Chapter 57

After teaching a patient who is receiving sucralfate about the drug, which statement indicates that the teaching has been successful? "i need to limit my fluid intake" "I should eat a high fiber diet" "I may need something to control diarrhea" "I need to avoid sugar lozenges"

"I should eat a high fiber diet"

Which instruction would be most important to give to a patient who is receiving omeprazole? "chew the tablet thoroughly before swallowing" "open the capsule and sprinkle in on applesauce" "swallow the tablet whole with a large glass of water" "take an antacid immediately before taking the drug"

"swallow the tablet whole with a large glass of water"

A patient is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame? 15 minutes 30 minutes 45 minutes 60 minutes

30 minutes

When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common? Dizziness Headache Alopecia Cough

Alopecia

2. Saliva substitute (Moi-Stir) may be useful in which of the following circumstances? Cancer radiation therapy Stroke Parkinson's disease Brain injury Situational anxiety Hypertension

Cancer radiation therapy Stroke Brain injury

Which agent is associated with anti-androgenic effects? Ranitidine Famotidine Cimetidine Nizatidine

Cimetidine

Which agent would a nurse identify as the prototype histamine-2 receptor antagonist? Cimetidine Ranitidine Famotidine Nizatidine

Cimetidine

Histamine-2 Antagonists (drug)

Cimetidine Action: selectively block histmaine-2 receptor sites on parietal cells. Leads to a reduction in gastric acid secretion Indication: Treatment of active duodenal ulcer or benign gastric ulcer. Treatment of hypersecretory conditions. Prophylaxis of stress-induced ulcers. GE reflux. Relief of heartburn Contraindication: allergy Adverse Effects: Diarrhea, constipation, dizzy, headache, sleepy, confusion, arrhythmias, hypotension, gynecomastia, impotence, rash Considerations: Not for use in children <16

Effect of drugs on GI secretions

Decrease GI secretory activity Block action of GI secretions Form protective covering on GI lining Replace missing GI enzymes

Proton pump inhibitor (definition)

Drug that blocks H+, K+ -ATPase enzyme system

Histamine-2 (H2) antagonist (definition)

Drug that blocks the H2 receptor sites Decreases acid production

GI protectant

Drug that coats an injured area of the stomach

Digestive enzymes (definition)

Enzymes produced in GI tract to break down food

Peptic ulcer

Erosion of the lining of the stomach or duodenum Possible from infection by H.Pylori bacteria

Peptic Ulcer Disease

Erosion of the stomach lining Gnawing or burning pain, usually after meals Helicobacter pylori bacteria

Which of the following would a nurse expect to administer intravenously? Esomeprazole Omeprazole Rabeprzole Dexlansoprazole

Esomeprazole

A patient is receiving sodium bicarbonate orally. Which of the following would lead the nurse to suspect that the patient is developing systemic alkalosis? Select all that apply... Headache Constipation Confusion Irritability Tatany

Headache Confusion Irritability Tatany

A patient is taking an antacid that contains aluminum salts. The nurse would monitor the patient for which of the following? Diarrhea Hypercalcemia Acid rebound Hypophosphatemia

Hypophosphatemia

Antacids (Definition)

Inorganic chemicals that neutralize stomach acid

Prostaglandin (drug)

Misoprostol Action: Inhibits gastric acid secretion and increases bicarbonate and mucous production in stomach Indications: Prevention of NSAID-induced gastric ulcers, treatment of duodenal ulcers Contraindications: Pregnancy Adverse effects: N/V/D, abdominal pain, flatulence, dyspepsia, constipation, miscarriages, excesive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea

3. Which H2 antagonist would the nurse expect to be ordered for a patient with known liver dysfunction? Cimetidine Famotidine Nizatidine Ranitidine

Nizatidine

A patient has a history of liver dysfunction. Which histamine-2 receptor antagonist would the nurse expect to prescribe? Cimetidine Famotidine Ranitidine Nizatidine

Nizatidine

A nurse is reviewing information about proton pump inhibitors. The nurse recognizes that which of the following is available as an OTC agent? Lansoprazole Omeprazole Rabeprazole Esomeprazole

Omeprazole

Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of H.pylori infection? Famotidine Calcium carbonate Omeprazole Sucralfate

Omeprazole

Proton Pump Inhibitors (drug)

Omeprazole Action: Act at specific secretory receptors (H+, K+ -ATPase) to prevent final step of acid production Indications: Treatment of active duodenal ulcers, GERD, erosive esophagitis, benign active gastric disease Contraindications: Allergy. Adverse Effects: Dizziness, headache, asthenia, vertigo, insomnia, apathy, diarrhea, abdominal pain, tongue atrophy, cough, stuffy nose, hoarseness, epistaxis, rash, alopecia, pruritis, dry skin, back pain, fever Considerations: not for use <18 except Prevacid

Acid rebound

Response of the stomach to lower-than-normal acid levels Gastrin production is increased

Digestive enzymes (drug)

Pancrelipase Action: Salivia substitute or pancreatic enzyme replacement Indication: Stroke, salivary gland disorder, surgery of head or neck, common pancreatic duct problems, pancreatic disease, cystic fibrosis Contraindications: Allergy Adverse Effects: Saliva-increased levels of magnesium, sodium, or potassium Pancreatic enzymes- GI irratation, N/D, cramps

Which agent would a nurse identify as inhibiting the secretion of gastrin? Histamine-2 receptor antagonist Proton pump inhibitor Antacid Prostaglandin

Prostaglandin

Which of the following best reflects the rationale for using histamine-2 receptor antagonists for stress ulcer prophylaxis? Reduces the overall acid level, promoting healing and comfort Blocks the overproduction of hydrochloric acid Decreases the acid being regurgitated into the esophagus Protects the stomach lining via acid blockage

Protects the stomach lining via acid blockage

Antacids (drug)

Sodium Bicarbonate Action: Neutralizes stomach acid Indications: Symptomatic relief of upset stomach associated with hyperacidity----peptic ulcer, gastritis, peptic esophagitis, hiatal hernia Contraindication: allergy Adverse effects: Rebound acidity, alkalosis, N/V, hypercalcemia, constipation, diarrhea, hypophosphatemia

Antipeptic (GI protectant) Agent

Sucralfate Action: Protects ulcer sites against acid, pepsin, and bile salts Indication: Promotes ulcer healing Contraindication: allergy, renal failure, dialysis Adverse effects: Constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth, dizziness, sleepiness, vertigo, skin rash, back pain

1. Patients who use antacids frequently can be expected to experience which of the following adverse effects? Systemic alkalosis Electrolyte imbalances Hypokalemia Metabolic acidosis Constipation or diarrhea Muscular weakness

Systemic alkalosis Electrolyte imbalances Hypokalemia Constipation or diarrhea Muscular weakness

1. Which of the following would a nurse include when describing the action of histamine-2 (H2) antagonists to a patient? They block the release of gastrin and pepsin, leading to a decrease in protein digestion. They selectively block histamine receptors, reducing swelling and inflammation at numerous sites. They selectively block specific histamine receptor sites, leading to a reduction in gastric acid secretion. They are effective primarily for long term use because of their slow onset of action.

They selectively block specific histamine receptor sites, leading to a reduction in gastric acid secretion.

Prostaglandin (definition)

Tissue hormones that have local organ effects Vasoconstriction, vasodilation, increased or decreased GI activity and pancreatic enzyme release

A patient is receiving pancrelipase. The nurse would expect to administer this drug at which time? 1 hour before meals With meals and snacks At bedtime First thing on arising

With meals and snacks

4. The nurse would monitor a patient receiving intravenous cimetidine (Tagamet) for an acute ulcer problem for...? gastrointestinal (GI) upset. gynecomastia. cardiac arrhythmias. constipation.

cardiac arrhythmias.

2. H2 receptors are found throughout the body, including...? in the nasal passages, upper airways, and stomach. in the central nervous system (CNS) and upper airways. in the respiratory tract and the heart. in the heart, CNS, and stomach.

in the heart, CNS, and stomach.

5. Acid rebound is a condition that occurs when...? lowering gastric acid to an alkaline level stimulates the release of gastric acid. raising gastric acid levels causes heartburn. combining protein, calcium, and smoking greatly elevates gastric acid levels. eating citrus fruit neutralizes gastric acid.

lowering gastric acid to an alkaline level stimulates the release of gastric acid.

7. Misoprostol (Cytotec) is a prostaglandin that is used to...? prevent uterine contractions. prevent nonsteroidal anti-inflammatory drug-related gastric ulcers in patients at high risk. decrease hyperacidity with meals and at bedtime. relieve the burning associated with hiatal hernia at night.

prevent nonsteroidal anti-inflammatory drug-related gastric ulcers in patients at high risk.

8. A nurse caring for a patient receiving pancreatic enzymes as replacement therapy should be assessing the patient for...? hypertension. cardiac arrhythmias. excessive weight gain. signs of GI irritation.

signs of GI irritation.

6. A nurse taking care of a patient who is receiving a proton pump inhibitor should teach the patient to...? take the drug after every meal. chew or crush tablets to increase their absorption. swallow tablets or capsules whole. stop taking the drug after 3 weeks of therapy.

swallow tablets or capsules whole.