PHARM CH 37, 39, 40 (PART 1): GI Meds
True or False. Cessation of pain and disappearance of ulcer coincide in most cases.
False, cessation of pain and disappearance of ulcer RARELY coincide.
(2) major groups of antidiarrheals:
Specific antidiarrheal drugs Nonspecific antidiarrheal drugs
Laxative Abuse True or False. Abrupt cessation of laxative use - absence of BM in several days expected.
True, abrupt cessation of laxative use - absence of BM in several days expected.
Treatment of PUD True or False. Drugs do not alter the disease process; they create conditions conducive to healing.
True, drugs do not alter the disease process; they create conditions conducive to healing.
True or False. Preferred drug therapy: PPIs > H2RAs
True, preferred drug therapy: PPIs > H2RAs
A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response? a. "By suppressing normal flora, antibiotics allow proliferation of the organism." b. "The antibiotic decreases the white blood count, which allows for bacteria to invade the body." c. "This is common of all antibiotic therapy and hospitalized clients." d. "The diarrhea is a result of overgrowth of viruses attacking the cells in the bowels."
a. "By suppressing normal flora, antibiotics allow proliferation of the organism."
A caregiver of a 1-year-old asks the nurse if they can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response? a. "Children younger than 1 year of age should not be given this medication." b. "The medication needs to be adjusted for the 1-year-old's weight." c. "I will call the prescriber to find out if this is safe." d. "There are over-the-counter medications that are better for the 1-year-old."
a. "Children younger than 1 year of age should not be given this medication."
Contraindications of Laxative Use (select all that apply): a. Abdominal pain b. Nausea c. Dry mouth d. RR of 11 e. Acute surgical abdomen
a. Abdominal pain b. Nausea e. Acute surgical abdomen
H. pylori Treatment SE: diarrhea a. Amoxicillin b. Metronidazole c. Tetracycline d. Bismuth compounds
a. Amoxicillin
Pharmacological therapy for PUD (select all that apply): a. Antibiotics b. Citrus juices c. NSAIDs d. Antisecretory agents e. Antacids
a. Antibiotics d. Antisecretory agents e. Antacids
Lifestyle changes for GERD (select all that apply): a. Avoid foods that aggravate symptoms b. Increased intake of potassium-rich foods c. Avoid alcohol & late-night meals d. Sleep in supine position e. Keep HOB elevated at sleep
a. Avoid foods that aggravate symptoms c. Avoid alcohol & late-night meals e. Keep HOB elevated at sleep
H. pylori Treatment Barriers to compliance (select all that apply): a. Can require up to 12 pills/day b. Decrease in oxygenation c. GI side effects d. Decrease in urinary output e. Expensive
a. Can require up to 12 pills/day c. GI side effects e. Expensive
H. pylori Treatment SE: nausea, diarrhea a. Clarithromycin b. Metronidazole c. Tetracycline d. Bismuth compounds
a. Clarithromycin
Characterized by stools of excessive volume and fluidity and increased frequency of defecation a. Diarrhea b. Constipation c. Opioid abuse
a. Diarrhea
Pharmacological therapy for PUD Antisecretory agents include: a. H2RA and PPIs b. Antibiotics c. Antacids
a. H2RA and PPIs
Laxative Abuse Mgmt (select all that apply): a. Increased exercise daily b. Decrease in intake of fiber c. Decrease in strength training d. Decrease in intake of bran e. Increased intake of fiber & fluid
a. Increased exercise daily e. Increased intake of fiber & fluid
A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease? a. Infection with H. pylori b. Decreased stomach acid secretion c. Excessive worrying d. Overconsumption of spicy foods
a. Infection with H. pylori
Most common cause of PUD a. Infection with H. pylori b. NSAIDs c. Smoking
a. Infection with H. pylori
Contributing factors of GERD (select all that apply): a. Obesity b. COPD c. Hiatal hernia d. Delayed gastric emptying e. Pneumonia
a. Obesity c. Hiatal hernia d. Delayed gastric emptying
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? a. Omeprazole b. Esomeprazole c. Lansoprazole d. Pantoprazole
a. Omeprazole
Erosion of the gut wall --> burning pain often occurring after meals a. Peptic Ulcer Disease (PUD) b. Digestive Enzyme Dysfunction c. GERD
a. Peptic Ulcer Disease (PUD)
Goals of drug therapy for PUD (select all that apply): a. Promote healing b. Prevent recurrence c. Alter disease process d. Cure disease e. Improve ventilation
a. Promote healing b. Prevent recurrence
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication? a. Proton pump inhibitors b. Sucralfate c. H2RAs d. Antacids
a. Proton pump inhibitors
Indications for Laxative Use (select all that apply): a. Removing poisons b. Frequent use of vitamin b12 supplements c. Preventing fecal impaction in bedridden patients d. Frequent use of vitamin C supplements e. Constipation
a. Removing poisons c. Preventing fecal impaction in bedridden patients e. Constipation
Diarrhea Management (select all that apply): a. Replacement of lost water and salts b. Relief of cramping c. Increasing use of diuretics d. Increasing use of NSAIDs e. Increasing use of laxatives
a. Replacement of lost water and salts b. Relief of cramping
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? a. Smaller than the average prescribed dose b. Larger than the average prescribed dose c. The same as the average prescribed dose d. No antacids, because they are contraindicated in the elderly
a. Smaller than the average prescribed dose Explanation: Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.
The nurse is taking a history of a client who reports burning pain in the stomach. The nurse knows that which risk factors increase this client's chance of having a peptic ulcer? (Select all that apply.) a. Smoking b. Psychological stress c. Acetaminophen use d. Physiological stress e. Sucralfate use
a. Smoking b. Psychological stress d. Physiological stress
H. pylori Treatment ________: (10-14 days) PPI + clarithromycin + amoxicillin, or PPI + clarithromycin + metronidazole a. Triple therapy b. Quadruple therapy c. Sequential therapy
a. Triple therapy
Infectious Diarrhea a. Variety of bacteria and protozoa can be responsible b. Need antibiotics in most cases c. Infections are usually self-limited d. Many cases require no treatment e. Antibiotics should be used only when clearly indicated
a. Variety of bacteria and protozoa can be responsible c. Infections are usually self-limited d. Many cases require no treatment e. Antibiotics should be used only when clearly indicated
Dietary fiber _____ which softens feces and increases size. a. absorbs water b. increase pH of stomach contents c. alters digestion process
a. absorbs water
Non-pharmacological therapy for PUD (select all that apply): a. avoid ASA and other NSAIDS b. stress and anxiety reduction c. increase in use of NSAIDS d. increase in use of aspirin e. moderate-high ETOH consumption
a. avoid ASA and other NSAIDS b. stress and anxiety reduction
An older adult client has been on long-term proton pump inhibitor (PPI) therapy. The nurse practitioner should focus on what assessment related to adverse effects? a. bone density b. dental health c. joint mobility d. integumentary system
a. bone density
____ is best source for fiber. a. bran b. fruit c. meat
a. bran
A client reports the intention to use an over-the-counter bismuth product. The nurse should inform the client that there is a potential that the medication will cause what side effect? a. dark stool b. photosensitivity c. hyperglycemia d. hypertension
a. dark stool
Non-pharmacological therapy for PUD (select all that apply): a. diet b. smoking cessation c. increase in use of NSAIDS d. increase in use of aspirin e. ETOH cessation
a. diet b. smoking cessation e. ETOH cessation
Allow effervescent tablets to _______ before drinking (this increases the surface area of drug available to neutralize gastric acid). a. dissolve completely and almost stop bubbling b. turn a blue-purple color c. dissolve partially
a. dissolve completely and almost stop bubbling
Antacids Chew chewable tablets thoroughly before swallowing, then ______. a. drink a glass of water b. eat immediately after c. avoid drinking fluids
a. drink a glass of water
Peptic Ulcer Disease (PUD) Ulcers commonly formed in (select all that apply): a. esophagus b. stomach c. lower intestine d. duodenum e. jejunum
a. esophagus b. stomach d. duodenum
GERD characterized by: a. heartburn & acid regurgitation b. stomach cramps c. foul body odor
a. heartburn & acid regurgitation
Peptic Ulcer Disease (PUD) Severe erosion can be complicated by: a. hemorrhage and perforation b. breast and bone cancer c. ischemia and bowel obstruction
a. hemorrhage and perforation
Dietary fiber can be digested by colonic bacteria whose growth ______. a. increases fecal mass b. decreases fecal mass c. no effect on fecal mass
a. increases fecal mass
Diarrhea Causes (select all that apply): a. infection b. opioid use c. maldigestion d. hypothermia e. elevated RR
a. infection c. maldigestion
The nurse is teaching a client about lansoprazole prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease? a. inhibiting acid secretion b. exerting an antibiotic effect c. healing damaged cells d. increasing mucus secretion
a. inhibiting acid secretion
Defenses against PUD (select all that apply): a. mucus b. pepsin c. bicarbonate d. gastric acid e. NSAID ingestion
a. mucus c. bicarbonate
Factors that cause/aggravate PUD (select all that apply): a. pepsin b. blood flow c. gastric acid d. NSAID ingestion e. prostaglandins
a. pepsin c. gastric acid d. NSAID ingestion
Peptic Ulcer Disease (PUD) is a _____ GI disorder. a. upper b. lower c. life-threatening
a. upper
The health care provider 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? a. "You must take this medication for the full 10 days." b. "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred." c. "You will need to take this medication for the rest of your life." d. "You will take it for 5 days, then skip 5 days, then take it for another 5 days and you will be done with it."
b. "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."
H. pylori Treatment Minimum of ____ antibiotics prescribed to decrease risk of developing resistance. a. 1 (up to 2) b. 2 (up to 3) c. 3 (up to 4)
b. 2 (up to 3)
Goals of drug therapy for PUD (select all that apply): a. Alter disease process b. Alleviate symptoms c. Reduce muscle atrophy d. Improve oxygenation e. Prevent complications
b. Alleviate symptoms e. Prevent complications
Indications for Laxative Use (select all that apply): a. Minimal straining b. Before treatment/procedure preparation c. Obtaining fresh stool sample d. Minimal struggle passing stool e. Expelling dead parasites after treatment
b. Before treatment/procedure preparation c. Obtaining fresh stool sample e. Expelling dead parasites after treatment
A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin? a. Octreotide b. Bismuth subsalicylate c. Polycarbophil d. Loperamide
b. Bismuth subsalicylate
Hard stools, infrequent stools, excessive straining, prolonged effort, sense of incomplete evacuation, unsuccessful defecation. a. Diarrhea b. Constipation c. GERD
b. Constipation
Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect? a. Diarrhea b. Drug-drug interactions c. Hypotension d. Macular rash and cough
b. Drug-drug interactions
What is first-line therapy for infants and children 1 to 4 years of age with diarrhea? a. Bismuth salts (Pepto-Bismol) b. Electrolyte replacement c. Paregoric d. Difenoxin (Motofen)
b. Electrolyte replacement
Factors that cause/aggravate PUD (select all that apply): a. mucus b. Helicobacter pylori (H-pylori) c. bicarbonate d. smoking e. blood flow
b. Helicobacter pylori (H-pylori) d. smoking
What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall? a. Bismuth subsalicylate b. Loperamide c. Paregoric d. Magnesium citrate
b. Loperamide
H. pylori Treatment SE: nausea & HA, disulfiram-like reaction (avoid alcohol) a. Clarithromycin b. Metronidazole c. Tetracycline d. Bismuth compounds
b. Metronidazole
Pharmacological therapy for PUD (select all that apply): a. Citrus juices b. Mucosal protectants c. PPIs d. NSAIDS e. H2RA
b. Mucosal protectants c. PPIs e. H2RA
Second most common cause of PUD a. Infection with H. pylori b. NSAIDs c. Smoking
b. NSAIDs
Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply: a. Metoclopramide (Reglan) b. Omeprazole (Prilosec) c. Ondansetron (Zofran) d. Lansoprazole (Prevacid) e. Promethazine (Phenergan)
b. Omeprazole (Prilosec) d. Lansoprazole (Prevacid)
H. pylori Treatment _________: (10-14 days) PPI + bismuth + metronidazole + tetracycline a. Triple therapy b. Quadruple therapy c. Sequential therapy
b. Quadruple therapy
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? a. Hypocalcemia b. Rebound acidity c. Gastric reflux d. Hyperactive gastric mucosa
b. Rebound acidity
Contraindications of Laxative Use (select all that apply): a. Dry mouth b. Signs of appendicitis c. Dry mucus membranes d. Constipation e. Crohn's disease (regional enteritis)
b. Signs of appendicitis e. Crohn's disease (regional enteritis)
Lifestyle changes for GERD (select all that apply): a. High-fat diet b. Smoking cessation c. High-sodium diet d. Increased intake of potassium-rich foods e. Weight loss
b. Smoking cessation e. Weight loss
Contraindications of Laxative Use (select all that apply): a. Dry mouth b. Use with caution in pregnancy and lactation c. Habitual use d. Constipation e. Fecal impaction or bowel obstruction
b. Use with caution in pregnancy and lactation c. Habitual use e. Fecal impaction or bowel obstruction
Traveler's diarrhea: (w/ E.Coli)- select all that apply: a. Seen only in visits to South America b. Usually self-limited, resolved in a few days c. Antibiotics indicated only w/ severe symptoms or prolonged d. Resolves in a few weeks e. Antibiotics are usually indicated
b. Usually self-limited, resolved in a few days c. Antibiotics indicated only w/ severe symptoms or prolonged
Defenses against PUD (select all that apply): a. pepsin b. blood flow c. gastric acid d. NSAID ingestion e. prostaglandins
b. blood flow e. prostaglandins
Contraindications of Laxative Use (select all that apply): a. HR of 65 b. diverticulitis c. dry mouth d. constipation e. ulcerative colitis
b. diverticulitis e. ulcerative colitis
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: a. tremors. b. headache. c. visual disturbances. d. anxiety.
b. headache.
Cause of Peptic Ulcer Disease (PUD) a. pyrexia b. imbalance between mucosal defensive and aggressive factors c. elevated BUN & creatinine levels
b. imbalance between mucosal defensive and aggressive factors
Diarrhea Causes (select all that apply): a. hypertension b. inflammation c. elevated HR d. hypothermia e. functional disorders of the bowel
b. inflammation e. functional disorders of the bowel
Frequent cause of constipation a. high-fiber diet b. low-fiber diet c. increased in take of bran
b. low-fiber diet
Evaluation of therapy for PUD (select all that apply): a. respiratory rate b. pain relief c. UA d. H. pylori tests e. radiologic or endoscopic examination of ulcer site
b. pain relief d. H. pylori tests e. radiologic or endoscopic examination of ulcer site
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? a. "I should crush the medication and mix it into apple sauce." b. "It is important that I take the drug after each meal." c. "I need to swallow the drug whole." d. "I'll have to stop using antacids."
c. "I need to swallow the drug whole."
The nurse is preparing for discharge a client who has a prescription for sucralfate. When does the nurse instruct the client to take the medication? a. With meals b. With an antacid before breakfast c. 1 hour before or 2 hours after meals and at bedtime d. After each meal, no more than 15 minutes after finishing
c. 1 hour before or 2 hours after meals and at bedtime
For acute peptic ulcer disease or esophagitis, drugs are given in relatively high doses for______ to promote healing. a. 1 - 2 days b. 1 week c. 4 - 8 weeks
c. 4 - 8 weeks
For treatment of peptic ulcer disease, take antacids 1 and 3 hours after meals and at bedtime (_______).. a. 1-2 doses daily b. as needed c. 4-7 doses daily
c. 4-7 doses daily
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common? a. Dizziness b. Headache c. Alopecia d. Cough
c. Alopecia
_______ the most common disorder of the esophagus, is a chronic digestive disease that occurs when stomach acid or, occasionally, bile refluxes into the esophagus. a. Peptic Ulcer Disease (PUD) b. Digestive Enzyme Dysfunction c. GERD
c. GERD
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs? a. Hypoxia b. Hypertension c. Gynecomastia d. Seizures
c. Gynecomastia
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 increase the risk for which problem for this client? a. Liver cancer b. Peptic ulcer disease c. Hip fractures d. Hypercalcemia
c. Hip fractures
The nurse is providing care for a 51-year-old client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment? a. Assess the client's lying, sitting, and standing blood pressures. b. Inspect the client's torso for rash. c. Inspect the client for gynecomastia. d. Assess the client for insomnia.
c. Inspect the client for gynecomastia.
H. pylori Treatment PPI + amoxicillin for 5 days, followed by: PPI + clarithromycin for 5 days. a. Triple therapy b. Quadruple therapy c. Sequential therapy
c. Sequential therapy
Client teaching should include what instruction about antacids? a. Take antacid with other medications. b. Take antacid 1/2 hour after other medications. c. Take antacid 1 hour before other medications. d. Take antacid only at bedtime.
c. Take antacid 1 hour before other medications.
H. pylori Treatment SE: stain teeth a. Amoxicillin b. Metronidazole c. Tetracycline d. Bismuth compounds
c. Tetracycline
Treatment of PUD Pain may subside before complete healing or may ______. a. be referred into leg pain b. decrease at same time of ulcer disappearance c. continue after healing
c. continue after healing
Laxative Abuse Consequences (select all that apply): a. red mucous membranes b. rebound hyperacidity c. dehydration d. constipation e. colonitis
c. dehydration e. colonitis
Proper function of bowel is highly dependent on ________. a. tyramine b. vitamin C c. dietary fiber
c. dietary fiber
Calcium antacids have high neutralizing capacity and rapid onset. They may cause ______ and hypercalcemia. a. indigestion b. acid reflux c. rebound acidity
c. rebound acidity
An older client has been prescribed omeprazole for the treatment of gastresophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine? a. "Famotidine and omeprazole are both histamine-2 antagonists and could be used interchangeably." b. "Famotidine is more expensive than omeprazole." c. "Omeprazole is taken at bedtime making it easier to remember." d. "Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population."
d. "Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population."
The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication? a. "You can expect to feel an increase in energy on this medication." b. "This medication has few side effects so you may not notice any." c. "Perianal irritation is a side effect of this medication." d. "This medication may make you feel lightheaded or drowsy."
d. "This medication may make you feel lightheaded or drowsy."
H. pylori Treatment SE: harmless black stools & tongue. a. Clarithromycin b. Metronidazole c. Tetracycline d. Bismuth compounds
d. Bismuth compounds
Laxative Abuse Causes (select all that apply): a. Bowel replenishment after evacuation can be 2-12 days b. CNS effects c. Drug Interactions d. Bowel replenishment after evacuation can be 2-5 days e. Misconception that bowel movements must occur daily
d. Bowel replenishment after evacuation can be 2-5 days e. Misconception that bowel movements must occur daily
Laxative Abuse Mgmt (select all that apply): a. Decrease in intake of fiber b. Decrease in strength training c. Decrease in intake of bran d. Bowel training e. Laxatives should only be used briefly in smallest dose
d. Bowel training e. Laxatives should only be used briefly in smallest dose
Laxative Abuse Consequences (select all that apply): a. Increased defecatory reflexes b. Dry muocus c. Fever d. Electrolyte imbalance e. Diminished defecatory reflexes
d. Electrolyte imbalance e. Diminished defecatory reflexes
Diarrhea Management (select all that apply): a. Increasing use of diuretics b. Increasing use of NSAIDs c. Increasing use of laxatives d. Reducing passage of unformed stools e. Diagnosis and treatment of underlying disease
d. Reducing passage of unformed stools e. Diagnosis and treatment of underlying disease
The following data identified during a nursing assessment and interview. When considering risks for the development of a peptic ulcer, which situation should the nurse discuss with the client? a. Eats spicy food at least twice a week. b. Has a stressful job as a air traffic controller. c. Is 15 pounds over ideal weight d. Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.
d. Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.
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? a. Swallow the tablet one hour before eating. b. Administer the drug one hour before travel. c. Do not chew, open, or crush the tablet. d. Use a reliable contraceptive.
d. Use a reliable contraceptive. Explanation: Misoprostol is a pregnancy category X drug.
Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in clients who: a. have diabetes. b. are hypertensive. c. have arthritis. d. are pregnant.
d. are pregnant.
Hiatal hernia
protrusion of a part of the stomach upward through the opening in the diaphragm
