Pharmacology Ch 57 (1)

A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to clients with which condition?

hepatic disease

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?

inhibiting acid secretion Rationale: Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.

A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?

2 tablets Rationale: The required dosage is 200 mcg. Available tablets contain 100 mcg of the drug. Therefore, the nurse should administer two tablets each time to the client.

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

Constipation Rationale: The nurse should warn a client taking aluminum- and calcium-containing antacids about constipation, which can be associated with taking products containing either medication. Client taking magnesium- and sodium-containing antacids can have diarrhea. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.

A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient's safety, which of the following would be a priority nursing action?

Coordinate bone density testing for the patient.

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

Gynecomastia Rationale: Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine. Ranitidine and cimetidine are both H2RAs used in the treatment of peptic ulcer disease.

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

Increased fracture risk Rationale: An increase in fractures of the hip, wrist, and spine have been seen in clients taking high doses of PPIs and undergoing treatment of osteoporosis with bisphosphonates.

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 Rationale: Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).

A client is prescribed misoprostol. The nurse would expect to administer this drug by which route?

Oral

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 Rationale: Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.

The client has Maalox ordered for administration before meals. Which condition is contraindicated with the administration of Maalox?

Renal dysfunction

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?

Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.

Client teaching should include what instruction about antacids?

Take antacid 1 hour before other medications. Rationale: Administer the drug apart from any other oral medications approximately 1 hour before or 2 hours after to ensure adequate absorption of the other medications.

Pancrelipase would most likely be used to treat a patient with cystic fibrosis.

True

A 23-year-old female client is prescribed misoprostol (Cytotec). Which client teaching intervention is most important?

Use effective contraceptive measures Rationale: Misoprostol (Cytotec) is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. It is not necessary for a client aged 23 years to report postmenopausal bleeding. The medication should be administered two to four times per day.

Which teaching intervention is most important to share with the client prescribed misoprostol?

Use effective contraceptive measures. Rationale: Misoprostol (Cytotec) is used to prevent NSAID gastric ulcer development. It is contraindicated during pregnancy because it is an abortifacient. Women of childbearing age should be advised to have a negative serum pregnancy test within 2 weeks of beginning treatment, and they should begin the drug on the 2nd or 3rd day of their next menstrual cycle. In addition, they should be instructed to use barrier contraceptives during therapy.

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

an hour before meals. Rationale: Sucralfate, a proton pump inhibitor, must be given time to act before significant gastric activity, and it requires an acidic environment to be effective. For these reasons, sucralfate should be given an hour before meals and antacids.

A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to

pork. Rationale: Pancrelipase is contraindicated in patients who are hypersensitive to pork protein or enzymes because the drug is derived from pork. Allergies to ragweed, pollen, and shellfish are not associated with the use of the drug

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. Rationale: H2RAs must be used with caution in clients with renal disease. Since these drugs are eliminated through the kidneys, dosages are reduced to avoid adverse effects.

A client has a magnesium-based antacid prescribed for administration as needed. Which condition contraindicates the administration of this classification of medications?

renal dysfunction