PrepU Ch 37 Drugs Therapy for Peptic Ulcer Disease and Hyperacidity
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? a. Hip fractures b. Hypercalcemia c. Peptic ulcer disease d. Liver cancer
a
A 75-year-old client is treating an ulcer with antacids. Based on the client's age, the nurse expects the health care provider to prescribe a dose of antacid that compares with the average prescribed dose in what way? a. Smaller than the average prescribed dose b. The same as the average prescribed dose c. Larger than the average prescribed dose d. No antacids, because they are contraindicated in the elderly
a
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic? a. Omeprazole b. Cimetidine c. Sucralfate d. Magaldrate
a
Which medication 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. a. Esomeprazole b. Ranitidine c. Lansoprazole d. Famotidine e. Calcium carbonate
a, c
A client presents to the walk-in clinic reporting vomiting and burning in the mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the provider is likely to order a diagnostic test to detect the possible presence of what? a. Upper gastrointestinal bleeding b. Infection with Helicobacter pylori c. Decreased stomach acid secretion. d. Gastric irritation caused by NSAIDs.
b
Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect? a. Hypotension b. Drug-drug interactions c. Diarrhea d. Macular rash and cough
b
Which agent would a nurse identify as the prototype histamine-2 receptor antagonist? a. Famotidine b. Cimetidine c. Ranitidine d. Nizatidine
b
Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection? a. Sucralfate b. Omeprazole c. Famotidine d. Calcium carbonate
b
A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform? a. Monitor the patient for reports of pain or sour taste. b. Monitor the patient for concentrated urine and restlessness. c. Closely monitor the patient for confusion and dizziness. d. Inform the PHCP if the patient exhibits tardive dyskinesia symptoms.
c
Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect? a. Simvastatin b. Quinidine c. Digoxin d. Dextroamphetamine
c
A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. What is one of the preferred antibiotics? a. Amoxicillin b. Gentamicin c. Ketoconazole d. Vancomycin
a
A female client is self-administering cimetidine. What is the home care nurse's most important assessment of this client? a. Potential drug-drug interactions b. Adverse reactions c. Allergic reactions d. Toxicity
a
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? a. smoking effects on the healing of ulcers b. the connection between smoking and chronic pain c. general health dangers research has proven to be associated with smoking d. the importance of taking prescribed medication until symptoms subside
a
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: a. metabolic alkalosis. b. hypercholesterolemia. c. hypocalcemia. d. metabolic acidosis.
a
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? a. "I need to swallow the drug whole." b. "I'll have to stop using antacids." c. "I should crush the medication and mix it into apple sauce." d. "It is important that I take the drug after each meal."
a
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? a. bone density b. joint mobility c. dental health d. integumentary system
a
An older adult reports chronic abdominal pain and dark, tarry stools. The client has a history of chronic arthritis being treated with naproxen daily. What is the most likely cause of the presenting symptomology? a. gastric ulcer b. duodenal ulcer c. pyloric stenosis d. gastresophageal reflux disease (GERD)
a
The health care provider has prescribed sucralfate for a client with a gastric ulcer. The client asks how long he must take this medication. What is the nurse's best response to this client? a. "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred." b. "You will take it for 5 days, then skip 5 days, then take it for another 5 days and you will be done with it." c. "You must take this medication for the full 10 days." d. "You will need to take this medication for the rest of your life."
a
The nurse is preparing for discharge a client who has a prescription for sucralfate. When does the nurse instruct the client to take the medication? a. 1 hour before or 2 hours after meals and at bedtime b. With meals c. With an antacid before breakfast d. After each meal, no more than 15 minutes after finishing
a
The nurse is teaching a client about lansoprazole prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease? a. inhibiting acid secretion b. increasing mucus secretion c. healing damaged cells d. exerting an antibiotic effect
a
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs? a. Gynecomastia b. Seizures c. Hypoxia d. Hypertension
a
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis? a. Increased fracture risk b. Abdominal pain c. Headache d. Diarrhea
a
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? a. Swallow the tablet one hour before eating. b. Use a reliable contraceptive. c. Do not chew, open, or crush the tablet. d. Administer the drug one hour before travel.
b
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication? a. Antacids b. Proton pump inhibitors c. H2RAs d. Sucralfate
b
A client is prescribed misoprostol. The nurse would expect to administer this drug by which route? a. Intravenous b. Oral c. Transdermal d. Subcutaneous
b
Which would a nurse anticipate as having antiandrogenic effects? a. Nizatidine b. Cimetidine c. Ranitidine d. Famotidine
b
Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply: a. Metoclopramide (Reglan) b. Lansoprazole (Prevacid) c. Omeprazole (Prilosec) d. Promethazine (Phenergan) e. Ondansetron (Zofran)
b, d
The nurse is taking a history of a client who reports burning pain in the stomach. The nurse knows that which risk factors increase this client's chance of having a peptic ulcer? (Select all that apply.) a. Sucralfate use b. Psychological stress c. Acetaminophen use d. Physiological stress e. Smoking
b, d, e
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.) a. Ondansetron (Zofran) b. A PPI c. Aluminum hydroxide d. Cisapride (Propulsid) e. Antibiotics
b, e
A client has presented to the emergency department with a 48-hour history of spasticity, malaise, and agitation. Arterial blood gas testing reveals that the client has metabolic alkalosis. What is the most appropriate action by the nurse? a. Assess whether the client has been taking over-the-counter H2 antagonists. b. Assess whether the client has a history of diverticulosis or diverticulitis. c. Assess the client's use of sodium bicarbonate and other antacids. d. Assess for any history of duodenal ulcers or gastroesophageal reflux.
c
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? a. "No, the two drugs will work against each other." b. "I wouldn't advise it. You may experience severe constipation." c. "Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine." d. "Sure, you may take an antacid with cimetidine."
c
A female client is currently taking sucralfate and has been given a prescription for ciprofloxacin for treatment of a urinary tract infection. The nurse will inform the client that she should take her medication in what way? a. "Eat breakfast, then take the sucralfate, and then an hour later take the ciprofloxacin." b. "Take the sucralfate 30 minutes before the ciprofloxacin." c. "Take the ciprofloxacin 2 hours before the sucralfate." d. "Both medications should be taken together on an empty stomach."
c
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? a. Hypocalcemia b. Gastric reflux c. Rebound acidity d. Hyperactive gastric mucosa
c
A female client's diagnoses include diabetes mellitus, gastric ulcer disease, and chronic renal disease. When the nurse reviews her medications with her, the nurse discover that she self-administers antacids containing magnesium. What statement is true about antacids containing magnesium? a. They are an acceptable treatment for gastric ulcer disease. b. They may cause an exacerbation of her hyperglycemia. c. They are contraindicated for clients with renal disease. d. They may cause hypoglycemia for clients with chronic renal disease and diabetes.
c
A male client is receiving morphine sulfate for pain after an accident. The health care provider has also ordered cimetidine IV to assist in preventing a stress ulcer. The nurse will monitor for what effect that is caused by the interaction of these two drugs? a. Increased symptoms of GERD b. Increased reports of pain c. Increased incidence of respiratory depression d. Increased nausea and vomiting
c
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? a. Is 15 pounds over ideal weight b. Has a stressful job as a air traffic controller. c. Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. d. Eats spicy food at least twice a week.
c
What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection? a. assists in eliminating the bacteria b. decreases pepsin production c. decreases production of gastric secretions d. protects ulcer craters
c
Which instruction would be most important to give to a client who is receiving omeprazole? a. "Chew the tablet thoroughly before swallowing." b. "Open the capsule and sprinkle it on applesauce." c. "Swallow the tablet whole with a large glass of water." d. "Take an antacid immediately before taking the drug."
c
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? a. venous thromboembolism b. rebound gastroesophageal reflux disease (GERD) c. hemorrhage d. fluid volume excess
c
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: a. heart palpitations. b. dry mouth. c. irritability. d. headache.
d
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. One antimicrobial tends to alter the action of the adjunct medications. b. A single antimicrobial is generally not strong enough to eradicate the infection. c. Two different microbes are involved, requiring two different antimicrobials. d. Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms.
d
A nurse is reviewing information about proton pump inhibitors. The nurse recognizes that which of the following is available as an over-the-counter agent? a. Rabeprazole b. Dexlansoprazole c. Pantoprazole d. Omeprazole
d
A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time? a. first thing on arising b. 2 hours after a meal c. at bedtime d. 1 hour before eating
d
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? a. Lansoprazole b. Pantoprazole c. Esomeprazole d. Omeprazole
d
Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms. a. Accumulates in ulcer craters b. Inhibits pepsin activity c. Antibacterial effects d. All of these
d
The client will receive cimetidine 800 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include: a. visual disturbances. b. anxiety. c. tremors. d. headache.
d
The nurse administers ranitidine cautiously to clients with evidence of what condition? a. Diabetes mellitus b. Migraine headaches c. Pulmonary disease d. Renal disease
d
The nurse is caring for a 27-year-old female client who has just been prescribed misoprostol. What is a priority teaching point for this client? a. Do not take NSAIDs with this drug b. Adverse effects include nausea and diarrhea c. It protects the lining of the stomach d. You will need to use a barrier-type contraceptive
d
The nurse is providing care for a 51-year-old client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment? a. Assess the client for insomnia. b. Inspect the client's torso for rash. c. Assess the client's lying, sitting, and standing blood pressures. d. Inspect the client for gynecomastia.
d
When caring for a client diagnosed with a peptic ulcer, the nurse administers omeprazole and amoxicillin. What diagnostic finding indicates therapeutic effects of this drug regimen? a. Absence of dyspepsia b. Absence of gastresophageal reflux c. Increased appetite and absence of nausea d. Absence of Helicobacter pylori
d