Peptic Ulcers and GERD Chapter 37

26s Report this Question An older client has been prescribed omeprazole for the treatment of gastroesophageal 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."

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."

A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is in the client's medications?

Acetaminophen

When describing proton pump inhibitors, which would be appropriate to include?

Acid labile

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

Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?

Digoxin dioxins effects will be decreased when also taking an antacid

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

Drug-Drug interactions

The nurse is caring for a client with a nasogastric tube. Which PPI would be most appropriate for the health care provider to order for this client?

Esomeprazole

When comparing the H2RAs to each other, you would find that cimetidine (Tagamet) is more likely to cause which adverse effect?

Gynecomastia

Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?

Gynecomastia (Man boobs) also confusion

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 dizziness, somnolence, and mental confusion

Why are histamine2 receptor antagonists preferred in the treatment of upper gastrointestinal (GI) disorders over traditional histamine1 receptor antagonists?

Histamine1 receptor antagonists do not block histamine effects on gastric acid production.

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 lead to what problem for this client?

Increase risk for hip fractures

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?

Increased fracture risk

A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the midepigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?

Infection with H. pylori

After several months of persistent heartburn, a 57 year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem?

Proton pump inhibitors; avoiding large meals; remaining upright after meals

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

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?

Omeprazole

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

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

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?

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.

What is an example of a proton pump inhibitor

Omprazole

What is an example of a histamine blocker?

Ranitidine

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

Ranitidine (Zantac) should be cautiously administered to individuals with evidence of which of the following conditions?

Renal disease

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?

Smaller than the average prescribed dose older adults secrete less gastric acid than younger adults

Client teaching should include what instruction about antacids?

Take one hour before other medications

The nurse is caring for a male client in the medical unit. He is fed via a nasogastric tube. The dose of antacid is based on what factors?

The pH of the stomach

A female client comes to the clinic with reports of burning pain in the stomach. She states that she thinks she had a virus 48 hours ago and she vomited many times. She hasn't vomited in 24 hours. She asks the health care provider to give her a prescription for omeprazole because she saw an ad on TV that said it would heal stomach pain. The nurse assists the client in understanding that PPIs are considered drugs of choice for treatment of what conditions?

Zollinger-Ellison syndrome Duodenal ulcers Gastric ulcers

Proton pump inhibitors works how

block final step of gastric acid production by inhibiting the enzyme H,K, ATPase

Where does ranitidine act

blocks histamine 2 receptors in the parietal cells to reduce the volume and concentration of gastric acid in both daytime and night time

Of the commonly used antacids, which is rarely used in the treatment of peptic ulcer disease (PUD) because of its effect on gastrin release?

calcium

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

constipation

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.

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?

ncreased fracture risk

Aluminum hydrochloride with magnesium hydroxide works how

raises the gastric pH in stomach and duodenum

A client is prescribed ranitidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has:

renal disease

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