Chapter 57 & 58 Pharm

The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine rather than cimetidine?

Drug-to-drug interaction

A male client is taking cimetidine. Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists

The nurse should explain that metoclopramide (Reglan) decreases nausea and vomiting by which of the following actions?

Inhibiting stimulation of the vomiting center in the brain

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?

"I need to swallow the drug whole."

After teaching a client who is receiving sucralfate about the drug, which statement indicates that the teaching has been successful?

"I should eat a high-fiber diet."

A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?

"Quitting smoking will significantly increase the chance that this drug will heal your ulcer."

Which drugs treat heartburn by neutralizing the acidity of the stomach by combining with hydrochloric acid (HCl) and increasing the pH of the stomach acid?

Aluminum hydroxide neutralizes or reduces the acidity of the stomach and duodenal contents by combining with hydrochloric acid and increasing the pH of the stomach

A nurse educating a client on the antacid calcium carbonate (Mylanta) should warn the client of which of the following adverse reactions? Select all that apply:

Confusion Headache Rebound hyperacidity

A nurse is providing education to an adult female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching?

Misoprostol 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.

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?

Omeprazole

The client has a magnesium-based antacid prescribed for administration before meals. The nurse knows to withhold the medication if the client exhibits what?

Renal dysfunction Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.

A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the client's safety. What would be an appropriate nursing diagnosis?

Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations

A client is receiving a liquid antacid. Which would the nurse instruct the client to do?

Shake the antacid thoroughly before using. Liquid antacid preparations must be shaken thoroughly immediately before administration.

Client teaching should include what instruction about antacids and other medications?

Take antacid 1 hour before other medications.

A client, with recent abdominal pain and a 40-pack per year smoking history, is prescribed a treatment regimen for a diagnosis of duodenal ulcer. What important teaching would the nurse include in relation to treatment?

smoking effects on the healing of ulcers Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of nonsmokers.

A client has been prescribed omeprazole by the primary health care provider. When the nurse asks whether the medication is providing relief, the client replies, "I think it's working quite well, and I've gotten in the routine of taking it every morning before breakfast." How should the nurse respond?

"I'm glad to hear that. It sounds like you're taking it exactly like it should be taken." It is important that omeprazole be administered before food intake. Once-daily dosing is typical. The drug is not taken solely as a response to acute symptoms.

The nurse is caring for a patient who has been prescribed a saliva substitute . The patient asks why this medication is necessary. What would be the most appropriate response?

"This medication helps people that have a condition that creates a lack of saliva."

A client with ulcers has asked the nurse if it would be acceptable to take bismuth subsalicylate. Before recommending an over-the-counter (OTC) formulation of bismuth subsalicylate, the nurse should conduct which client assessment?

Allergy status

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

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 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?

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

Which agent would a nurse identify as the prototype histamine-2 receptor antagonist?

Cimetidine is considered the prototype histamine-2 receptor antagonist.

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

Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.

Which agent is associated with antiandrogenic effects?

Cimetidine was the first drug in this class to be developed and has been associated with antiandrogenic effects including gynecomastia and galactorrhea. Ranitidine, famotidine, and nizatidine are not associated with these effects.

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is:

Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe.

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?

Hip fracture

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?

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

Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?

Omeprazole Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.

A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?

Omeprazole is a proton pump inhibitor which is used as part of combination therapy to treat H. pylori infections.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

PPIs decrease gastric acid secretion.

A client is in the intensive care unit and being administered ranitidine parenterally. How long will it take for ranitidine to reach peak blood levels?

Parenteral ranitidine reaches peak blood level in 15 minutes

A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the client's safety. What would be an appropriate nursing diagnosis?

Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations Appropriate nursing diagnosis related to safety would be Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations.

The nurse should be aware that ranitidine achieves a therapeutic effect by which means?

The histamine2 receptor antagonists (H2RAs) inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin. These drugs, such as ranitidine, do not change the pH of secretions, bind to the proton pumps, or decrease gastric motility.

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:

The nurse should monitor the client's serum phosphate level because aluminum binds with phosphate. This can lower phosphate levels and cause an electrolyte imbalance.

A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. What is one of the preferred antibiotics?

The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?

The treatment of choice for Helicobacter pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

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

constipation

A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for:

metabolic alkalosis Overuse of antacids containing calcium carbonate can cause alkalosis and raise urine pH.

The nurse is caring for a client who has been prescribed sucralfate for treatment of peptic ulcer disease. Which nursing diagnosis may relate specifically to administration of this medication?

Since sucralfate can cause constipation, Impaired Bowel Elimination: Constipation may be relevant to administration of the drug.

Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which medication will likely be used in an attempt to eradicate the patient's H. pylori infection?

Classic quadruple therapy for H. pylori eradication (bismuth, a PPI, 1,500 mg of metronidazole, and 1,500 mg of tetracycline) is highly effective and is frequently the regimen of choice. A newer sequential therapy (PPI plus amoxicillin followed by a PPI plus clarithromycin plus metronidazole) has been proposed and is expected to replace legacy therapy. Both regimens include PPIs and antibiotics and exclude aluminum hydroxide, ondansetron, and cisapride.

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?

The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach.