Pharmacology - Chapter 35

Ms. Diniger is prescribed omeprazole for gastric reflux disorder. Which strategy would help minimize the risk of adverse effects associated with omeprazole?

Divide daily dosage larger than 80 mg into smaller doses to be administered through the day.

The nurse is caring for a patient who is prescribed esomeprazole magnesium (Nexium) for the treatment of diarrhea. The patient informs the nurse that he is also taking sucralfate for GI distress. What effects of interaction between the two drugs should the nurse inform the patient about?

Decreased absorption of the esomeprazole magnesium

When teaching a patient about an antacid containing aluminum, which of the following would the nurse include?

Decreased risk of acid rebound

A female client self-administers magnesium antacids. She presents to the office with symptoms of dizziness and weakness. The nurse knows that these symptoms are secondary to what common adverse effect of magnesium antacids

Diarrhea

A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the patient's drug history to determine if the patient is taking which of the following drugs?

Digoxin

The nurse should warn a patient taking aluminum and calcium containing antacids about which of the following adverse effects? (Choose one)

Constipation

A client taking ginger for motion sickness complains of heartburn. What is the nurse's best response?

"Adverse effects are rare, but heartburn has been reported by some individuals taking ginger."

A student asks the pharmacology instructor why bismuth is sometimes added to H. pylori eradication regimens. Which of the following responses accurately answers the student's question?

"Bismuth is antibacterial."

You are teaching your 47-year-old client about omeprazole, which the physician has prescribed as part of a regimen to treat an H. pylori infection. What statement, made by the client, suggests that he understands proper use of the drug?

"I need to swallow the drug whole."

A client expresses concern about the legality of prescribed dronabinol(Marinol) for nausea. What is the nurse's best response?

"Marijuana is legally allowed for medical use in some states."

A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?

"Quitting smoking will significantly increase the chance that this drug will heal your ulcer."

The physician at your clinic has prescribed a chewable antacid to a patient with peptic ulcer disease. Which of the following instructions should you offer the patient regarding use of the drug?

"Take the antacid two hours before or after other oral medications."

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?

"Take the ciprofloxacin 2 hours before the sucralfate."

You are conducting patient teaching with a patient has just been prescribed lansoprazole (Prevacid). What statement would indicate that the patient correctly understands the action of this medication?

"This medication inhibits acid secretion."

You are caring for a patient who is going home on sucralfate (Carafate). You would teach the patient take sucralfate (Carafate) when?

1 hour before or 2 hours after meals and at bedtime

To induce vomiting for therapeutic reasons, various substances can be used. Which of the following is used to induce vomiting?

Ipecac

An 86-year-old client has been prescribed ranitidine (Zantac). The nurse knows that an older adult who takes H2RAs may experience what adverse effect?

Agitation

Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms.

All of these

Which of the following would a nurse anticipate as having antiandrogenic effects?

Cimetidine

A nurse is caring for an elderly patient who has been administered cimetidine. Which of the following interventions should the nurse perform?

Closely monitor the patient for confusion and dizziness.

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

Esomeprazole

A patient with GI upset is prescribed an antacid for outpatient use. Which of the following instructions should the nurse provide the patient and family members?

Explain that the drug may change the color of the stool

If a patient is receiving sucralfate and omeprazole, the doses can be taken together.

False

Your new admit, a 73-year-old woman whose husband recently died, reports chronic abdominal pain and dark, tarry stools. She has a history of chronic arthritis, for which she takes naproxen daily. What might be the cause of her symptoms?

Gastric Ulcer

A male client is overweight and lives a sedentary lifestyle. He presents to the office with complaints of acid regurgitation, especially at night. The nurse is aware that this client is displaying symptoms of what disorder?

Gastroesophageal reflux disease

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

Gynecomastia

Which of the following adverse effects is more likely to be caused by cimetidine than by other H2RAs?

Gynecomastia

The physician has prescribed ranitidine for a patient in your unit. Prior to administering the drug for the first time, which of the following adverse effects should you mention to the patient?

Headache

Your patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, you should inform the patient that common side effects related to this medication include what?

Headache

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

Increased fracture risk

A male client is receiving morphine sulfate for pain after an accident. The physician 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?

Increased incidence of respiratory depression

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?

Increased risk for hip fractures

A 25-year-old patient arrives at the walk-in clinic complaining of vomiting and a burning sensation in the midepigastric region. The nurse suspects that the patient has peptic ulcer disease. Which of the following is a potential cause of peptic ulcer disease?

Infection with H. pylori

A patient presents to the walk-in clinic complaining of vomiting and burning in their mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the physician is likely to order a diagnostic test to detect the possible presence of what?

Infection with helicobacter pylori

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.

Which part of the brain is responsible for autonomic functioning such as ventilation, cardiac conduction, and vomiting?

Medulla oblongata

Your 32-year-old patient tells you that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, you caution the patient that overuse could place him at risk for

Metabolic Alkalosis

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

Potential drug-to-drug interactions

Misoprostol is contraindicated for patients with what condition

Pregnancy

Misoprostol is contraindicated for patients with what condition?

Pregnancy

The nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has been newly prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug?

Protects the stomach's lining

A client is diagnosed with Helicobacter pylori infection. The physician will order amoxicillin and what other type of medication?

Proton Pump Inhibitor

You are talking with your nursing students about the drugs that affect the gastrointestinal secretions. What group of drugs would you tell the students is used to treat peptic ulcers by suppressing the secretion of hydrochloric acid into the lumen of the stomach?

Proton Pump Inhibitors

A female client presents to the physician'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

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

A female client is going on a cruise to Nova Scotia with her husband to celebrate their 15th wedding anniversary. She is concerned because she has experienced severe, debilitating seasickness in the past. What would the nurse expect the physician to order?

Scopalamine

A patient 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 which of the following?

Serum Phosphate Level

A 75-year-old client is treating his ulcer with antacids. Based on the client's age, the nurse expects the physician to prescribe a dose of antacid that compares with the average prescribed dose in what way?

Smaller than the average prescribed dose

Your patient arrives at his sick call reporting chronic abdominal pain. Having a 40-pack year history, he reports his smoking has decreased to approximately ½ pack/day. The physician, after thorough assessment and evaluation and labs, prescribes a treatment regimen for duodenal ulcer. What important teaching would you include in relation to treatment?

Smoking's effects on healing

Why would a nurse encourage a patient to avoid using OTC medications to treat decreased acid?

Some of these drugs can change the normal environment of the GI tract

Patient teaching should include what about antacids?

Take antacid 1 hour before other medications

A patient has been prescribed a histamine-2 (H2) receptor antagonist for the treatment of GERD. Why are H2RAs more effective than H1 receptor antagonists in the treatment of diseases of the upper GI tract?

The parietal cells of the stomach have H2 receptors but not H1 receptors.

The use of calcium carbonate is associated with the development of acid rebound.

True

In treating Helicobacter pylori infection, a physician prescribes two antimicrobials. Why two?

Two are needed to prevent the emergence of drug-resistant H. pylori organisms.

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

You are caring for a 27-year-old female patient who has just been prescribed misoprostol. What is a priority teaching point for this patient?

You need to use a barrier type contraceptive

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered

an hour before meals.

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.

Antacids are alkaline substances primarily used to directly neutralize gastric acid in the stomach to prevent/treat PUD, GERD, heartburn, and GI bleed. In what other conditions might aluminum-based antacids be used? Select all that apply.

• Chronic renal failure • Hyperphosphatemia

A female client comes to the clinic with complaints 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 physician 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? (Select all that apply.)

• Duodenal ulcers • Zollinger-Ellison syndrome • Gastric ulcers

When preparing a teaching plan for a patient who is to receive misoprostol, which of the following would the nurse include as possible adverse effects? Select all that apply.

• Flatulence • Excessive vaginal bleeding • Dyspepsia • Dysmenorrhea

What is an indication for the use of antacids? (Mark all that apply.)

• Gastric hyperacidity • Gastritis • Peptic esophagitis • Hiatal hernia

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)

The nurse should administer which of the following medications cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12? Select all that apply:

• Pantoprazole (Protonix) • Rabeprazole (Aciphex)

A client receiving chemotherapy has begun receiving aprepitant. The client also takes oral contraceptives. What should the nurse tell the client in regard to birth control?

"Use alternative means of birth control for 1 month after taking aprepitant."

A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following 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."

The physician 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?

"You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."

When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?

Alopecia

A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. Which of the following is one of the preferred antibiotics?

Amoxicillin

You are caring for four patients. Which of your patients would benefit most from misoprostol, a synthetic prostaglandin E analog?

An 83-year-old male with rheumatoid arthritis

You are teaching a 31-year-old patient about lansoprazole, which the physician has prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease?

By inhibiting acid secretion

The nurse is caring for a client who has just had an episode of vomiting. What is the first intervention that the nurse would complete after the client has finished vomiting?

Help the patient rinse their mouth

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

Your 59-year-old client has peptic ulcer disease and is started on sucralfate (Carafate). What is a potential nursing diagnosis related to this medication?

Impaired bowel elimination: constipation

The physician orders sucralfate to assist in the healing of a duodenal ulcer. The nurse is aware that to ensure this medication's effectiveness, it should be administered under what condition?

In an acid pH

Ranitidine is a histamine2 receptor antagonist (H2RA) prescribed for treatment of peptic ulcer disease and gastric reflux. Dosage of ranitidine must be reduced in patients with what condition?

Renal disease

Your patient, a 35-year-old man who works on the stock exchange, is at his follow-up visit for GERD. Antacids have not been effective for his reflux, and the physician is prescribing a proton pump inhibitor. Why might he prescribe a PPI, rather than an H2RA?

PPIs suppress acid more strongly and for a longer time.

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

Renal disease

A patient who requires digestive enzyme replacement therapy has been admitted to your unit. What would be an appropriate nursing diagnosis for this patient?

Risk for imbalanced nutrition

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 contents