chapter 37
The nurse admits a client who reports having taken a proton pump inhibitor for more than a decade. What assessment question will the nurse ask this client? "Are you experiencing diarrhea?" "Do you ever experience flank pain?" "Have you noticed any blood in your urine?" "When is the last time you checked your blood pressure?"
"Are you experiencing diarrhea?" Explanation: Research indicates that clients taking proton pump inhibitors or histamine-2 antagonists demonstrate a significant increase in cases of Clostridium difficile infections leading to diarrhea so the nurse should assess this client for diarrhea. There would be no indications to ask about flankpain, blood in the urine, or blood pressure.
The nurse is caring for four clients. Which client would benefit most from misoprostol, a synthetic prostaglandin E analog? A 12-year-old male with obsessive-compulsive disorder A 22-year-old pregnant female A 46-year-old female with hypertension An 83-year-old male with rheumatoid arthritis
An 83-year-old male with rheumatoid arthritis Explanation: Misoprostol is prescribed for concurrent use with NSAIDs to prevent NSAID-induced erosion and ulceration of the gastric mucosa. The client with rheumatoid arthritis likely uses NSAIDs frequently, placing him at risk of developing gastric ulcers and making him a candidate for misoprostol.
Although frequently used in the treatment of psychosis, phenothiazines are also prescribed as antiemetics. By what mechanism do phenothiazines control vomiting and nausea? By increasing gastric motility By blocking dopamine receptors By blocking histamine receptors All the above
By blocking dopamine receptors Phenothiazines produce an antiemetic effect by blocking dopamine receptor sites in the chemoreceptor trigger zone and the vomiting center of the brain.
Which is a side effect a nurse should recognize after administration of hydroxyzine? Client rubbing eyes, reporting blurry vision. Client is having shortness of breath. Client is having 2 or 3 loose stools a day. Client reporting nausea and vomiting.
Client rubbing eyes, reporting blurry vision. Explanation: Hydroxyzine has anticholinergic effects. The nurse should assess for these effects, which include blurry vision, urinary retention, constipation, and thick secretions. Hydroxyzine is used for the treatment of nausea and vomiting.
A client has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the client's drug history to determine if the client is taking which drug? Levodopa Morphine Digoxin Dicyclomine hydrochloride
Digoxin Explanation: The nurse should assess for the use of digoxin. Rabeprazole interacts with digoxin and increases its serum concentration. It is necessary to monitor for signs of digoxin toxicity when these drugs are given together. Morphine, levodopa, and dicyclomine hydrochloride can cause adverse interactions with metoclopramide.
Ms. Diniger is prescribed omeprazole for gastric reflux disorder. Which strategy would help minimize the risk of adverse effects associated with omeprazole? Crush the capsule before administration. Divide daily dosage larger than 80 mg into smaller doses to be administered through the day. Do not administer the drug for more than 1 week. Advise the patient to chew the drug thoroughly before swallowing.
Divide daily dosage larger than 80 mg into smaller doses to be administered through the day. Explanation: Daily dosages larger than 80 mg should be given in divided doses. Because the drug is enteric coated, it cannot be crushed before use or chewed before swallowing. It is not necessary to restrict use of the drug to 1 week; the nurse must ensure that omeprazole is administered for the recommended time, based on the clinical indication for therapy, usually between 2 weeks and 8 weeks.
A female client is receiving chemotherapy to treat her cancer. Several antiemetics have been prescribed, and each has been unsuccessful in treating her nausea and vomiting. The health care provider chooses to prescribe what cannabinoid drug to manage her symptoms? Scopolamine Fosaprepitant Ondansetron Dronabinol
Dronabinol Explanation: Dronabinol is a cannabinoid used in the management of nausea and vomiting associated with chemotherapy unrelieved by other antiemetic drugs. It is a Schedule III drug under federal narcotic laws.
The nurse is preparing a teaching plan for a patient who is receiving sucralfate. Which would the nurse need to address? (Select all that apply.) A. Eating a high fiber diet B.Ensuring safety precautions C.Taking the drug on an empty stomach D.Encouraging frequent mouth care E.Limiting fluid intake F.Using an antidiarrheal agent
Eating a high fiber diet Ensuring safety precautions Taking the drug on an empty stomach Encouraging frequent mouth care
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? Remove items with strong smells and odors. Use mouthwash or frequent oral rinses. Make the environment as pleasant as possible. Explain that the drug may change the color of the stool.
Explain that the drug may change the color of the stool. Explanation: When antacids are prescribed for outpatient use, the nurse should explain to the patient and family members that the drug may change the color of the stool (white, white streaks). When caring for a patient with nausea, the nurse makes the environment as pleasant as possible to enhance the patient's appetite and removes items with strong smells and odors. The nurse gives the patient mouthwash or frequent oral rinses to remove the disagreeable taste that accompanies vomiting.
When comparing the H2RAs to each other, you would find that cimetidine (Tagamet) is more likely to cause which adverse effect? Hypoxia Hypertension Gynecomastia Seizures
Gynecomastia Explanation: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrongenic effects, including gynecomastia and galactorrhea. Therefore the other options are incorrect.
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? Smaller than the average prescribed dose Larger than the average prescribed dose The same as the average prescribed dose No antacids, because they are contraindicated in the elderly
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.
aluminum hydroxide with magnesium hydroxide (mylanta)
antacids -relieve symptoms associated with GERD, gastritis, PUD, raises gastric pH of stomach and duodenal AE- osteomalacia (softening of bone), encephalopathy (swell brain), and rebound gastric acid production
The nurse is caring for a patient who is going home on sucralfate (Carafate). The nurse would teach the patient to take sucralfate: with meals. with an antacid before breakfast. before meals. after each meal.
before meals. Explanation: Administer drug before meals to ensure that the patient does not open, chew, or crush capsules; they should be swallowed whole to ensure the therapeutic effectiveness of the drug.
An older adult reports chronic abdominal pain and dark, tarry stools. The client has a history of chronic arthritis being treated with naproxen daily. What is the most likely cause of the presenting symptomology? gastric ulcer gastroesophageal reflux disease (GERD) pyloric stenosis duodenal ulcer
gastric ulcer Explanation: Gastric ulcers associated with stress may occur in any age group. Those associated with nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen ingestion are more likely to occur in older adults, especially those in the sixth or seventh decades of life, and to be chronic in nature. Reference:
Ranitidine (-dine)
histamine 2 blockers -ulcers, GERD, gastritis inhibits both daytime and nighttime basal gastric acid secretion AE-headache, blood count changes, GI effects non-erosive this is the best
Sucrafate
musocal Protectant -PUD, gastritis Covers and protects ulcer AE-hyperglycemia, constipation(gel formation) drug-drug- phosphate supplement
A nurse is reviewing information about proton pump inhibitors. The nurse recognizes that which of the following is available as an over-the-counter agent? Lansoprazole Omeprazole Rabeprazole Esomeprazole
omeprazole
A client is prescribed misoprostol. The nurse would expect to administer this drug by which route? Oral Subcutaneous Transdermal Intravenous
oral
Misoprostol is contraindicated for clients with what condition? Diabetes Hypertension Arthritis Pregnancy
pregnancy
Omeprazole (azole)
proton pump inhibitor -heartburn/GERD suppresses last phase gastric acid production by suppressing proton pump AE-headache, diarrhea, dizziness, cough Heal erosive
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. diabetes mellitus. pulmonary disease. migraine headaches.
renal disease. Explanation: 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 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: blood glucose level. serum phosphate level. urine specific gravity. aspartate transaminase levels.
serum phosphate levels serum phosphate levels because aluminum binds with phosphate. This can lower phosphate levels and cause an electrolyte imbalance
The nurse is caring for a 27-year-old female client who has just been prescribed misoprostol. What is a priority teaching point for this client? The need to use a barrier-type contraceptive A warning against using NSAIDs Adverse effects include nausea and diarrhea It protects the lining of the stomach
the need to use a barrier-type contraceptive