Prep U - Qs /Chapter 57: Drugs Affecting Gastrointestinal Secretions

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." Explanation: Constipation is the most frequently seen adverse effect; thus, the client should increase his fiber intake to prevent constipation. Diarrhea is possible, but constipation is more likely. The client should drink fluids and use sugarless lozenges to help with a dry mouth. Fluid intake also will help to prevent constipation.

Which statement by a patient receiving pancrelipase indicates that the patient has understood his instructions?

"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 32-year-old female executive comes to the clinic with severe heartburn. The health care provider prescribes omeprazole (Prilosec). The client asks the nurse when the pain will go away. What is an appropriate response by the nurse?

Acid-inhibiting effects occur within 2 hours. Explanation: Acid-inhibiting effects occur within 2 hours, not within minutes of the first dose. Symptoms will usually be eliminated within 1-2 weeks, with the full course of medication lasting 2-8 weeks, and some patients do remain on omeprazole longer term, however these responses do not answer the client's question.

A client, with recent abdominal pain and a 40-pack per year smoking history, is prescribed a treatment regimen for a diagnosis of duodenal ulcer. What important teaching would the nurse include in relation to treatment?

smoking effects on the healing of ulcers Explanation: Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of nonsmokers. The treatment is focused on healing, and smoking will impede the achievement of that goal. Acute not chronic pain is the focus of the client's concerns. Medication should be taken until discontinued by the health care provider. While a discussion concerning the health dangers associated with smoking is appropriate, such information is not related to the client's current health issue.

A nurse is teaching a client about omeprazole, which has been prescribed as part of a regimen to treat an H. pylori infection. What statement, made by the client, suggests that the client understands proper use of the drug?

"I need to swallow the drug whole." Explanation: Omeprazole, a proton pump inhibitor, must be swallowed whole; it should not be cut, crushed or chewed. The drug should be taken approximately an hour before a meal, not after a meal. Concomitant use of antacids is common, though the health care provider may instruct the client to take the two medications at different times during the day.

A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time?

1 hour before eating Explanation: Proton pump inhibitors such as lansoprazole should be swallowed whole at least 1 hour before eating. The proton pump inhibitors suppress gastric acid secretion by blocking the final step in the production of gastric acid by the gastric mucosa. After meals will inhibit suppression of gastric acid. On rising and at bedtime are not optimal times to take lansoprazole.

Which of the following antacids may produce constipation and should be used cautiously in clients that have chronic constipation? Select all that apply:

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

A hospital client's current drug regimen includes antibiotics and proton pump inhibitors. When planning this client's care, the nurse should perform what action?

Ensure the client's meals are not spicy or highly acidic Explanation: Currently, the most commonly used therapy for gastric ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate Helicobacter pylori. A client with gastric ulcers benefits from a low-spice, low-acid diet. Hospital clients should not be encouraged to supplement with medications from home. The client's calcium levels are not threatened and rescheduling meals may or may not be beneficial.

A 75-year-old client is diagnosed with type 2 diabetes mellitus, hypertension, osteoporosis, and gastric ulcer disease. She is prescribed PPIs. The nurse is aware that long-term (greater than 1 year) administration of PPIs may increase the risk for which problem for this client?

Hip fractures Explanation: Proton pump inhibitors (PPIs) are known to decrease calcium absorption which can lead to hypocalcemia. This in turn affects the bones leading to osteoporosis. For clients over the age of 50, the long term use of PPIs (more than one year) will increase the risk for hip fractures due to the affect on the bones. PPTs can be used to treat gastric ulcers. It is not known to cause liver cancer.

Which of the following would a nurse expect to administer if the goal of therapy is to block the release of hydrochloric acid in the stomach?

Histamine-2 receptor antagonist Explanation: Histamine-2 (H2) 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. Antacids interact with acids at the chemical level to neutralize them. Prostaglandins inhibit the secretion of gastrin and increase the secretion of the mucous lining of the stomach, providing a buffer.

The nurse should be aware that ranitidine achieves a therapeutic effect by which means?

Inhibiting the secretion of gastric acid Explanation: 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.

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 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.

A female client presents to the health care provider'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 Explanation: Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.

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 Explanation: Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.

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?

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.

Which antacids would the nurse identify as being contraindicated in clients with heart failure?

Sodium bicarbonate Explanation: Sodium bicarbonate is the antacid that is contraindicated in clients with cardiovascular problems, such as hypertension and heart failure, and in those on sodium-restricted diets, as sodium bicarbonate can alter the body's sodium-water balance and cause fluid retention. Calcium carbonate, magnesium hydroxide, and aluminum hydroxide are all acid neutralizers and are not contraindicated in clients with heart failure.

Client teaching should include what instruction about antacids?

Take antacid 1 hour before other medications. Explanation: Administer the drug apart from any other oral medications approximately 1 hour before or 2 hours after to ensure adequate absorption of the other medications.

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. Explanation: 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. Explanation: 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.

An older adult client has been on long-term proton pump inhibitor (PPI) therapy. The nurse practitioner should focus on what assessment related to adverse effects?

bone density Explanation: Long-term use of PPIs is associated with increased risk of hip fractures in people older than 50 years of age; the risk of fractures increases the longer the medications are taken and is greater in people who take higher dosages of PPIs. Bone density assessment may thus be warranted. None of the other options are associated with this class of medications.

The nurse is caring for a client who is prescribed esomeprazole. The client informs the nurse that they are also taking sucralfate. The nurse would anticipate which effect as a possibility when these two drugs are administered?

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.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

decreases production of gastric secretions Explanation: PPIs decrease gastric acid secretion. Antimicrobials and bismuth can eliminate H. pylori infection. Sucralfate provides a protective barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production.

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. 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.

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. Explanation: 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.

A client 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. Explanation: The nurse should monitor the client's serum phosphate level because aluminum binds with phosphate. This can lower phosphate levels and cause an electrolyte imbalance. Blood glucose, urine specific gravity, and aspartate transaminase levels are not affected by this drug combination.

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

1 to 2 weeks Explanation: The symptoms of gastroesophageal reflux disease will most likely be resolved in 1 to 2 weeks after the start of the proton pump inhibitor medication regime. It will not take 6, 10, or 12 weeks to see a change with the proton pump inhibitor.

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

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

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 Explanation: 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 asthma can take cimetidine safely.

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 Explanation: Omeprazole is considered the prototype proton pump inhibitor.

A female client is self-administering cimetidine. What is the home care nurse's most important assessment of this client?

Potential drug-drug interactions Explanation: The home care nurse can assist clients by providing information about taking the drugs correctly and monitoring responses. If cimetidine is being taken, the home care nurse needs to assess for potential drug-drug interactions.

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?

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.

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?

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.

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

True

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?

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.

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

are pregnant. Explanation: Misoprostol is contraindicated during pregnancy because it may cause abortion, premature birth, or birth defects. It is also contraindicated in women of childbearing potential who are not using effective contraception.

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 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.

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. Explanation: 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.

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

A nurse is teaching a client who has just been prescribed lansoprazole . What statement would indicate that the client correctly understands the action of this medication?

"The medication inhibits acid secretions." Explanation: The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine triphosphatase (H+,K+-ATPase) enzyme system on the secretory surface of the gastric parietal cells. The statement, "The medication inhibits acid secretions," indicates that the client understands that the medication inhibits acid secretion. This medication does not act as an antibiotic or analgesic, nor will it repair the ulcer.

A female client has GERD and is taking cimetidine. 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 cimetidine." Explanation: If both cimetidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of cimetidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the cimetidine. The other three statements are not true.

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 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.

Which would a nurse anticipate as having antiandrogenic effects?

Cimetidine Explanation: Cimetidine has been associated with antiandrogenic effects such as gynecomastia and galactorrhea.

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

Cimetidine Explanation: Cimetidine is considered the prototype histamine-2 receptor antagonist.

Which agent is associated with antiandrogenic effects?

Cimetidine Explanation: Cimetidine was the first drug in this class to be developed and has been associated with antiandrogenic effects including gynecomastia and galactorrhea. Ranitidine, famotidine, and nizatidine are not associated with these effects.

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. 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.

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 Explanation: 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.

The nurse should warn a client taking magnesium- and sodium-containing antacids about which adverse effects?

Diarrhea Explanation: The nurse should warn a client taking magnesium- and sodium-containing antacids about diarrhea, which can be associated with taking products containing either medication. Constipation is seen with taking aluminum- and calcium-containing antacids. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.

Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?

Drug-drug interactions Explanation: Ranitidine, which is longer acting and more potent than cimetidine, is not associated with the antiandrogenic adverse effects or the marked slowing of metabolism in the liver, as cimetidine is, and therefore does not interfere with the metabolism of other drugs.

The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine rather than cimetidine?

Drug-to-drug interaction Explanation: Ranitidine causes fewer drug interactions than cimetidine. Ranitidine possesses the following adverse effects: headache, diarrhea, and bradycardia.

A male client is taking cimetidine. Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

Gynecomastia Explanation: Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine.

A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to clients with which condition?

Hepatic disease Explanation: No absolute contraindications exist, but 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.

Mr. Palmer is scheduled to receive ranitidine at 9:00 am this morning. What is a correct explanation of the pharmacodynamics of ranitidine?

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

Omeprazole Explanation: Omeprazole is a proton pump inhibitor which is used as part of combination therapy to treat H. pylori infections. Magaldrate is an antacid that is used to relieve GI hyperacidity. Sucralfate is a GI protectant that is used as short-term treatment of duodenal ulcers. Cimetidine is a H-2 receptor antagonist used to treat duodenal and benign gastric ulcers.

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 Explanation: Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.

Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply:

Omeprazole (Prilosec) Lansoprazole (Prevacid) Explanation: The proton pump inhibitors, like omeprazole (Prilosec) and lansoprazole , are commonly used in combination with certain antibiotics in the treatment of H. pylori.

An older client has been prescribed a proton pump inhibitor. When addressing the medication's effect on nutrient absorption and the resulting risks, which medical condition should the nurse discuss with the client?

Pernicious anemia Explanation: The use of proton pump inhibitors and H2 blockers in older adults has been associated with decreased absorption of vitamin B12 and the development of pernicious anemia. The medication can cause hypocalcemia and hypomagnesemia. The medication is connected with Vitamin C absorption.

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 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.

A nurse assesses a client for signs and symptoms of tardive dyskinesia when the client is receiving which drug?

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 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.