Nursing Pharm - Chapter 57
The nurse should be aware that ranitidine achieves a therapeutic effect by which means?
Inhibiting the secretion of gastric acid The histamine2 receptor antagonists (H2RAs) inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin. These drugs, such as ranitidine, do not change the pH of secretions, bind to the proton pumps, or decrease gastric motility.
An older client has been prescribed omeprazole for the treatment of gastresophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine?
"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." Proton pump inhibitors like omeprazole may be the best choice for treating GERD in older patients because of fewer adverse effects and better therapeutic response with these drugs. Famotidine is a histamine-2 antagonists. The cost of the medication is not a primary factor in prescribing therapy for GERD. It is not standardly recommended to take omeprazole at bedtime.
A female client has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse?
"Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine." If both ranitidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of ranitidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the ranitidine. The other three statements are not true.
A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?
30 minutes Sucralfate has an onset of action of 30 minutes and a duration of 5 hours.
A critical care nurse is preparing to administer an intragastric drip of an antacid to a client through a nasogastric tube. How should the nurse most accurately titrate the dose and frequency?
By aspirating stomach contents and measuring the pH For clients with a nasogastric tube in place, antacid dosage may be titrated by aspirating stomach contents, determining pH, and then basing the dose on the pH. Accurate measurement of gastric pH cannot be determined from the buccal mucosa or urine.
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 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.
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?
Gynecomastia Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.
A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition?
Hepatic disease No contraindications exist, but the use of cimetidine should be used cautiously in clients with impaired hepatic and renal function. The client with cancer, hypertension, and diabetes mellitus can take cimetidine safely.
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?
Increased fracture risk An increase in fractures of the hip, wrist, and spine have been seen in clients taking high doses of PPIs and undergoing treatment of osteoporosis with bisphosphonates.
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 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.
A client has a history of liver dysfunction. Which histamine-2 receptor antagonist would the nurse expect to be prescribed?
Nizatidine Nizatidine is the drug of choice for clients with liver dysfunction because it does not undergo first-pass metabolism in the liver like the other histamine-2 receptor antagonists such as cimetidine, famotidine, or ranitidine.
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 Omeprazole is considered the prototype proton pump inhibitor.
A client is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which disease is a result of cellular destruction of the gastrointestinal tract from this medication?
Peptic ulcer disease Cell destruction will occur from the ingestion of NSAIDs, which can lead to the development of peptic ulcer disease. Nonsteroidal anti-inflammatory agents do not cause esophageal cancer, bowel obstruction, or liver cancer.
The client has a magnesium-based antacid prescribed for administration before meals. The nurse knows to withhold the medication if the client exhibits what?
Renal dysfunction Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.
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?
Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. 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 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. The nurse should instruct the patient to use a reliable contraceptive to avoid pregnancy during the course of treatment as it can cause birth defects. The nurse should instruct the patient taking proton pump inhibitors not to chew, open, or crush the tablet but to swallow the tablet whole at least one hour before eating. The nurse needs to inform the patient to take the drug for motion sickness about one hour before travel.
A nurse is providing education to a 23-year-old female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching?
Use effective contraceptive measures. Misoprostol is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. It is not necessary for a client aged 23 years to report postmenopausal bleeding. The medication should be administered two to four times per day.
A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?
Infection with H. pylori Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).
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?
hemorrhage 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.
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. Unlike cimetidine, ranitidine does not affect the cytochrome P450 drug-metabolizing system in the liver and therefore does not interfere with the metabolism of other drugs by that system.
The client will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include:
headache. Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists.
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 Pancrelipase is contraindicated in patients who are hypersensitive to pork protein or enzymes because the drug is derived from pork. Allergies to ragweed, pollen, and shellfish are not associated with the use of the drug.
An older adult has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect?
constipation With the antacid that contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.
