Chapter 41 Drugs for peptic ulcer disease

The nurse is using this diagram to teach a patient about GERD. Which spot would the nurse identify as the cardiac sphincter?

Ans: A The cardiac sphincter is located between the end of the esophagus and the stomach.

An older adult client comes to the emergency department with his wife. He has a history of peptic ulcer disease (PUD) and is currently experiencing confusion and severe headaches. What does the best plan by the nurse include? 1. Ask the client if he has experienced any head injuries recently. 2. Obtain a complete blood count (CBC), chemistry profile, and urine drug screen. 3. Ask the client's wife for a list of medications that the client has taken. 4. Obtain a magnetic resonance imaging (MRI) exam to assess if the client has experienced a stroke.

Correct Answer: 3 Rationale 1: Since the client has PUD, it would be logical to ask about medication prior to asking about injury. Rationale 2: A complete blood count (CBC), chemistry profile, and urine drug screen are worthwhile tests, but the first priority for a client with a history of peptic ulcer disease (PUD) should be to find out what medications he has been taking. Rationale 3: There is a known correlation between H2-receptor antagonists and confusion and headaches in the older adult population; the nurse should ascertain what medications the client is taking. Rationale 4: It is premature to obtain a magnetic resonance imaging (MRI) exam until other causes have been ruled out.

An erosion of the mucosal layer of the stomach or duodenum describes a 1. diverticulum. 2. Crohn's lesion. 3. hiatal hernia. 4. Peptic ulcer.

Correct Answer: 4 Rationale 1: Diverticulum occurs in the large intestine. Rationale 2: Crohn's lesion can occur anywhere in the gastrointestinal tract. Rationale 3: Hiatal hernias are an outpouching in the esophagus. Rationale 4: A peptic ulcer is erosion of the mucosal layer of the stomach or duodenum.

The nurse is caring for a patient with gastroesophageal reflux disease and would question an order for which of the following? A. Amoxicillin (Amoxil) B. Ranitidine (Zantac) C. Pantoprazole (Protonix) D. Calcium carbonate (Tums)

Ans: A Antibiotics such as amoxicillin (Amoxil) are used in the treatment of PUD caused by H. pylori. They are not indicated for the treatment of GERD. Options B, C, and D are incorrect. Antacids, H2 blockers, and PPIs are used in the treatment of GERD. Calcium carbonate, ranitidine, and pantoprazole would be appropriate drugs to use.

The nurse is assisting the older adult diagnosed with a gastric ulcer to schedule her medication administration. What would be the most appropriate time for this patient to take her lansoprazole (Prevacid)? A. About 30 minutes before her morning meal B. At night before bed C. After fasting at least 2 hours D. 30 minutes after each meal

Ans: A PPIs such as lansoprazole (Prevacid) should be taken before the first meal of the day. The pro- ton pump is activated by food intake. The administration of a PPI 20 to 30 minutes before the first major meal of the day will allow peak serum levels to coincide with the occurrence of maximum acidity from the proton pump activity. Options B,C and D are incorrect. PPIs should be taken before the first major meal of the day, not at night or after meals. Fasting is not required for this drug.

Simethicone (Gas-x, Mylicon) may be added to some medications or given plain for what therapeutic effect? A. Decrease the amount of gas associated with GI disorders. B. Increase the acid-fghting ability of some medications. C. Prevent constipation associated with gastrointestinal drugs. D. Prevent diarrhea associated with gastrointestinal drugs.

Ans: A Simethicone is used along with other GI drugs or alone to decrease the amount of gas bubbles that accumulate with GI disorders or indigestion. Options B, C, and D are incorrect. Simethicone will not affect the acid-fighting ability of medications or pre- vent constipation or diarrhea from developing.

A 35-year-old male patient has been prescribed omeprazole (Prilosec) for treatment of gastroesophageal reflux disease. Which of the following assessment findings would assist the nurse to determine whether drug therapy has been effective? (Select all that apply.) A. Decreased "gnawing" upper abdominal pain on an empty stomach B. Decreased belching C. Decreased appetite D. Decreased nausea E. Decreased dysphagia

Ans: B,D,E Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, and chest pain. Therapeutic effects of omeprazole (Prilosec) would include relief of these symptoms. Options A and C are incorrect. Gnawing or burning upper abdominal pain is symptomatic of PUD, not GERD. A decreased appetite should not occur with omeprazole.

A female patient reports using OTC aluminum hydroxide (AlternaGEL) for relief of gastric upset. She is on renal dialysis three times a week. What should the nurse teach this patient? A. Continue using the antacids but if she needs to continue them beyond a few months, she should consult the health care provider about different therapies. B. Take the antacid no longer than for two weeks; if it has not worked by then, it will not be effective. C. Consult with the health care provider about the appropriate amount and type of antacid. D. Continue to take the antacid; it is OTC and safe.

Ans: C Antacids are generally combinations of aluminum hydroxide, calcium, and/or magnesium hydroxide. Hypermagnesemia, hypercalcemia, or hypophosphatemia can develop with use of OTC antacids. Because this patient is on renal dialysis, her kidneys are unable to adequately control the excretion of electrolytes. The nephrologist should be contacted about whether an antacid is appropriate for this patient. Options A, B, and D are incorrect. Because of concerns about electrolyte imbalance, taking the antacid for limited periods may not be advisable. Because a drug is OTC does not guarantee its safety and it may pro- duce adverse effects in patients.

In taking a new patient's history, the nurse notices that he has been taking omeprazole (Prilosec) consistently over the past 6 months for treatment of epigastric pain. Which recommendation would be the best for the nurse to give this patient? A. Try switching to a different form of the drug. B. Try a drug like cimetidine (Tagamet) or famotidine(Pepcid). C. Try taking the drug after meals instead of before meals. D. Check with his health care provider about his continued discomfort.

Ans: D PPIs such as omeprazole (Prilosec) are recommended for short-term therapy, approximately 4 to 8 weeks in length. If symptoms of epigastric pain and discomfort continue, other therapies and screening for H. pylori may be indicated. Options A, B, and C are incorrect. Switching to another PPI still exceeds the recommended time of use for this category of drugs. H2-receptor blockers such as cimetidine (Tagamet) and famotidine (Pepcid) may be indicated but their use should be evaluated by a health care provider because more definitive treatment (e.g., for H. pylori) may be required. PPIs should be taken 30 minutes before meals.

The nurse is aware that antacids containing aluminum can cause 1. low iron levels. 2. abdominal pain. 3. constipation. 4. indigestion.

Correct Answer: 1 Rationale 1: Aluminum compounds can inhibit the absorption of dietary iron. Rationale 2: Antacids do not cause abdominal pain. Rationale 3: Calcium-based products, such as Tums, cause constipation. Rationale 4: Antacids would help the indigestion.

The nurse has completed education about peptic ulcer disease (PUD) with the client. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I will limit my intake of caffeine products." 2. "I will take ibuprofen (Motrin) for my headaches." 3. "I will drink more milk and limit spicy foods." 4. "I will join a gym and increase my exercise."

Correct Answer: 1 Rationale 1: Caffeine is a risk factor for peptic ulcer disease (PUD), so limiting caffeine will be beneficial in the treatment of peptic ulcer disease (PUD). Rationale 2: Nonsteroidal anti-inflammatory drugs (NSAIDs) are a primary cause of peptic ulcer disease (PUD). Rationale 3: Milk can increase acid production, and spicy foods are not an issue with peptic ulcer disease (PUD). Rationale 4: There is no correlation between exercise and the management of peptic ulcer disease (PUD).

The pyloric sphincter regulates flow of food into the 1. small intestine. 2. stomach. 3. esophagus. 4. rectum.

Correct Answer: 1 Rationale 1: The pyloric sphincter regulates food out of the stomach into the small intestine. Rationale 2: The pyloric sphincter is where food moves out of the stomach. Rationale 3: The cardiac sphincter keeps food from moving back into the esophagus. Rationale 4: The pyloric sphincter regulates food out of the stomach, not the rectum.

A patient who has been diagnosed with GERD is reluctant to make suggested lifestyle changes. What information about GERD should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The damage to your esophagus may result in esophagitis." 2. "Long-term exposure to acid increases risk for esophageal cancer." 3. "Without lifestyle changes, the medications will be totally ineffective." 4. "The lifestyle changes are not so bad if you adopt them one at a time and institute them gradually." 5. "You will have trouble swallowing if you do not treat this condition."

Correct Answer: 1,2 Rationale 1: Esophagitis is a possible complication of GERD. Rationale 2: Approximately 10% of those with GERD will develop Barrett's esophagus, which is associated with increased risk of cancer. Rationale 3: Medications may be somewhat effective even if lifestyle changes are not made. Rationale 4: The nurse should not determine if the patient will think the lifestyle changes are "not so bad." Rationale 5: It is unknown what this particular patient will experience if treatment is not undertaken.

A client comes to the clinic with report of intermittent epigastric pain that is associated with meals. The nurse would review the client's medical record and assess for the presence of which risk factors for peptic ulcer disease (PUD)? Select all that apply. 1. The client reports that his mother and grandfather both had ulcers. 2. The client has type AB blood. 3. The client reports drinking several cups of coffee every morning. 4. The client reports mild to moderate job and family stress. 5. The client tested positive for influenza A.

Correct Answer: 1,3 Rationale 1: A close family history of PUD increases the client's risk for developing the disease. Rationale 2: The risk for developing PUD is higher in those with type O. Rationale 3: Consumption of beverages that contain caffeine increases the risk for PUD. Rationale 4: The presence of excessive psychological stress increases the risk for PUD. Rationale 5: Infection with Helicobacter pylori increases the risk for PUD. Influenza A is not associated with increased risk.

The nurse is collecting information from a patient who has history of peptic ulcer disease (PUD). The nurse will evaluate that the goals of therapy for PUD have been met when the patient makes which statements? Select all that apply 1. "I was surprised at how quickly my symptoms went away after I started taking the medications and following the lifestyle changes." 2. "My PUD comes back once in a while if I am under a lot of stress." 3. "My previous doctor said my ulcer was completely healed." 4. "I still have to be very careful about what I eat." 5. "As long as I do not lay down for a couple of hours after I eat, I have no problems."

Correct Answer: 1,3 Rationale 1: Relief of symptoms is a goal of PUD therapy. Rationale 2: The goal is permanent cure. Rationale 3: The goal is promoting healing of the ulcer. Rationale 4: Symptoms should not recur. Rationale 5: Symptoms should not recur.

The nurse designs a plan of care for the client with peptic ulcer disease (PUD) who is taking omeprazole (Prilosec) for the management of his illness. What will the best plan by the nurse include? Select all that apply. 1. Omeprazole (Prilosec) should not be crushed or chewed. 2. Omeprazole (Prilosec) is best taken with yogurt. 3. Omeprazole (Prilosec) is recommended for long-term treatment of peptic ulcer disease (PUD). 4. Omeprazole (Prilosec) should be administered before meals. 5. Omeprazole (Prilosec) should be administered after meals.

Correct Answer: 1,4 Rationale 1: Omeprazole (Prilosec) is enteric-coated and needs to dissolve in the intestine; it should not be crushed or chewed. Rationale 2: Yogurt may help replace beneficial bacteria but should not be taken at the same time. Rationale 3: Omeprazole (Prilosec) is recommended for short-term, not long-term, use. Rationale 4: Omeprazole (Prilosec) should be administered before meals. Rationale 5: Omeprazole (Prilosec) should be administered before, not after, meals in order to be most effective.

A client who has gastroesophageal reflux disease (GERD) has been taking proton pump inhibitors (PPIs) for many years. The nurse discusses which potential complication of this long-term therapy? 1. Increased risk of anemia 2. Increased risk of osteopenia 3. Increased risk of hypertension 4. Increased risk of intestinal irritation

Correct Answer: 2 Rationale 1: Anemia is not a consequence of long-term use of PPIs. Rationale 2: Long-term use of PPIs increases risk of osteopenia and osteoporosis. Rationale 3: Hypertension is not a consequence of long-term use of PPIs. Rationale 4: Intestinal irritation is not a consequence of long-term use of PPIs.

The physician has ordered combination therapy for the client with peptic ulcer disease (PUD) who tested positive for H. pylori. The nurse plans to do medication education. What will the best plan by the nurse include? 1. Combination therapy has the best outcomes when antibiotics are used with antacids. 2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. 3. The use of sucralfate (Carafate) along with antibiotics is the best combination therapy for peptic ulcer disease (PUD). 4. Various antibiotics are used to eradicate the bacteria that are responsible for the development of peptic ulcer disease (PUD).

Correct Answer: 2 Rationale 1: Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors, not with antacids. Rationale 2: Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. Rationale 3: Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors, not with sucralfate (Carafate). Rationale 4: More than one antibiotic may be used but is more effective when these antibiotics are used with a proton-pump inhibitor.

The client receives esomeprazole (Nexium). He asks the nurse why that medication is better than his cimetidine (Tagamet). What is the best response by the nurse? 1. "It is about the same but a lot cheaper than your cimetidine (Tagamet)." 2. "It decreases acid in your stomach better than cimetidine (Tagamet)." 3. "It is about the same but has fewer side effects than your cimetidine (Tagamet)." 4. "It is not as effective as cimetidine (Tagamet) but kills bacteria better."

Correct Answer: 2 Rationale 1: Esomeprazole (Nexium) is not cheaper than cimetidine (Tagamet). Rationale 2: Proton-pump inhibitors reduce acid secretion to a greater extent than H2-receptor antagonists, and have a longer duration of action. Rationale 3: Esomeprazole (Nexium) does not have fewer side effects than cimetidine (Tagamet). Rationale 4: Esomeprazole (Nexium) is more effective than cimetidine (Tagamet) but will not kill bacteria.

A client is admitted for treatment of a duodenal ulcer. What will the nurse's admission assessment likely reveal? 1. Nausea and lower right quadrant abdominal pain 2. Burning pain several hours after eating a meal 3. Anorexia and weight loss 4. Low back pain radiating down the left leg

Correct Answer: 2 Rationale 1: Nausea and lower right quadrant abdominal pain are more likely associated with appendicitis. Rationale 2: Duodenal ulcers are associated with burning upper abdominal pain after a meal. Rationale 3: Anorexia and weight loss are more common with gastric, not duodenal, ulcers. Rationale 4: Duodenal ulcers do not cause low back pain radiating down the left leg.

The nurse completes medication education for the client receiving sucralfate (Carafate). The nurse evaluates that learning has occurred when the client makes which statement? 1. "This works by inhibiting bacterial growth in my stomach." 2. "This works by dissolving into a jelly and sticking to my ulcer." 3. "This works by decreasing the amount of acid in my stomach." 4. "This works by neutralizing the acid in my stomach."

Correct Answer: 2 Rationale 1: Sucralfate (Carafate) does not inhibit bacterial growth. Rationale 2: Sucralfate (Carafate) works by dissolving into a gel and adhering to the site of the ulcer. Rationale 3: Sucralfate (Carafate) does not decrease the amount of acid in the stomach. Rationale 4: Sucralfate (Carafate) does not neutralize stomach acid.

The client receives misoprostol (Cytotec) for treatment of peptic ulcer disease (PUD). The client asks the nurse why he is receiving this medication. What is the best response by the nurse? 1. "It dissolves into a gel and sticks to your ulcer." 2. "It increases mucus production in your stomach." 3. "It inhibits bacterial growth." 4. "It neutralizes stomach acid."

Correct Answer: 2 Rationale 1: Sucralfate (Carafate), not misoprostol (Cytotec), dissolves into a gel and adheres to the ulcer site. Rationale 2: Misoprostol (Cytotec) inhibits gastric secretion and stimulates the production of protective mucus. Rationale 3: Bismuth (Pepto-Bismol), not misoprostol (Cytotec), inhibits bacterial growth. Rationale 4: Antacids, not misoprostol (Cytotec), neutralize stomach acid.

The mechanism of the action of proton pump inhibitors is to 1. neutralize acid. 2. reduce acid secretion in the stomach. 3. block H2 receptors in the stomach. 4. decrease infection.

Correct Answer: 2 Rationale 1: The mechanism of action of proton pump inhibitors is to reduce acid secretion in the stomach.

A patient being treated for GERD has increased risk for development of infection with Clostridium difficile. The nurse would include which information in this patient's teaching? Select all that apply. 1. Report any episode of diarrhea. 2. Treat diarrhea with over-the-counter antidiarrheal drugs. 3. Increase intake of active culture yogurt. 4. Avoid fatty foods. 5. Increase fluid intake.

Correct Answer: 2,3 Rationale 1: The patient does not need to report each episode of diarrhea but should report if the amount increases or is frequent, or if the stool includes mucus, blood, or pus. Rationale 2: Antidiarrheal drugs may cause retention of harmful bacteria. Rationale 3: Dairy products containing live active cultures help restore normal flora. Rationale 4: Avoidance of fatty foods is not specifically prescribed to treat this condition. Rationale 5: Increasing fluid intake is not specifically prescribed to treat this condition.

It is suspected that a client has developed peptic ulcer disease (PUD). Which information should the nurse provide this client regarding projected course of treatment? Select all that apply. 1. You will be started on an antibiotic. 2. You will be tested for the presence of H. pylori. 3. You may be directed to take Pepto-Bismol along with your other medications. 4. You should plan on taking medication for 4 to 8 weeks. 5. There are some lifestyle changes you can take to make therapy more successful.

Correct Answer: 2,3,4,5 Rationale 1: The client may or may not be started on an antibiotic. Rationale 2: The client should be tested for the presence of H. pylori before antibiotic therapy is started. Rationale 3: If the client is positive for H. pylori, bismuth-containing medications are sometimes prescribed for concurrent use. Rationale 4: It takes time to heal a peptic ulcer, so therapy may continue for several weeks. Rationale 5: Some lifestyle changes such as changing dietary habits and smoking cessation can help therapy be more successful.

The nurse is presenting community education regarding self-treatment of heartburn with antacids. As part of this discussion, the nurse advises people with which conditions to avoid antacids? Select all that apply. 1. People with low calcium levels. 2. Those with diminished renal function. 3. Women who are peri menopausal. 4. People who are on sodium-restricted diets. 5. People with coronary artery disease.

Correct Answer: 2,4 Rationale 1: Calcium antacids are often used as calcium supplements. Rationale 2: Diminished renal function is a reason to avoid self-directed antacid use. Rationale 3: There is no reason for perimenopausal women to avoid antacids. Rationale 4: Many over-the-counter antacids contain significant amounts of sodium. Rationale 5: There is no reason for those with coronary artery disease to avoid antacids.

The patient being treated for GERD says, "I seem to have so many colds and coughs now." How should the nurse respond to this statement? Select all that apply. 1. "Be sure to get your flu shot." 2. "The medicine you are on for GERD changes your gastric pH." 3. "You need to avoid crowds until your GERD is under control." 4. "You may be more susceptible to respiratory infection while taking this medication." 5. "You may be having an allergic reaction to your medicine."

Correct Answer: 2,4 Rationale 1: Getting immunized against influenza is a wise choice but is not specifically associated with this report. Rationale 2: The medications for GERD change gastric pH, which increases risk for respiratory illnesses. Rationale 3: There is no reason to avoid crowds. Rationale 4: The patient's normal defense mechanisms are impaired by this drug, increasing susceptibility to respiratory infection. Rationale 5: This is not an allergic reaction.

A client has been prescribed ranitidine (Zantac). The nurse plans to include which information in the teaching plan for this client? Select all that apply. 1. You should experience symptom relief in 10 to 15 minutes after taking this drug. 2. Take this medication after your meal. 3. Take this medication first thing in the morning, before breakfast. 4. This drug will not work as well if you continue smoking. 5. If you experience confusion, discontinue the drug and call for an appointment.

Correct Answer: 2,4 Rationale 1: Onset of action is 30 to 60 minutes. Rationale 2: This medication should be administered after a meal. Rationale 3: This medication should be taken after meals. Rationale 4: Smoking decreases the effectiveness of ranitidine. Rationale 5: Ranitidine does not cause the confusion and CNS depression observed with cimetidine.

The nurse planning medication administration instruction for a client receiving antacids should consider including which information? 1. Antacids can be safely administered with H2-receptor medications. 2. Antacids can be safely administered with antibiotics. 3. Administer antacids at least 2 hours before other oral medications. 4. Lie down for 30 minutes after taking antacids.

Correct Answer: 3 Rationale 1: Administering antacids with H2-receptor antagonists will decrease their absorption. Rationale 2: Administering antacids with antibiotics will decrease their absorption. Rationale 3: Administering antacids with other oral medications can affect the absorption of the other medications; they should be taken 2 hours before other oral medications. Rationale 4: There is no need for the client to lie down after taking antacids.

The client receives H2-receptor antagonists for treatment of peptic ulcer disease (PUD). Which assessment finding should be reported immediately to the physician? 1. The client reports he is constipated. 2. The client reports pain after 24 hours of treatment. 3. The client reports episodes of melena. 4. The client reports he took the antacid Tums with his H2-receptor antagonist.

Correct Answer: 3 Rationale 1: Constipation is a common side effect that does not need to be immediately reported to the physician. Rationale 2: The client may still experience pain for several days with this type of medication. Rationale 3: Melena could indicate GI bleeding and should be reported to the physician immediately. Rationale 4: Taking Tums with an H2-receptor antagonist will cause decreased absorption of the H2-receptor antagonist, but this does not need to be reported to the physician; the nurse should educate the client.

The physician orders misoprostol (Cytotec) for the female client with peptic ulcer disease (PUD). What is a priority question for the nurse to ask the client prior to administration of this medication? 1. "Do you plan on becoming pregnant?" 2. "Are you sexually active?" 3. "Are you pregnant?" 4. "Are your menstrual cycles irregular?"

Correct Answer: 3 Rationale 1: Misoprostol (Cytotec) is safe as long as the client is not currently pregnant. Rationale 2: Asking if a client is sexually active could be appropriate, but the nurse would also ask if the client is using birth control. Rationale 3: Misoprostol (Cytotec) is contraindicated during pregnancy; it is sometimes used to terminate pregnancies. Rationale 4: There is no contraindication for misoprostol (Cytotec) in a client with irregular menstrual cycles.

Peptic ulcer disease is treated primarily with 1. pharmacotherapy. 2. exercise. 3. a combination of lifestyle changes and pharmacotherapy. 4. diet.

Correct Answer: 3 Rationale 1: Pharmacotherapy is not as effective when used alone. Rationale 2: Exercise alone is not an effective treatment for PUD. Rationale 3: A combination of lifestyle changes and pharmacotherapy is the best and most effective way to treat peptic ulcer disease. Rationale 4: Diet alone is not an effective treatment for PUD.

The primary goal in treatment of gastroesophageal reflux disease is to 1. promote ulcer healing. 2. prevent infection. 3. reduce gastric acid secretions. 4. decrease stomach pain.

Correct Answer: 3 Rationale 1: Promoting ulcer healing is not the goal. Rationale 2: Preventing infection is not the goal. Rationale 3: The primary goal is to reduce gastric secretions, which produce the reflux. Rationale 4: Heartburn occurs, but not pain in the stomach.

The physician has ordered bismuth (Pepto-Bismol) for the client with a peptic ulcer who is colonized with H. pylori. The client asks the nurse why he is receiving this drug. What is the best response by the nurse? Select all that apply. 1. "Bismuth (Pepto-Bismol) increases stomach acid to help kill bacteria." 2. "Bismuth (Pepto-Bismol) helps prevent the side effects of antibiotics." 3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach." 5. "Bismuth (Pepto-Bismol) helps relieve ulcer-related constipation."

Correct Answer: 3,4 Rationale 1: Bismuth (Pepto-Bismol) does not increase stomach acid. Rationale 2: Bismuth (Pepto-Bismol) does not prevent the side effects of antibiotics. Rationale 3: Bismuth compounds (Pepto-Bismol) are added to the antibiotic regimen to inhibit bacterial growth. Rationale 4: Bismuth compounds (Pepto-Bismol) prevent H. pylori from adhering to the gastric mucosa. Rationale 5: Bismuth (Pepto-Bismol) is used to relieve diarrhea, not constipation.

A client has been prescribed aluminum hydroxide (AlternaGEL) for the treatment of heartburn. Which information should the nurse plan to teach this client? Select all that apply. 1. You should expect this medication to take up to 2 days to start taking effect. 2. Take this medication with a glass of milk. 3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking. 5. This medication will reduce the acid your stomach produces.

Correct Answer: 3,4 Rationale 1: This medication's onset of action is within 20-40 minutes. Rationale 2: There is no reason for the client to drink milk with this medication. Rationale 3: Constipation may be a side effect of this antacid. Rationale 4: Absorption may be affected if taken within 2 hours of any other drug. Rationale 5: This medication acts to neutralize acid, not to reduce its production.

The nursing instructor teaches the student nurses about intrinsic factor. The instructor evaluates that learning has occurred when the students make which response? 1. "Intrinsic factor is secreted by the chief cells of the stomach." 2. "Intrinsic factor is necessary for absorption of vitamin B6." 3. "Intrinsic factor aids in the secretion of mucus to protect the stomach." 4. "Intrinsic factor is necessary for absorption of vitamin B12

Correct Answer: 4 Rationale 1: Chief cells secrete pepsinogen and rennin, not intrinsic factor. Rationale 2: Intrinsic factor is necessary for the absorption of vitamin B12, not B6. Rationale 3: Intrinsic factor does not aid in the secretion of mucus in the stomach. Rationale 4: Parietal cells secrete intrinsic factor, which is essential for the absorption of vitamin B12.