Ch. 50 Acid-Controlling Drugs

The nurse is preparing to administer the first dose of misoprostol for a patient who has been diagnosed with a gastric ulcer. What condition would be a contraindication to this medication? a. hypothyroidism b. Type 2 diabetes mellitus c. pregnancy d. hypertension

c. pregnancy

A nurse is providing discharge teaching to a pt who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? a. take the medication with food b. monitor for diarrhea c. wait 1 hr before taking other medications d. maintain a low-fiber diet

c. wait 1 hr before taking other medications (don't take oral medications within 1 hr of antacids) ATI MS

Administration of histamine₂ blockers and antacids should be separated by at least how long? - 30 minutes - 1 hour - 2 hours - 4 hours

- 1 hour

When should antacids be taken in relation to other medications? - 1-2 hours before medication - With all medications - 1-2 hours after medications - 30 minutes after medications

- 1-2 hours after medications

Which antacid has the potential to cause kidney stones? - Sodium bicarbonate - Aluminum hydroxide - Magnesium hydroxide - Calcium carbonate

- Calcium carbonate

Antacids promote the integrity of the abdominal wall by neutralizing which acid? - Lipase - Gastric - Amylase - Lactase

- Gastric

If taken in large dose, PPIs can be combined with antibiotics to treat which gastric ailment? - H. Pylori - Hypersecretion - Hypomagnesemia - Occult blood in the stool

- H. Pylori

The nurse has an order to administer a PPI to a patient who has already eaten breakfast. What is the nurse's next step? - Consult with the charge nurse. - Administer the mediation anyway. - The nurse needs to call the health care provider. - Hold the medication and educate the patient that this medication needs to be taken on an empty stomach.

- Hold the medication and educate the patient that this medication needs to be taken on an empty stomach.

Which is an adverse effect of long-term PPI use? - Bleeding - Petechiae - Gastric ulcers - Hypomagnesemia

- Hypomagnesemia

Why is drinking 2-4 ounces of water recommended after taking a liquid antacid? - It facilitates systemic absorption - Helps with nausea associated with antacids - Helps with diarrhea associated with antacids - Increases gastric emptying time

- Increases gastric emptying time

Histamine₂ blockers should be administered at which time to decrease food-induced acid secretion? Select all that apply. - Just before meals - During meals - Just after meals - Just after waking - At bedtime

- Just before meals - At bedtime

The mode of action of histamine₂ blockers includes inhibition of gastric acid secretion by blocking histamine in which type of cell? - Stem cell - Chief cell - Acid cell - Parietal cell

- Parietal cell

Antacids are primarily used to treat which condition? - Gastroesophageal reflux disease - Irritable bowel syndrome - Peptic ulcer disease - Pancreatitis

- Peptic ulcer disease

Which condition can result from long-term high doses of PPIs? - HIV - Seizures - Pneumonia - Acute coronary syndrome

- Pneumonia

Which antacid is unsuitable for treating peptic ulcers? - Magnesium hydroxide - Aluminum hydroxide - Sodium bicarbonate - Calcium carbonate

- Sodium bicarbonate

When a patient is taking self-prescribed antacids, at what point should the patient seek medical advice? - One month - Six weeks - Two weeks - Five days

- Two weeks

The nurse determines the client needs further instruction on cimetidine is which statements were made? (Select all that apply) 1. "I will take the cimetidine with my meals." 2. "I'll know the medication is working if my diarrhea stops." 3. "My episodes of heartburn will decrease if the medication is effective." 4. "Taking the cimetidine with an antacid will increase its effectiveness." 5. "I will notify my health care provider if I become depressed or anxious." 6. "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

1. "I will take the cimetidine with my meals." 2. "I'll know the medication is working if my diarrhea stops." 4. "Taking the cimetidine with an antacid will increase its effectiveness." (cimetidine = H2-receptor antagonist) NCLEX

A client has been taking omeprozole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. diarrhea 2. heartburn 3. flatulence 4. constipation

2. heartburn (omeprazole = PPI) NCLEX

A client who uses NSAIDs has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? 1. resolved diarrhea 2. relief of epigastric pain 3. decreased platelet count 4. decreased WBC count

2. relief of epigastric pain (misoprostol is used for treatment of NSAID-induced ulcers) NCLEX

An older adult client recently has been taking cimetidine. The nurse monitors the client for which most frequent CNS side effect of this medication? 1. tremors 2. dizziness 3. confusion 4. hallucinations

3. confusion (cimetidine = H2-receptor antagonist) NCLEX

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1. with meals and at bedtime 2. every 6 hrs around the clock 3. one hr after meals and at bedtime 4. one hr before meals and at bedtime

4. one hr before meals and at bedtime NCLEX

Review Question 5: When providing education regarding the use of PPIs, which statement will the nurse include? A. "Take the medication along with the first meal of the day." B. "Take the medication on an empty stomach, 30 to 60 minutes before eating." C. "Take the medication when you have symptoms of heartburn." D. "Take the medication at bedtime with a snack."

B. "Take the medication on an empty stomach, 30 to 60 minutes before eating."

Review Question 4: Simethicone (Mylicon) is often combined with calcium carbonate antacids because: A. an increased antacid effect will result when these drugs are given in combination B. simethicone helps to reduce the gas that is caused by the calcium antacids C. simethicone reduces the diarrhea that is caused by the calcium D. simethicone improves the taste of the calcium tablets, which must be chewed

B. simethicone helps to reduce the gas that is caused by the calcium antacids

Review Question 3: When teaching a patient about sucralfate (Carafate) therapy, which of the following statements will the nurse include? A. Take sucralfate 1 hour before your other medications B. Sucralfate is administered once daily upon waking up C. Sucralfate acts systemically to heal gastric ulcers D. Sucralfate binds and concentrates epidermal growth factor to promote ulcer healing

D. Sucralfate binds and concentrates epidermal growth factor to promote ulcer healing

A patient who is taking oral tetracycline complains of heartburn and requests an antacid. Which action by the nurse is correct? a. Give the tetracycline, but delay the antacid for 1 to 2 hours. b. Give the antacid, but delay the tetracycline for at least 4 hours. c. Administer both medications together. d. Explain that the antacid cannot be given while the patient is taking the tetracycline.

a. Give the tetracycline, but delay the antacid for 1 to 2 hours.

When the nurse is administering a proton pump inhibitor (PPI), which actions by the nurse are correct? (select all that apply) a. Giving the PPI on an empty stomach b. Giving the PPI with meals c. Making sure the patient does not crush or chew the capsules. d. Instructing the patient to open the capsule and chew the contents for best absorption. e. Administering the PPI only when the patient complains of heartburn.

a. Giving the PPI on an empty stomach c. Making sure the patient does not crush or chew the capsules.

Which patient should be advised to limit or avoid use of sodium bicarbonate as an antacid? a. a patient who is 6 months pregnant. b. a patient with hypertension c. a patient with heart failure d. a patient with gout e. a patient with scleroderma

b. a patient with hypertension c. a patient with heart failure

A nurse is caring for 4 clients who have peptic ulcer disease. The nurse should recognize that misoprostol is contraindicated for which of the following clients? a. a client who is pregnant b. a client who has osteoarthritis c. a client who has a kidney stone d. a client who has a urinary tract infection

a. a client who is pregnant ATI

A nurse is teaching a pt who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply) a. take the medication 1 hr before meals b. limit NSAIDs when taking this medication c. expect skin flushing when taking this medication d. increase fiber intake when taking this medication e. chew the medication thoroughly before swallowing

a. take the medication 1 hr before meals b. limit NSAIDs when taking this medication (esomeprazole = PPI) ATI MS

When evaluating the medication list of a patient who will be starting therapy with an H2 receptor antagonist, the nurse is aware that which drug may interact with it? a. codeine b. penicillin c. phenytoin d. acetaminophen

c. phenytoin

A patient with a history of renal problems is asking for advice about which antacid he should use. The nurse will make make which recommendation? a. Patients with renal problems cannot use antacids. b. Aluminum-based antacids are the best choice for you. c. Calcium-based antacids are the best choice for you. d. Magnesium-based antacids are the best choice for you.

b. Aluminum-based antacids are the best choice for you.

Which is the correct action when the nurse is administering sucralfate? a. Giving the dug with meals. b. Giving the drug on an empty stomach c. Instructing the patient to restrict fluids d. Waiting 30 minutes before administering other drugs

b. Giving the drug on an empty stomach

What is the mechanism of action for Famotidine (Pepcid)? a. It causes a decrease in stomach pH, reducing stomach acidity. b. It competes with histamine for binding sites on the parietal cells. c. It forms a protective coating against gastric acid, pepsin, and bile salts. d. It irreversibly binds to the hydrogen-potassium-adenosine triphosphatase (ATPase) pump.

b. It competes with histamine for binding sites on the parietal cells

A pregnant woman asks the nurse about taking an antacid for indigestion. What's the nurse's best response? a. You won't be allowed to take an antacid while you are pregnant. b. Let's check with your obstetrician to see what is recommended? c. Go ahead and use an aluminum-based antacid. d. sodium-bicarbonate would be the safest choice.

b. Let's check with your obstetrician to see what is recommended?

Which nursing diagnoses is appropriate for a client receiving famotidine (Pepcid)? a. Increased risk for infection related to immunosuppression b. Potential risk for bleeding related to thrombocytopenia c. Alteration in urinary elimination related to retention d. Alteration in tissue perfusion related to hypertension

b. Potential risk for bleeding related to thrombocytopenia

A patient with renal failure wants to take an antacid for "sour stomach." The nurse needs to consider that some antacids may be dangerous when taken by patients with renal failure and will recommend which type of antacid? a. activated charcoal b. aluminum-containing antacids c. calcium-containing antacids d. magnesium-containing antacids

b. aluminum-containing antacids

The nurse is administering a proton pump inhibitor during morning medication rounds. Which statement about proton pump inhibitors are true? a. they should be taken 1 hour before antacids b. they should be taken 30 to 60 minutes before meals c. they should be taken with meals d. they are part of the treatment of patients with H. pylori infections e. there are very few adverse effects with these drugs

b. they should be taken 30 to 60 minutes before meals d. they are part of the treatment of patients with H. pylori infections e. there are very few adverse effects with these drugs

A nurse is teaching a client who has a new prescription for omeprazole for management of heartburn. Which of the following information should the nurse include in the teaching? a. take this medication at bedtime b. this medication decreases the production of gastric acid c. take this medication 2 hrs after eating d. this medication can cause hyperkalemia

b. this medication decreases the production of gastric acid (omeprazole = PPI) ATI

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. What instructions should the nurse include? a. "Take the medication on an empty stomach for full effectiveness." b. "You may discontinue this medication when stomach discomfort subsides." c. "Report yellowing of the skin." d. "Store the medication in the refrigerator."

c. "Report yellowing of the skin." (ranitidine can be hepatotoxic and cause jaundice. client should report any yellowing of the eyes or skin to provider) ATI

The nurse will question an order for misoprostol (Cytotec) in which patient? a. A 21-year-old man with Zollinger-Ellison syndrome b. A 64-year-old man with hypertension c. A 32-year-old pregnant woman with a urinary tract infection d. A 45-year-old woman with GERD

c. A 32-year-old pregnant woman with a urinary tract infection (misoprostol is a prostaglandin E analogue and an abortifacient, therefore is contraindicated in pregnancy) Pharm

When administering sucralfate (Carafate) to a client with a nasogastric tube, what is an essential intervention? a. Crush the tablet into a fine powder before mixing it with water. b. Administer with a bolus tube feeding. c. Allow the tablet to dissolve in water before administering. d. Administer with an antacid for maximum benefit.

c. Allow the tablet to dissolve in water before administering.

The nurse determines a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? a. Nausea b. Belching c. Epigastric pain d. Difficulty swallowing

c. Epigastric pain (Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain.) MS ch 41

When caring for an older adult patient diagnosed with peptic ulcer disease and receiving each of the following medications, the nurse would relate the onset of confusion as a possible side effect to which medication? a. antacids b. carafate c. H2 antagonists d. Cytotect

c. H2 antagonists

A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? a. Sucralfate b. Cimetidine c. Omeprazole d. Metoclopramide

c. Omeprazole (long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine) MS ch 41

A patient with peptic ulcer disease will be starting medication therapy. He tells the nurse that he smokes and wonders if that will affect his treatment. Which is the nurse's best response? a. Smoking has no effect on these medications. b. The actions of antacids are less potent when you smoke. c. Smoking has been known to decrease the effectiveness of H2 blockers. d. Smoking has been shown to increase the adverse effects of H2 blockers.

c. Smoking has been known to decrease the effectiveness of H2 blockers.

A nurse is teaching a client who is taking sucralfate PO for peptic ulcer disease and has a new prescription for phenytoin to control seizures. Which of the following instructions should the nurse include? a. take an antacid with the sucralfate b. take sucralfate with a glass of milk c. allow a 2-hr interval between these medications d. chew the sucralfate thoroughly before swallowing

c. allow a 2-hr interval between these medications (sucralfate can interfere with the absorption of phenytoin) ATI

A 30-year-old patient is taking simethicone for excessive flatus associated with diverticulitis. During a patient teaching session, the nurse explains the mechanism of action of simethicone by saying: a. It neutralizes gastric pH, thereby preventing gas. b. It buffers the effects of pepsin on the gastric wall. c. It decreases gastric acid secretion and thereby minimizes flatus. d. It causes mucous-coated gas bubbles to break into smaller ones.

d. It causes mucous-coated gas bubbles to break into smaller ones.

Which drug class would be used as first-line therapy for GERD that has not responded to customary medical treatment? a. H2 blockers b. antacids c. mucosal protectants d. proton pump inhibitors

d. proton pump inhibitors (omeprazole)