NCLEX Pharma chapter 50- acid controlling drugs

2. When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition? a.Peptic ulcer disease b.Renal failure c.Hypertension d.Heart failure

ANS: B Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

1. The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.) a.Antacids reduce the production of acid in the stomach. b.Antacids neutralize acid in the stomach. c.Rebound hyperacidity may occur with calcium-based antacids. d.Aluminum-based antacids cause diarrhea. e.Magnesium-based antacids cause diarrhea.

ANS: B, C, E Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.

7. A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate 5 or 6 times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate? a.Constipation b.Metabolic acidosis c.Metabolic alkalosis d.Excessive gastric mucus

ANS: C Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.

6. A patient is complaining of excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem? a.famotidine (Pepcid) b.aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta) c.calcium carbonate (Tums) d.simethicone (Mylicon)

ANS: D Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent. The other options are incorrect.

1. A patient will be receiving pantoprazole (Protonix), 20 mg IV daily every morning. The medication, once reconstituted, has a strength of 40 mg/10 mL. How many milliliters will the nurse draw up for this dose?

ANS: 5 mL 40 mg : 10 mL :: 20 mg : x mL (40 ´ x) = (10 ´ 20); 40x = 200; x = 5 mL

14. A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect? a.Prevent stress ulcers b.Reduce bacteria levels in the stomach c.Reduce gastric gas formation (flatulence) d.Promote gastric motility

ANS: A Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. The other options are incorrect.

8. A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole? a.An antibiotic b.A nonsteroidal antiinflammatory drug c.An antacid d.An antiemetic

ANS: A The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

1. A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect? a.Diarrhea b.Constipation c.Nausea d.Abdominal cramping

ANS: B Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

11. During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result? a.No serious consequences b.Prevention of more serious problems, such as an ulcer c.Chronic constipation d.Masked symptoms of serious underlying diseases

ANS: D Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.

5. A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication? a."Take this medication once a day after breakfast." b."You will be on this medication for only 2 weeks for treatment of the reflux disease." c."The medication may be dissolved in a liquid for better absorption." d."The entire capsule must be taken whole, not crushed, chewed, or opened."

ANS: D Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.

9. A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that calcium antacids are not used as frequently as other antacids because a.their use may result in kidney stones. b.they cause decreased gastric acid production. c.they cause severe diarrhea. d.their use may result in fluid retention and edema.

ANS: A Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.

12. An elderly patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, "He seems to be more confused this afternoon. He's never been like this. What could be the problem?" The nurse reviews the patient's medication record and suspects that which drug could be the cause of the patient's confusion? a.cimetidine (Tagamet) b.pantoprazole (Protonix) c.clarithromycin (Biaxin) d.sucralfate (Carafate)

ANS: A Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the elderly, including confusion and disorientation. The nurse needs to be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.

4. A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug? a.He takes the cimetidine with meals. b.He smokes two packs of cigarettes a day. c.He drinks a glass of water with each dose. d.He takes an antacid 3 hours after the cimetidine dose.

ANS: B Smoking may impair the absorption of H2 antagonists. The other factors are correct interventions for this medication.

10. At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct? a.Give both the antacid and medications at 0900. b.Give the antacid at 0900, and then the medications at 0930. c.Give the medications at 0900, and then the antacid at 1000. d.Give the medications at 0900, and then the antacid at 0915.

ANS: C Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of their impact on the absorption of many medications in the stomach.

3. The nurse is reviewing the medication orders for a patient who will be taking an H2 antagonist. Which drug may have an interaction if taken along with the H2 antagonist? a.ibuprofen (Motrin) b.ranitidine (Zantac) c.tetracycline (Doryx) d.ketoconazole (Nizoral)

ANS: D All H2 receptor antagonists may inhibit the absorption of certain drugs, such as the antifungal ketoconazole, which require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.

13. The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct? a.Proton pump inhibitors can cause diarrhea. b.These drugs can cause nausea and anorexia. c.Proton pump inhibitors cause drowsiness. d.Long-term use of these drugs may contribute to osteoporosis.

ANS: D New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.