Chapter 40: Upper GI Drugs PrepU
13 See full question 12s The nurse admits a client who reports having taken a proton pump inhibitor for more than a decade. What assessment question will the nurse ask this client?
"Are you experiencing diarrhea?" Explanation: Research indicates that clients taking proton pump inhibitors or histamine-2 antagonists demonstrate a significant increase in cases of Clostridium difficile infections leading to diarrhea so the nurse should assess this client for diarrhea. There would be no indications to ask about flankpain, blood in the urine, or blood pressure. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
18 See full question 17s A client has been prescribed omeprazole by the primary care provider. When questioned by the nurse about the client's perceived effectiveness of the prescribed omeprazole, the client states, "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?
"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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
20 See full question 39s The nurse is educating a client diagnosed with peptic ulcer disease about the prescribed medications aluminum hydroxide-magnesium hydroxide-simethicone mixture and ranitidine. Which statement made by the client indicates the need for further clarification?
"To decrease interactions with other drugs I take, I will take the drug 30 minutes before taking the rest of my meds." Explanation: The nurse needs to clarify the statement that the client made in regard to when to space the antacid with other medications the client also takes to prevent possible interactions. Other medications need to be taken 1 to 2 hours apart from a dose of the antacid. The other statements are correct. Antacids help relieve epigastric pain within minutes, and ranitidine, a histamine2 receptor antagonist, peak action occurs 1 to 3 hours after administration orally. Eating foods high in fiber and drinking 2 to 3 L of fluid helps prevent constipation, a common adverse effect of aluminum hydroxide-magnesium hydroxide-simethicone mixture. The client needs to take the antacid doses at regularly scheduled intervals to be therapeutically effective in neutralizing the gastric acid.
17 See full question 12s How long will it take for ranitidine to reach peak blood levels when administered parenterally?
15 minutes Explanation: Parenteral ranitidine reaches peak blood level in 15 minutes. Parenteral ranitidine reaches its peak prior to 30 minutes, 1 hour, and 2 hours. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 464. Chapter 40: Upper Gastrointestinal System Drugs - Page 464 Add a Note
15 See full question 15s The client prescribed nizatidine (Axid) chooses to take the medication once a day at bedtime. What dosage will the nurse administer?
150 to 300 mg Explanation: The dosage for nizatidine, when taken PO only at bedtime, is 150 to 300 mg. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 464. Chapter 40: Upper Gastrointestinal System Drugs - Page 464 Add a Note
8 See full question 17s A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?
2 tablets Explanation: The required dosage is 200 mcg. Available tablets contain 100 mcg of the drug. Therefore, the nurse should administer two tablets each time to the client. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 465. Chapter 40: Upper Gastrointestinal System Drugs - Page 465 Add a Note
3 See full question 16s For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be?
20 mg bid Explanation: Famotidine should be administered 40 mg every day at bedtime or 20 mg bid. for treatment of a gastric ulcer. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 464. Chapter 40: Upper Gastrointestinal System Drugs - Page 464 Add a Note
15 See full question 33s The nurse at a long-term care facility administers proton pump inhibitors to several residents. Which client should the nurse monitor for increased effects of his or her other medications?
A client with atrial fibrillation who takes warfarin Explanation: There is a risk of increased serum levels and increased toxicity of benzodiazepines, phenytoin, and warfarin if these are combined with proton pump inhibitors. This is not the case with antidiabetic medications, diuretics, calcium channel blockers beta blockers. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, pp. 455-456. Chapter 40: Upper Gastrointestinal System Drugs - Page 455-456 Add a Note
12 See full question 18s The nurse is caring for four clients. Which client would benefit most from misoprostol, a synthetic prostaglandin E analog?
An 83-year-old male with rheumatoid arthritis Explanation: Misoprostol is prescribed for concurrent use with NSAIDs to prevent NSAID-induced erosion and ulceration of the gastric mucosa. The client with rheumatoid arthritis likely uses NSAIDs frequently, placing him at risk of developing gastric ulcers and making him a candidate for misoprostol. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 457. Chapter 40: Upper Gastrointestinal System Drugs - Page 457 Add a Note
4 See full question 25s What is currently the most commonly used therapy for peptic ulcers?
Antibiotics and proton pump inhibitors Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate H. pylori. H2 receptor antagonists are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection, but they are not the drug of choice, proton pump inhibitors are. Bicarbonate salts are not used. ZES is the Zollinger-Ellison syndrome and not a drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 463. Chapter 40: Upper Gastrointestinal System Drugs - Page 463 Add a Note
14 See full question 1m 1s 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 nurse's best assessment?
Assess the client's use of sodium bicarbonate and other antacids Explanation: Sodium bicarbonate and other antacids can cause metabolic alkalosis due to their action of increasing pH. H2 antagonists do not have this adverse effect. Diverticular disease, ulcers and GERD do not directly create a risk for metabolic alkalosis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
10 See full question 10s 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 Explanation: Antacids are best administered one to two hours after meals and at bedtime. No oral drugs should be administered within one to two hours of an antacid. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 460. Chapter 40: Upper Gastrointestinal System Drugs - Page 460 Add a Note
12 See full question 19s When educating a client prescribed a histamine-2 antagonists, which of the following should be avoided? Select all that apply.
Cigarettes Alcohol Caffeine 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 462. Chapter 40: Upper Gastrointestinal System Drugs - Page 462 Add a Note
6 See full question 11s The nurse would administer cimetidine cautiously to a client with a history of which condition?
Diabetes Explanation: The H2 blocker cimetidine should be used cautiously in clients with diabetes. The calcium-containing antacids are used cautiously in clients with respiratory insufficiency, renal impairments, or cardiac disease. Hypertension and hyperlipidemia are both risk factors for cardiac disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
1 See full question 30s 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
7 See full question 20s 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.
Esomeprazole Lansoprazole Explanation: The proton pump inhibitors, like esomeprazole and lansoprazole, reduce the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate enzyme system of the gastric parietal cells. Famotidine (Pepcid) and ranitidine are both histamine H2 antagonists decreasing stomach acid by inhibiting the action of H2 receptors in the stomach. Calcium carbonate is an acid neutralizer that reduces the pH of the acid in the stomach and duodenum. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
19 See full question 18s A client with a complex medical history states that the primary care provider has changed the client's proton pump inhibitor from omeprazole to esomeprazole. The client is unsure of the rationale for this change in medication and has raised this question with the nurse. What rationale is most plausible?
Esomeprazole has fewer drug interactions. Explanation: The actions and pharmacokinetics of the other PPIs—esomeprazole, lansoprazole, pantoprazole, and rabeprazole—are similar to those of omeprazole. However, the drug interactions associated with omeprazole reportedly do not occur with these other PPIs. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 457. Chapter 40: Upper Gastrointestinal System Drugs - Page 457 Add a Note
5 See full question 18s 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.
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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
4 See full question 14s 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
11 See full question 14s Which statement made by a client currently being treated for several medical conditions requires additional medication education by the nurse concerning the use of calcium salts?
I take an antacid with my morning medications to minimize their effect on my stomach Explanation: Antacids should be avoided for 1-2 before or after ingestion of other drugs since they have be proven to interfere with the absorption or action of other drugs. The remaining statements concerning calcium salts are true. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 454. Chapter 40: Upper Gastrointestinal System Drugs - Page 454 Add a Note
11 See full question 13s The nurse is caring for a client who has been prescribed sucralfate for treatment of peptic ulcer disease. Which nursing diagnosis may relate specifically to administration of this medication?
Impaired Bowel Elimination: Constipation Explanation: Since sucralfate can cause constipation, Impaired Bowel Elimination: Constipation may be relevant to administration of the drug. Although the other diagnoses may be appropriate for the underlying disease, they do not relate to the use of sucralfate. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 458. Chapter 40: Upper Gastrointestinal System Drugs - Page 458 Add a Note
14 See full question 23s The nurse is caring for a client with cystic fibrosis who has recently not been taking prescribed pancreatic enzymes recently. What is the primary assessment finding the nurse will see as a result of this noncompliance?
Malnutrition Explanation: Clients with cystic fibrosis take pancreatic enzymes to promote digestion and absorption of nutrients so failure to take the drug would result in malnutrition and weight loss. Constipation, diarrhea, and abdominal pain would not be in the primary assessment finding. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 454. Chapter 40: Upper Gastrointestinal System Drugs - Page 454 Add a Note
7 See full question 20s An adult client with type 1 diabetes since age 4 tells the nurse that in the past 3 months he has experienced nausea, heartburn, and a persistent fullness after meals. He states that his blood sugar levels have been stable and his hemoglobin A1C level that morning was 6.8%. The client has been diagnosed with gastroparesis. Which medication would the physician most likely prescribe to treat this condition?
Metoclopramide Explanation: Metoclopramide is used to relieve symptoms of diabetic gastroparesis, also known as diabetic gastric stasis. Symptoms of this disorder include nausea, vomiting, heartburn, persistent fullness after meals, and anorexia. Misoprostol (Cytotec) is a synthetic form of prostaglandin E and is used to prevent NSAID-induced gastric ulcers in high-risk patients. Famotidine (Pepcid), another frequently used H2RA, is also available as a prescription and OTC drug. Cisapride (Propulsid) is a prokinetic agent that was removed from the U.S. market because of its potential to induce fatal cardiac arrhythmias. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 465. Chapter 40: Upper Gastrointestinal System Drugs - Page 465 Add a Note
8 See full question 28s A nurse is preparing to administer a prostaglandin drug used to reduce the risk of NSAID-induced gastric ulcers in high-risk clients, such as the elderly or the critically ill. Which medication will the client administer?
Misoprostol Explanation: Misoprostol is a prostaglandin drug that is used to reduce the risk of NSAID-induced gastric ulcers in high-risk clients, such as the elderly or the critically ill. Ranitidine is used to treat esophagitis and is used cautiously in clients with diabetes. Pantoprazole is used to treat GERD, erosive esophagitis, and hypersecretory conditions and is used cautiously in older clients with hepatic impairment. Sucralfate is used for the short-term treatment of duodenal ulcers and is used cautiously in the elderly, severely ill, or debilitated clients with renal or hepatic impairment. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 457. Chapter 40: Upper Gastrointestinal System Drugs - Page 457 Add a Note
3 See full question 41s A 35-year-old man is at his follow-up visit for GERD. Antacids have not been effective for his reflux, and the health care provider is prescribing a proton pump inhibitor. Why might the provider prescribe a PPI rather than an 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
9 See full question 16s What is the most likely reason esomeprazole (Nexium) has been prescribed for a client who has a diagnosis of H. Pylori and is taking antiplatelet drugs?
Prevention of bleeding Explanation: Proton pump inhibitors, such as Nexium, are used for prevention of bleeding in high-risk clients using antiplatelet drugs. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
10 See full question 16s The nurse is providing client education for a client with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The client has been newly prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the client about the drug?
Protects the stomach's lining Explanation: Misoprostol is a synthetic prostaglandin that, like prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the client to peptic ulceration. Misoprostol doesn't reduce gastric acidity, improve emptying of the stomach, or increase lower esophageal sphincter pressure. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 457. Chapter 40: Upper Gastrointestinal System Drugs - Page 457 Add a Note
5 See full question 23s 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?
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). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 460. Chapter 40: Upper Gastrointestinal System Drugs - Page 460 Add a Note
20 See full question 38s A client is receiving a liquid antacid. Which would the nurse instruct the client to do?
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.
2 See full question 9s 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
1 See full question 1m 13s A male client arrives at his sick call reporting chronic abdominal pain. Having a 40-pack year history, he reports his smoking has decreased to approximately 20 packs/year. The health care provider, after thorough assessment and evaluation and labs, prescribes a treatment regimen for a duodenal ulcer caused by H. pylori infection. What type of medication might be used to treat the ulcer?
Two antimicrobials and either a PPI or H2RA Explanation: Two antimicrobials to treat H. pylori bacterium and an antisecretory medication to treat an active ulcer. The antisecretory drug accelerates symptom relief and ulcer healing. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
19 See full question 56s 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?
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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 456. Chapter 40: Upper Gastrointestinal System Drugs - Page 456 Add a Note
18 See full question 2m 22s A client with a diagnosis of peptic ulcer disease has begun taking sucralfate. The nurse should caution the client against the concurrent use of which classification of medications?
antacids Explanation: Antacids decrease the effects of sucralfate, and people should not take them within 30 minutes before or after administration of sucralfate. None of the other options affect the effectiveness of sucralfate. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 457. Chapter 40: Upper Gastrointestinal System Drugs - Page 457 Add a Note
16 See full question 8s 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: Unlike cimetidine, ranitidine, famotidine, and nizatidine do not affect the cytochrome P-450 drug-metabolizing system in the liver and therefore do not interfere with the metabolism of other drugs. Use of these other drugs may be preferable in clients who are critically ill because they often require numerous other drugs with which cimetidine may interact. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 464. Chapter 40: Upper Gastrointestinal System Drugs - Page 464 Add a Note
17 See full question 15s The client, recently diagnosed with peptic ulcer disease, states achieving adequate symptom relief with the use of over-the-counter (OTC) antacids but has asked the nurse about the optimal schedule for taking these drugs. What action should the nurse recommend?
one hour and three hours after each meal and at bedtime Explanation: For treatment of peptic ulcer disease, clients should take antacids 1 and 3 hours after meals and at bedtime (four to seven doses daily), 1 to 2 hours before or after other medications. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 464. Chapter 40: Upper Gastrointestinal System Drugs - Page 464 Add a Note
13 See full question 43s A client with a history of peptic ulcer disease has responded well to treatment with a histamine-2 antagonist. This client is most likely experiencing:
reduction in the quantity of hydrochloric acid secreted. Explanation: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) coat and protect the stomach lining like sucralfate (Carafate), or increase the pH of the secreted hydrochloric acid. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 454. Chapter 40: Upper Gastrointestinal System Drugs - Page 454 Add a Note
16 See full question 12s A client has a magnesium-based antacid prescribed for administration as needed. Which condition contraindicates the administration of this classification of medications?
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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 459. Chapter 40: Upper Gastrointestinal System Drugs - Page 459 Add a Note
2 See full question 27s What is an effect of histamine release that is related to ulcer formation?
stimulates gastric acid secretion Explanation: Histamine also causes strong stimulation of gastric acid secretion. 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 that is a factor in stomach ulcer formation. Histamine is not associated with either pepsin or gastrin. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
6 See full question 20s A client who is postoperative day one following a metatarsal amputation is experiencing nausea and vomiting. Consequently, the nurse has administered an intravenous dose of metoclopramide. This drug will relieve the client's nausea by:
stimulating the motility of the client's upper GI tract. Explanation: Metoclopramide's mechanism of action is unclear. However, it appears to sensitize tissues to the effect of acetylcholine. It has the cholinergic-like effect on the upper GI tract of stimulating motility but does not stimulate gastric, pancreatic, or gallbladder secretions. The drug does not affect gastric pH, inhibit proton pumps, or eradicate H. Pylori. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 457. Chapter 40: Upper Gastrointestinal System Drugs - Page 457 Add a Note
9 See full question 16s A nurse is caring for a client experiencing stomach hyperacidity. The health care provider has prescribed aluminum carbonate gel. The nurse would administer this drug cautiously to the client with which condition?
upper GI bleeding Explanation: The nurse should administer the aluminum carbonate gel with caution in clients with upper GI bleeding. Calcium-containing antacids are used with caution in clients with renal impairment. Misoprostol is contraindicated in clients with pheochromocytoma. Metoclopramide is contraindicated in clients with GI obstruction. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Upper Gastrointestinal System Drugs, p. 455. Chapter 40: Upper Gastrointestinal System Drugs - Page 455 Add a Note
