Chapter 57: Drugs Affecting Gastrointestinal Secretions
The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions? A) Renal disease B) Diabetes mellitus C) Pulmonary disease D) Migraine headaches
Ans: A Feedback: All histamine-2 antagonists are eliminated through the kidneys; dosages need to be reduced in patients with renal impairment. No caution is necessary with Zantac therapy in people with diabetes, pulmonary disease, or migraine headaches.
The nurse questions an order for a proton pump inhibitor when the patient is known to take what other medication? A) Theophylline B) Penicillin C) Digoxin D) Heparin
Ans: A Feedback: Decreased levels of ketoconazole and theophylline have been reported when combined with these drugs, leading to loss of effectiveness. There are no drugdrug interactions with penicillin, digoxin, or heparin.
The nurse is caring for a 27-year-old female patient who has just been prescribed misoprostol. What is a priority teaching point for this patient? A) You will need to use a barrier-type contraceptive B) Do not take NSAIDs with this drug C) Adverse effects include nausea and diarrhea D) It protects the lining of the stomach
Ans: A Feedback: Misoprostol is contraindicated during pregnancy because it is an abortifacient. Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives. All other options are correct but are not a priority for this patient.
A patient presents to the walk-in clinic complaining of vomiting and burning in his or her mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the physician is likely to order a diagnostic test to detect the possible presence of what? A) Infection with Helicobacter pylori B) Decreased stomach acid secretion C) Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) D) Overconsumption of spicy foods
Ans: A Feedback: Peptic ulcers may result from increased acid production, decrease in the protective mucous lining of the stomach, infection with Helicobacter pylori bacteria, or a combination of these. Peptic ulcers do not result from decreased acid secretion or overconsumption of spicy foods. While gastric irritation can be caused by NSAIDs gastric irritation can result from many different causes so this would not be specifically assessed for unless the patient was found to use NSAIDs frequently, which is not indicated by the question.
A patient comes to the clinic complaining of acid indigestion and tells the nurse he is tired of buying over-the-counter (OTC) antacids and wants a prescription drug to cure the problem. What would the nurse specifically assess for? A) Alkalosis B) Hypocalcemia C) Hypercholesterolemia D) Rebound tenderness at McBurneys point
Ans: A Feedback: Prolonged or excessive use of OTC antacids can lead to the development of metabolic alkalosis. Many antacids contain calcium so that low calcium levels would be unlikely. Because metabolic alkalosis is a concern, metabolic acidosis is unlikely. High cholesterol levels are not associated with OTC antacid use. Rebound tenderness at McBurneys point is related to appendicitis and not antacid use.
The nurse admits a patient who reports having taken a proton pump inhibitor for more than a decade. What assessment question will the nurse ask this patient? A) Are you experiencing diarrhea? B) Do you experience much abdominal pain? C) Have you noticed any blood in your urine? D) When is the last time you checked your blood pressure?
Ans: A Feedback: Research indicates that patients 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 patient for diarrhea. There would be no indications to ask about abdominal pain, blood in the urine, or blood pressure.
The 59-year-old patient has peptic ulcer disease and is started on sucralfate (Carafate). What is an appropriate nursing diagnosis related to this medication? A) Risk for constipation related to GI effects B) Risk for injury: bleeding C) Imbalanced nutrition related to nausea D) Deficient fluid volume
Ans: A Feedback: The adverse effects associated with sucralfate are primarily related to its GI effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug.
The patient prescribed nizatidine (Axid) chooses to take the medication once a day at bedtime. What dosage will the nurse administer? A) 150 to 300 mg B) 100 to 125 mg C) 20 to 40 mg D) 5 to 7.5 mg
Ans: A Feedback: The dosage for nizatidine, when taken PO only at bedtime, is 150 to 300 mg. Options B, C, and D are not correct.
After providing teaching to a patient prescribed lansoprazole (Prevacid), the nurse evaluates the patient understands the action of this medication when the patient makes what statement? A) The medication inhibits acid secretions. B) The medication is an antibiotic. C) The medication is an analgesic. D) The medication will promote healing of my ulcer.
Ans: A Feedback: The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogenpotassium adenosine triphosphatase (H+,K+-ATPase) enzyme system on the secretory surface of the gastric parietal cells. The statement, The medication inhibits acid secretions, indicates that the patient understands that the medication inhibits acid secretion. This medication does not act as an antibiotic or analgesic, nor will it repair the ulcer.
What symptoms would the nurse find to be consistent with a diagnosis of a peptic ulcer? A) Pain a few hours after eating B) Pain described as sharp and stabbing C) Explosive diarrhea within 1 hour of eating D) Unable to stand comfortably due to abdominal pain
Ans: A Feedback: Ulcer patients present with a predictable description of gnawing, burning pain often occurring a few hours after meals. The pain is not described as sharp and stabbing. Diarrhea is not usually associated with peptic ulcer disease and patients do not find it difficult to stand upright.
What would the nurse consider an indication for the use of antacids? (Select all that apply.) A) Gastric hyperacidity B) Gastritis C) Peptic esophagitis D) Hiatal hernia E) Duodenal ulcer
Ans: A, B, C, D Feedback: Antacids neutralize stomach acid by direct chemical reaction. They are recommended for the symptomatic relief of upset stomach associated with hyperacidity, as well as the hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, and hiatal hernia. Duodenal ulcer is not an indication for the use of an antacid.
The nurse would question an order for misoprostol if the patient was diagnosed with what condition? A) Diabetes B) Hypertension C) Arthritis D) Pregnancy
Ans: D Feedback: This drug is contraindicated during pregnancy because it is an abortifacient. The other options are not correct.
What nursing interventions are included in the plan of care for a patient receiving antacids to relieve GI discomfort? A) Administer this drug with other drugs or food. B) Administer the antacid 1 hour before or 2 hours after other oral medications. C) Limit fluid intake to decrease dilution of the medication in the stomach. D) Have the patient swallow the antacid whole and do not crush or chew the tablet.
Ans: B Feedback: A patient taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so that patients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs, nor with food.
What histamine-2 antagonist might the nurse administer to a child? A) Cimetidine B) Famotidine C) Nizatidine D) Ranitidine
Ans: B Feedback: Famotidine is the only histamine2 antagonist approved for use in children if a histamine-2 antagonist is needed. Therefore, other options are not correct.
For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be? A) 10 mg b.i.d B) 20 mg b.i.d C) 60 mg at bedtime D) 40 mg q am
Ans: B Feedback: Famotidine should be administered 40 mg every day at bedtime or 20 mg b.i.d for treatment of a gastric ulcer. Options A, C, and D are not correct.
The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse will inform the patient that common adverse effects related to this medication include what? A) Tremors B) Headache C) Visual disturbances D) Anxiety
Ans: B Feedback: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists. Visual disturbances, tremors, and anxiety are not normally associated with ranitidine.
What H2 antagonist would the nurse consider the drug of choice for a patient with advanced liver failure? A) Cimetidine B) Nizatidine C) Ranitidine D) Famotidine
Ans: B Feedback: Nizatidine differs from the other three drugs in that it is eliminated by the kidneys, with no first-pass metabolism in the liver. It is the drug of choice for patients with liver disease or dysfunction.
The nurse, caring for a patient with cystic fibrosis, administers pancreatic enzymes on what schedule? A) 1 hour after meals and snacks B) With meals and snacks C) 2 hours before meals and snacks D) In the morning and before bed
Ans: B Feedback: To be sure the pancreatic enzymes are in place when food enters the small bowel the enzymes are administered with every meal and snack. Administering them before or after meals would render them ineffective. 35.
The nurse would assess patients with what condition to determine whether there is a need for a saliva substitute? (Select all that apply.) A) Cystic fibrosis B) Stroke C) Cancer receiving chemotherapy or radiation therapy D) Myocardial infarction E) Chronic dry mouth
Ans: B, C, E Feedback: A saliva substitute helps in conditions that result in dry mouthstroke, radiation therapy, chemotherapy, and other illnesses. Patients with myocardial infarction do not require this drug. Patients with cystic fibrosis receive pancreatic enzymes rather than saliva substitute.
A patient has been prescribed esomeprazole (Nexium). What statement by the patient does the nurse evaluate as indicating that he or she has a good understanding of his newly prescribed drug? A) I should open the capsules and crush the drug into applesauce. B) It is important that I take the drug after each meal. C) I need to swallow the drug whole and not chew the capsules. D) I should always take the drug with an antacid.
Ans: C Feedback: Esomeprazole must be swallowed whole, not cut, crushed, or chewed, which would interfere with its effectiveness. The drug should not be taken with an antacid, which could interfere with absorption. The drug is taken once a day, not with each meal.
The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when? A) With meals B) With an antacid before breakfast C) 1 hour before or 2 hours after meals and at bedtime D) After each meal
Ans: C Feedback: Administer drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug. Options A, B, and D are not correct.
When comparing the histamine-2 antagonists to each other the nurse recognizes that cimetidine (Tagamet) is more likely to cause which adverse effect? A) Dizziness B) Headache C) Gynecomastia D) Somnolence
Ans: C Feedback: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Dizziness, headache, and somnolence are associated with all histamine-2 antagonists.
A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid? A) Milk of Magnesia B) Tums C) Aluminum salts D) Proton pump inhibitors
Ans: C Feedback: If aluminum salts (AlternaGEL) are taken concurrently with sucralfate, a risk of high aluminum levels and related aluminum toxicity exists. The combination of sucralfate and aluminum salts should be avoided or used with extreme caution. Adverse reactions with sucralfate are not associated with Milk of magnesia, Tums, or proton pump inhibitors.
The nurse is providing education for a patient with peptic ulcer disease resulting from chronic nonsteroidal anti-inflammatory drug (NSAID) use who will begin a prescription of misoprostol (Cytotec). The nurse evaluates that the patient understands the actions of this drug when he or she says it does what? A) Reduces the stomachs volume of hydrochloric acid B) Increases the speed of gastric emptying C) Protects the stomachs lining D) Increases lower esophageal sphincter pressure
Ans: C Feedback: Misoprostol is a synthetic prostaglandin that, like physiologic prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the patient to peptic ulceration. Misoprostol does not reduce gastric acidity (option A), improve emptying of the stomach (option B), or increase lower esophageal sphincter pressure (option D).
The nurse develops a discharge teaching plan for a patient who was prescribed pancreatic enzyme replacement and includes what important teaching point? A) Take the enzymes on an empty stomach. B) Crush the capsules and take with food. C) Avoid spilling the powder on the skin because it may be irritating. D) Pancreatin and pancrelipase are interchangeable.
Ans: C Feedback: Patients receiving pancreatic enzymes should be taught to avoid spilling the powder on the skin because it can be very irritating. The enzymes should be taken with food and are often in a powder form. Pancreatin and pancrelipase are not interchangeable.
The nurse is caring for a patient with cystic fibrosis who has recently not been taking her pancreatic enzymes recently. What is the primary assessment finding the nurse will see as a result of this noncompliance? A) Constipation B) Diarrhea C) Malnutrition D) Abdominal pain
Ans: C Feedback: Patients with cystic fibrosis take pancreatic enzymes to promote digestion and absorption of nutrients so failure to take the drug would result in malnutrition and weight loss. Constipation, diarrhea, and abdominal pain would not be in the primary assessment finding.
What classification of drugs does the nurse administer to treat peptic ulcers by suppressing the secretion of hydrochloric acid into the lumen of the stomach? A) Antipeptic agents B) Histamine-2 antagonists C) Proton pump inhibitors D) Prostaglandins
Ans: C Feedback: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antipeptic agents coat any injured area in the stomach to prevent further injury. H2 antagonists block the release of hydrochloric acid in response to gastrin. Prostaglandins inhibit secretion of gastrin and increase secretion of the mucous lining of the stomach.
What priority teaching point does the nurse include when instructing patients about the use of antacids? A) Reduce calorie intake to reduce acid production. B) Take before each meal and before bed. C) Be aware of risk of acid rebound with long-term use. D) Consider liquid diet if diarrhea occurs.
Ans: C Feedback: Repeated use of antacids can result in rebound acid production because more gastrin is produced when pH of acid level decreases. Patients should be taught that long-term use of antacids requires follow-up care. Calorie and fluid intake does not need to be reduced because it is important to maintain nutrition, especially if diarrhea occurs. Antacids are taken at least 1 hour before or 2 hours after any other drug or meal.
The nurse is caring for a patient requiring digestive enzyme replacement therapy and establishes what appropriate nursing diagnosis for this patient? A) Acute pain B) Risk for constipation C) Risk for imbalanced nutrition D) Bowel incontinence
Ans: C Feedback: The nurse would be concerned about the patients nutritional status because lack of digestive enzymes results in malnutrition. Replacement digestive enzymes help the patient improve digestion and absorption of essential nutrients. Effectiveness of the therapy is determined by the patients ability to maintain balanced nutrition. The other three options are not applicable to the use of replacement digestive enzymes.
The clinic nurse is caring for a 78-year-old male patient who is taking a proton pump inhibitor. What condition is this patient at increased risk for developing? A) Sickle cell anemia B) Megaloblastic anemia C) Pernicious anemia D) Iron deficiency anemia
Ans: C Feedback: The use of proton pump inhibitors and H2 blockers in older adults has been associated with decreased absorption of vitamin B12 and the development of pernicious anemia. The use of proton pump inhibitors does not increase the risk of sickle cell, megaloblastic, or iron deficiency anemias.
An adult patient is prescribed cimetidine (Tagamet). A nurse will instruct the patient that an appropriate dosage and frequency of cimetidine is what? A) 20 mg PO b.i.d B) 150 mg PO b.i.d C) 300 mg PO at bedtime D) 800 mg PO at bedtime
Ans: D Feedback: An appropriate dosage and frequency for cimetidine is 800 mg PO at bedtime. Also, 300 mg can be taken q.i.d at meals and at bedtime. Ranitidine is taken 150 mg daily or b.i.d. Famotidine is taken 20 mg PO b.i.d. Nizatidine can be taken 150 to 300 mg PO at bedtime.
What drug combination will the nurse normally administer most often to treat a gastric ulcer? A) Antibiotics and histamine-2 antagonists B) H2 antagonists, antibiotics, and bicarbonate salts C) Bicarbonate salts, antibiotics, and ZES D) Antibiotics and proton pump inhibitors
Ans: D Feedback: Currently, the most commonly used therapy for gastric ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate Helicobacter pylori. H2 receptor antagonists are used to treat duodenal ulcers. Bicarbonate salts are not used. ZES is the abbreviation for ZollingerEllison syndrome and not a drug.
When caring for a patient diagnosed with a peptic ulcer, the nurse administers omeprazole (Prilosec) along with what antibiotic to eradicate Helicobacter pylori? A) Gentamicin B) Ketoconazole C) Tetracycline D) Amoxicillin
Ans: D Feedback: Gastric acid pump or proton pump inhibitors are recommended for the short-term treatment of active duodenal ulcers, gastroesophageal reflux disease, erosive esophagitis, and benign active gastric ulcer; for the long-term treatment of pathologic hypersecretory conditions; as maintenance therapy for healing of erosive esophagitis and ulcers; and in combination with amoxicillin and clarithromycin for the treatment of H. pylori infection. The other options are not antibiotics used to eradicate H. pylori.
What action does the histamine-2 antagonist administered by the nurse have on the human body that will help to prevent peptic ulcer disease? A) Destroys Helicobacter pylori B) Coats and protects the stomach lining C) Increases the pH of the secreted hydrochloric acid D) Reduces the amount of hydrochloric acid secreted
Ans: D Feedback: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) coat and protect the stomach lining like sucralfate (Carafate), or increase the pH of the secreted hydrochloric acid.
Which of these patients would the nurse expect to be the best candidate for misoprostol (Cytotec)? A) A 12-year-old with obsessive-compulsive disorder B) A 22-year-old pregnant patient C) A 46-year-old trial lawyer with hypertension D) An 83-year-old man with rheumatoid arthritis
Ans: D Feedback: The 83-year-old man with rheumatoid arthritis is most likely to be taking nonsteroidal anti-inflammatory drugs (NSAIDs). Misoprostol is indicated for prevention of NSAID induced ulcers in adults at high risk for development of gastric ulcers. The other three patients would not be candidates for this drug.