in patients with what condition?

Renal disease

After teaching a client who is receiving sucralfate about the drug, which statement indicates that the teaching has been successful?

"I should eat a high-fiber diet"

Ms. Kime is prescribed ranitidine in addition to the antacid that she already takes for gastric reflux. Which statement made by the patient indicates that she understood the teaching provided about taking these medications?

"I should take ranitidine 2 hours before or after my antacid dosage."

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."

A patient is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the patient's symptoms be abolished?

1-2 weeks

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

30 minutes

When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?

Alopecia

The nurse is caring for four patients. Which patient would benefit most from misoprostol, a synthetic prostaglandin E analog?

An 83-year-old male with rheumatoid arthritis

Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in patients who:

Are pregnant

An antacid has been added to the treatment regimen for a client on multiple medications. When is the best time for the nurse to administer the antacid?

At bedtime

The nurse is teaching a 31-year-old patient about lansoprazole, which the physician has prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease?

By inhibiting acid secretion

Which agent is associated with antiandrogenic effects?

Cimetidine

Which agent would a nurse identify as the prototype histamine-2 receptor antagonist?

Cimetidine

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?

Closely monitor the patient for confusion and dizziness.

The nurse should warn a patient taking aluminum and calcium-containing antacids about which adverse effects?

Constipation

The nurse is caring for a male patient who is prescribed esomeprazole magnesium (Nexium) for the treatment of diarrhea. The patient informs the nurse that he is also taking sucralfate for GI distress. What effects of interaction between the two drugs should the nurse inform the patient about?

Decreased absorption of the esomeprazole magnesium

When teaching a patient about an antacid containing aluminum, what would the nurse include?

Decreased risk for acid rebound

The nurse instructs the patient to use over-the-counter ranitidine (Zantac) instead of cimetidine (Tagamet). What risk is decreased when using ranitidine over cimetidine?

Drug-Drug interaction

Which of the following would a nurse expect to administer intravenously?

Esomeprazole

What reduces the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells? (Select all that apply.)

Esomeprazole (Nexium) Lansoprazole (Prevacid)

If a patient is receiving sucralfate and omeprazole, the doses can be taken together.

False

Saliva substitute is absorbed systemically.

False

A male patient is taking misoprostol (Tagamet). Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

Gynecomastia

Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?

Gynecomastia

The physician has prescribed ranitidine for a patient in your unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the patient?

H/A

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

A patient is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to patients with which of the following conditions?

Hepatic Disease

Carter, age 2, is diagnosed with cystic fibrosis; the physician places him on pancrelipase. What would be the most appropriate diagnosis for Carter related to his medication regimen?

Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?

Increased fracture risk

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

A 32-year-old patient 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 patient that overuse could place him at risk for:

Metabolic Alkalosis

Which medication is a prostaglandin drug that is used to reduce the risk of NSAID-induced gastric ulcers in high-risk patients, such as the elderly or the critically ill?

Misoprostol (Cytotec)

A client has a history of liver dysfunction. Which histamine-2 receptor antagonist would the nurse expect to be prescribed?

Nizatidine

A patient is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?

Omeprazole

After teaching a group of students about proton pump inhibitors, the instructor determines that the students have understood the information when they identify which agent as the prototype proton pump inhibitor?

Omeprazole

Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?

Omeprazole

A patient is prescribed misoprostol. The nurse would expect to administer this drug by which route?

Oral

A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to

Pork

A client is diagnosed with Helicobacter pylori infection. The physician will order amoxicillin and what other type of medication?

Proton Pump Inhibitors

A female client presents to the physician's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client?

Rebound acidity

The patient has Maalox ordered for administration before meals. Which of the following conditions is contraindicated with the administration of Maalox?

Renal dysfunction

A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the patient's safety. Which of the following would be an appropriate nursing diagnosis?

Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations

A patient who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess:

Serum phosphate level

A 75-year-old client is treating his ulcer with antacids. Based on the client's age, the nurse expects the physician to prescribe a dose of antacid that compares with the average prescribed dose in what way?

Smaller than the average prescribed dose

Histamine is a substance found in almost every body tissue and is released in response to specific stimuli. What is an effect of histamine release?

Stimulation of gastric acid secretion

Pancrelipase would most likely be used to treat a patient with cystic fibrosis.

True

The use of calcium carbonate is associated with the development of acid rebound.

True

In treating Helicobacter pylori infection, a physician prescribes two antimicrobials because:

Two are needed to prevent the emergence of drug-resistant H. pylori organisms.

A 30-year-old nonpregnant patient is prescribed misoprostol. Which of the following should the nurse instruct the patient as part of the teaching plan?

Use a reliable contraceptive.

A 23-year-old female patient is prescribed misoprostol (Cytotec). Which patient teaching intervention is most important?

Use effective contraceptive measures

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:

an hour before meals.

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.