Cytn 32

Which medication is used to treat gastric reflux esophagitis? Sucralfate (Carafate) Lansoprazole (Prevacid) Metoclopramide (Reglan) Dexlansoprazole (Dexilant) Rationale Metoclopramide (Reglan) is prokinetic agent used to treat gastric reflux esophagitis. Sucralfate (Carafate) is used to treat duodenal ulcers. Lansoprazole (Prevacid) and dexlansoprazole (Dexilant) are proton pump inhibitors that reduce the risk of gastric and duodenal ulcers.

Metoclopramide (Reglan)

Which question is appropriate to assess a patient's nutritional status? "How often do the stressors occur?" "Have there been any changes in taste?" "Have there been any changes in stool color or consistency or in bowel elimination?" "Are there any food allergies or foods that cause gastric distress when eaten?" Rationale Food allergies or foods that particularly cause gastric distress when eaten should be determined because they may increase acidity and cause gastroesophageal reflux disease. Asking the patient about stressors and their occurrences would help assess anxiety or stress levels. Asking about changes in taste such as bitterness would help determine the cause of abdominal pain or discomfort. Asking about changes in stool color or consistency or in bowel elimination would determine the history of diseases or disorders.

"Are there any food allergies or foods that cause gastric distress when eaten?"

Which question would the nurse ask about activity and exercise while completing a focused assessment on a patient with suspected gastroesophageal reflux disease? "How frequently do you exercise?" "Are you able to tolerate moderate physical activity?" "Does your exercise routine include strengthening exercises?" "Do you do any activities that include bending over frequently?" Rationale The nurse questions the patient about any activities that can increase intraabdominal pressure such as bending over frequently or lifting heavy objects. Asking how frequently the patient exercises, how well they tolerate moderate physical activity, and if the exercise routine includes strengthening exercises are all general activity- and exercise-related questions that would not necessarily provide information pertinent to the patient's disease.

"Do you do any activities that include bending over frequently?"

Which statements are inappropriate to tell a patient with regards to antacid therapy? Select all that apply. "For indigestion, antacids can be administered for more than 2 weeks." "Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity." "Large quantities of antacids can effectively manage acute ulcer disease." "Patients with renal failure should use large quantities of antacids containing magnesium." "Antacids should be used only by patients with occasional indigestion or heartburn." Rationale Antacids should not be administered for more than 2 weeks to treat indigestion. Effective management of acute ulcer disease requires large volumes of antacids to reduce hyperacidity and neutralize stomach acids. Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity by increasing gastric secretion. Only patients with occasional indigestion or heartburn should use antacid tablets. Excessive use may cause diarrhea or constipation. Patients with renal failure should not use large quantities of antacids containing magnesium because of the risk of developing hypomagnesemia.

"For indigestion, antacids can be administered for more than 2 weeks." "Large quantities of antacids can effectively manage acute ulcer disease." "Patients with renal failure should use large quantities of antacids containing magnesium."

Which statements are inappropriate to tell a patient with regards to antacid therapy? Select all that apply. "For indigestion, antacids can be administered for more than 2 weeks." "Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity." "Large quantities of antacids can effectively manage acute ulcer disease." "Patients with renal failure should use large quantities of antacids containing magnesium." "Antacids should be used only by patients with occasional indigestion or heartburn." Rationale Antacids should not be administered for more than 2 weeks to treat indigestion. Effective management of acute ulcer disease requires large volumes of antacids to reduce hyperacidity and neutralize stomach acids. Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity by increasing gastric secretion. Only patients with occasional indigestion or heartburn should use antacid tablets. Excessive use may cause diarrhea or constipation. Patients with renal failure should not use large quantities of antacids containing magnesium because of the risk of developing hypomagnesemia.

"For indigestion, antacids can be administered for more than 2 weeks." "Large quantities of antacids can effectively manage acute ulcer disease." "Patients with renal failure should use large quantities of antacids containing magnesium."

Which statement by the patient helps the nurse understand the reason for a lack of improvement while taking 400 mg sustained-release oral lansoprazole? "I am not crushing the tablet." "I am chewing the tablet thoroughly." "I am swallowing the tablet whole." "I am taking the tablet before meals." Rationale A sustained-release capsule should not be chewed as this causes the release of all the medication and makes the sustained-release aspect of the medication ineffective. The patient should avoid crushing the tablet for the same reason. Swallowing the tablet whole can result in an effective outcome. Proton pump inhibitors such as lansoprazole are effective when taken on an empty stomach.

"I am chewing the tablet thoroughly."

Which information provided by the patient indicates the need for additional instruction concerning nutritional intake with a gastric disorder? Select all that apply. "I should avoid late-night snacks or meals." "I should drink a large amount of fluid with the meals." "I should avoid coffees, teas, colas, and alcoholic beverages." "I should increase protein foods and fats to about 50 g per day." "I should eat small, more frequent meals to support optimal energy requirements and healing." Rationale The patient should drink a small amount of water with meals and between meals and not a large amount because it may result in indigestion. A patient with a gastric disorder should increase protein intake and decrease fat intake to about 45 g per day. The patient should avoid late-night snacks or meals because they may result in increased gastric secretions. The patient should avoid coffees, teas, colas, and alcoholic beverages because they may cause hyperacidity. The patient should eat small, more frequent meals to support optimal energy requirements and promote healing.

"I should drink a large amount of fluid with the meals." "I should increase protein foods and fats to about 50 g per day."

Which nursing response is accurate to a patient taking misoprostol (Cytotec) who reports having diarrhea after 2 weeks of therapy? "It will likely resolve in about 8 days." "Take the medication on an empty stomach." "Take a half dose of misoprostol (Cytotec)." "It will resolve if you take the medication with large amounts of water." Rationale After 2 weeks of therapy, diarrhea induced by misoprostol (Cytotec) should resolve within 8 days. Taking the medication on an empty stomach can increase the risk of diarrhea. Taking the medication with large amounts of water does not reduce the risk of diarrhea. Taking a half dose will not affect the recovery time from diarrhea.

"It will likely resolve in about 8 days."

Which instruction is beneficial to a patient taking metoclopramide? "Avoid taking the tablet at bedtime." "Take a tablet 30 minutes before meals." "Take the tablet along with an antihistamine." "Take the tablet with a small amount of water." Rationale Metoclopramide should be taken 30 minutes before a meal to ensure effective absorption. The patient should also take the medication at bedtime to ensure an effective outcome. Taking an antihistamine with metoclopramide will increase its sedative effects. Taking metoclopramide with a small amount of water may not result in effective drug absorption.

"Take a tablet 30 minutes before meals."

Which instruction regarding the administration of misoprostol is beneficial to this patient? "Take this medication along with food." "Take the tablet on an empty stomach." "Follow a fluid-restricted diet while taking this medication." "Limit whole-grain products while taking this medication." Rationale An adult dose of misoprostol oral tablets is between 100 and 200 mcg; this medicine should be taken four times a day with food during nonsteroidal anti-inflammatory drug (NSAID) therapy. The patient should take this medication along with food to ensure a positive outcome. Taking the medication on an empty stomach can increase the risk of diarrhea. The patient should be sure to take in a lot of fluids. The patient should also eat sufficient roughage such as fruits, vegetables, and whole-grain products.

"Take this medication along with food."

Which instructions are beneficial for a patient taking sucralfate who reports constipation and dry mouth? Select all that apply. "You should suck ice chips frequently." "You should avoid sucking hard candies." "You should avoid mouthwashes that contain alcohol." "You should include whole-grain products in your diet." "You should swallow medication with small amounts of water." Rationale Sucralfate can cause constipation and dry mouth as adverse effects. Sucking ice chips can alleviate dry mouth. Alcohol-containing mouthwashes can increase the risk of dry mouth; the patient should avoid using them. Whole-grain products and fresh fruits can reduce the risk of constipation. Sucking hard candy can give comfort for a dry mouth. Swallowing medication with small amounts of water will not reduce the risk of constipation and dry mouth.

"You should suck ice chips frequently." "You should avoid mouthwashes that contain alcohol." "You should include whole-grain products in your diet."

In addition to a proton pump inhibitor, the nurse anticipates the healthcare provider will prescribe another medication from which drug class to eradicate the Helicobacter pylori in a patient being treated for gastritis? Antibiotic Antiinflammatory Prostaglandin inhibitor Therapeutic nutrients

Antibiotic So close! Rationale Antibiotics may be prescribed in addition to proton pump inhibitors to eradicate Helicobacter pylori. Helicobacter pylori would not be eradicated by antiinflammatories, prostaglandin inhibitors, or therapeutic nutrients.

Which premedication assessment should the nurse perform in a patient taking digoxin (Lanoxin) who has also prescribed esomeprazole (Nexium)? Assess serum thyroxin levels. Assess the blood platelet count. Assess the white blood cell count. Assess serum magnesium levels. Rationale Long-term use of esomeprazole (Nexium) and digoxin (Lanoxin) can induce hypomagnesemia; therefore the nurse should assess the patient's serum magnesium levels before administration of esomeprazole to ensure safety. Long-term use of esomeprazole does not reduce the serum thyroxin levels, blood platelet counts, or white blood cell counts.

Assess serum magnesium levels.

Which medications might be beneficial for a patient who has heartburn and stomach distention resulting from hyperacidity? Select all that apply. Ranitidine Sucralfate Bismuth Simethicone Metoclopramide Rationale Bismuth and simethicone are used to treat heartburn and stomach distention by acting as defoaming agents and breaking up gas bubbles in the stomach. Ranitidine is used to treat gastroesophageal reflux disease, duodenal ulcers, and pathologic hypersecretory conditions. Sucralfate is used to treat duodenal ulcers, particularly in those patients who do not tolerate other forms of therapy. Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis.

Bismuth Simethicone

Which antiulcer medication may cause rebound hyperacidity? Cimetidine (Tagamet) Omeprazole (Prilosec) Misoprostol (Cytotec) Calcium carbonate (Dicarbosil) Rationale Calcium carbonate (Dicarbosil) may cause rebound hyperacidity. Omeprazole (Prilosec) may cause rashes and hypomagnesemia. Cimetidine (Tagamet) may cause gynecomastia and hepatotoxicity. Misoprostol (Cytotec) may cause diarrhea.

Calcium carbonate (Dicarbosil)

Which intervention may help decrease the unpleasant chalky taste associated with taking an antacid tablet? Take half the dose of medication. Change the brand and flavor of the medication. Take the tablets along with antacid oral solution. Report to the healthcare provider immediately. Rationale Antacids may have an unpleasant chalky taste; changing the brand or flavor may reduce the patient's discomfort. Taking half the dose of medication can result in drug insufficiency. Taking tablet and liquid dosage forms of antacids simultaneously can result in drug toxicity. The healthcare provider does not need to be notified because the situation is not urgent.

Change the brand and flavor of the medication.

Which medication may cause breast soreness and gynecomastia? Cimetidine (Tagamet) Misoprostol (Cytotec) Lansoprazole (Prevacid) Metoclopramide (Reglan)

Cimetidine (Tagamet) Rationale Cimetidine (Tagamet) is an histamine-2 (H 2) blocker that may cause chest soreness and gynecomastia. Misoprostol (Cytotec) may cause miscarriage and is contraindicated during pregnancy. Lansoprazole (Prevacid) may cause hypomagnesemia or increase the risk of fractures. Metoclopramide (Reglan) may cause extrapyramidal symptoms.

Which class of medication would the nurse recognize as most beneficial to a patient with ulcer craters on the gastric mucosa? Antacids Coating agents Prokinetic agents Proton pump inhibitors Rationale Ulcer craters are characteristic features that occur on the lining of the stomach wall. Coating agents provide a protective barrier around the mucosal lining and prevent hydrochloric acid from coming into contact with the craters. Antacids are prescribed for hyperacidity associated with GERD, gastritis, and hiatal hernia. Prokinetic agents are used to treating Zollinger-Ellison syndrome. Proton pump inhibitors are administered to control acid reflux and GERD.

Coating agents

Which instruction by the nurse is accurate to give a patient taking rabeprazole who experiences headaches and fatigue? Take the medication after meals. Crush the drug before taking it. Stop using the medication immediately with a headache. Consult the healthcare provider if the proton pump inhibitor causes headache or fatigue. Rationale Proton pump inhibitors such as rabeprazole may cause headache and fatigue. The nurse would encourage the patient to consult the prescribing healthcare provider about these effects. The patient should take rabeprazole 30 minutes before the first meal of the day and they should be kept whole to ensure effective absorption. Crushing the tablets can result in decreased drug absorption. A licensed practical nurse is not authorized to instruct the patient to stop taking medication.

Consult the healthcare provider if the proton pump inhibitor causes headache or fatigue.

Which laboratory finding correlates with Q-T interval prolongation in a patient taking lansoprazole? Decreased calcium level Decreased thyroxin level Decreased magnesium level Decreased red blood cell level Rationale The use of a proton pump inhibitor for longer than a year can result in hypomagnesemia, which is indicated by the presence of a prolonged Q-T wave. Decreased calcium levels, thyroxin levels, and red blood cell count are not indicated by a prolonged Q-T wave.

Decreased magnesium level

Which premedication assessments should be done on a female patient taking a gastrointestinal prostaglandin medication? Select all that apply. Determine whether the patient is pregnant. Check the bowel elimination pattern. Check renal function test results. Determine whether other drugs being taken may induce extrapyramidal symptoms. Check liver function test results. Rationale Gastrointestinal prostaglandin medication includes misoprostol. The nurse should determine whether the patient is pregnant before administering this medication because of the risk of miscarriage. The pattern of bowel elimination should also be checked because misoprostol may induce diarrhea. The renal function test results should be checked to ensure that renal function is normal for patients taking an antacid because antacids inhibit magnesium and potassium ion excretion, which may lead to hypermagnesemia and hyperkalemia. Extrapyramidal symptoms are assessed before administering metoclopramide therapy because this may increase anxiety and irritability. Cimetidine in high doses can affect liver functioning.

Determine whether the patient is pregnant. Check the bowel elimination pattern. Check renal function test results.

Which common adverse effect is associated with famotidine? Dizziness Anorexia Jaundice Mild gynecomastia Rationale Dizziness is a common adverse effect of famotidine. Anorexia, jaundice, and mild bilateral gynecomastia are serious adverse effects of famotidine.

Dizziness

Which interventions does the nurse include in a discussion about nonpharmacologic interventions to supplement drug therapy with a patient with peptic ulcer disease? Select all that apply. Eat smaller, more frequent meals. Sit upright at the table when eating. Limit fluid intake to mealtimes if possible. Do not lie down for at least 2 hours after meals. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain or fever. Rationale Patients experiencing stomach issues should eat smaller, more frequent meals, sit upright at the table when eating, and not lie down until 2 hours after eating. Fluid intake should occur mostly between meals and be limited during meals. NSAIDs should be avoided because they aggravate gastric mucosa.

Eat smaller, more frequent meals. Sit upright at the table when eating. Do not lie down for at least 2 hours after meals.

A patient with which condition should not receive metoclopramide? Epilepsy Diabetes Hypertension Coronary artery disease Rationale Metoclopramide will increase the frequency and severity of seizures; a patient with epilepsy should not receive this medication. Metoclopramide does not affect diabetes, coronary artery disease, or blood pressure.

Epilepsy

Which medication could be beneficial for the treatment of intermittent heartburn? Misoprostol Esomeprazole Metoclopramide Sucralfate Rationale Esomeprazole is a proton pump inhibitor that is available over-the-counter; it is used to treat intermittent heartburn. Misoprostol is prescribed to treat gastric ulcers caused by prostaglandin inhibitors. Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis. Sucralfate is used to treat duodenal ulcers.

Esomeprazole

Which instruction is beneficial to a patient on long-term omeprazole (Prilosec) therapy for gastric and duodenal ulcers? Discontinue the medication if you have a headache. Frequently undergo tests to determine bone mass. Eat foods that are low in calcium. Avoid foods rich in vitamin D. Rationale Long-term use of proton pump inhibitors such as omeprazole (Prilosec) can make the patient more prone to hip, wrist, and spine fractures. Therefore the patient should undergo frequent bone mass monitoring. Omeprazole (Prilosec) may cause headaches; the patient should consult the healthcare provider but should not discontinue the medication on his or her own. Long-term use of omeprazole (Prilosec) can lead to a risk of osteoporosis; therefore the patient should ingest foods rich in calcium and vitamin D.

Frequently undergo tests to determine bone mass.

Which statement best describes the action of antacids? Gastric acid in the stomach is neutralized. Gastric acid secretion is inhibited. Antacids cause the thickness of the gastric mucus to be increased. Gastric mucosa is desensitized to the effects of acid. Rationale Antacids lower the acidity of gastric secretions by buffering the hydrochloric acid to a lower hydrogen ion concentration. Antacids do not inhibit gastric acid secretion; histamine-receptor antagonists and gastric acid pump inhibitors do this. Antacids do not increase the thickness of the gastric mucus and do not desensitize the mucosa.

Gastric acid in the stomach is neutralized.

Which antiulcer medication when combined with warfarin therapy increases a patient's risk for gastrointestinal bleeding? Select all that apply. Prokinetic agents H 2-receptor antagonist Gastrointestinal prostaglandin Proton pump inhibitors Coating agents Rationale A histamine-receptor antagonist and omeprazole, a proton pump inhibitor, may increase the risk of gastrointestinal bleeding when coadministered with warfarin. The therapeutic effect of prokinetic agents is reduced by coadministering anticholinergic agents with narcotic analgesics. There is no significant drug interactions associated with gastrointestinal prostaglandins. Coating agents may interfere with the absorption of tetracycline.

H 2-receptor antagonist Proton pump inhibitors

Which condition might be present in a patient who is taking a peptic a ulcer medication and has elevated alkaline phosphatase level and prothrombin time? Hepatotoxicity Gynecomastia Hypomagnesemia Dizziness Rationale Elevated alkaline phosphatase levels and prothrombin times indicate the presence of hepatotoxicity. This condition may occur because of increased bleeding tendencies caused by a histamine-2 (H 2) antagonist. Gynecomastia is caused by H 2 antagonists, but not related to elevated liver enzymes. Decreased magnesium levels result in hypomagnesemia and are associated with proton pump inhibitors. Dizziness iS a common adverse effect of sucralfate.

Hepatotoxicity

The nurse would assess for which increased risk factor during a follow-up for a patient taking a high dose of omeprazole (Prilosec) for more than a year? Constipation Hepatotoxicity Hypomagnesemia Hip, wrist, or spine fractures Rationale Long-term use and high doses of omeprazole (Prilosec) place the patient at greater risk of fractures of the hip, wrist, and spine. Diarrhea, not constipation, is an adverse effect of omeprazole (Prilosec) use. Hepatotoxicity is a risk related to use of histamine-2 receptor antagonists, not omeprazole. Hypermagnesemia is a more common risk after one year of omeprazole (Prilosec) use.

Hip, wrist, or spine fractures

Which statement made by a patient indicates a need for further education of the use of metoclopramide? "I should avoid driving after taking metoclopramide tablets." I should avoid taking metoclopramide tablets if have nausea. "I should avoid working around machinery while taking metoclopramide tablets." "I should avoid taking metoclopramide tablets just before meals." Rationale Metoclopramide (Reglan) may cause nausea; if this condition occurs, the patient should consult the healthcare provider immediately but should not stop taking the medication on his or her own. Metoclopramide (Reglan) may cause dizziness and weakness; therefore the patient should avoid driving and working around machinery while taking this medication. Patients should take metoclopramide at least 30 minutes before meals to ensure effective absorption.

I should avoid taking metoclopramide tablets if have nausea.

Which laboratory findings indicate a patient taking ranitidine is experiencing hepatotoxicity? Select all that apply. Increased bilirubin level Increased alkaline phosphatase level Increased alanine aminotransferase level Decreased aspartate aminotransferase level Decreased gamma-glutamyl transferase level Rationale H2-receptor antagonists such as ranitidine (Zantac) may rarely induce hepatotoxicity. This condition is indicated by increased levels of bilirubin, alkaline phosphatase, and alanine aminotransferase. Increased, not decreased, levels of aspartate aminotransferase and gamma-glutamyl transferase indicate hepatotoxicity.

Increased bilirubin level Increased alkaline phosphatase level Increased alanine aminotransferase level

Which basic principle does the nurse consider when scheduling the administration of drugs used to treat patients with GERD or peptic ulcer disease (PUD)? These drugs must be given with meals or snacks. Individualized scheduling is required to avoid drug interactions. These drugs are taken only in the presence of active symptomatology. Significant fluid and electrolyte imbalances are associated with these drugs. Rationale Each type of drug used to treat GERD or PUD may require somewhat different scheduling to avoid drug interactions. Many of these drugs are given routinely, not just when symptoms are present. The absence of symptoms indicates that they are working. With prescribed use, these drugs do not have significant effects on fluid and electrolyte balance. These drugs do not need to be given with meals; other prescribed drugs should be scheduled 1 hour before or 2 hours after antacids.

Individualized scheduling is required to avoid drug interactions.

Which medication could be beneficial for a patient with barium remaining in the intestine after and upper gastrointestinal series with barium? Sucralfate Nizatidine Metoclopramide Rabeprazole Rationale Metoclopramide (Reglan) is used to stimulate gastric emptying and to promote the intestinal transit of barium. Sucralfate is used to treat duodenal ulcers. Nizatidine is used to treat gastroesophageal reflux disease (GERD), duodenal ulcers, and pathologic hypersecretory conditions. Rabeprazole is used to treat severe esophagitis, GERD, gastric and duodenal ulcers, and hypersecretory disorders.

Metoclopramide

A patient is diagnosed with diabetic gastroparesis. Which medication does the nurse recognize as appropriate in treating a patient with diabetic gastroparesis? Omeprazole Dexlansoprazole Metoclopramide Famotidine

Metoclopramide Rationale Metoclopramide treats diabetic gastroparesis by increasing peristalsis in the gastrointestinal tract, which results in an increased rate of gastric emptying and intestinal transit time. Omeprazole and dexlansoprazole are prescribed to treat severe esophagitis, hyperacidity, and gastric and duodenal ulcers. Famotidine is used to treat gastroesophageal reflux disease, duodenal ulcers, and pathologic hypersecretory conditions.

Which medication is most beneficial to treat a patient with a nonsteroidal anti-inflammatory drug (NSAID)-related gastric ulcer? Ranitidine Misoprostol Rabeprazole Pantoprazole Rationale Prostaglandins, which are normally present in the gastrointestinal tract, inhibit the section of gastric acid and pepsin and therefore protect the stomach and duodenal lining against ulceration. NSAIDs reduce pain and inflammation by inhibiting prostaglandins and make the patient more prone to gastric ulcers. Misoprostol can effectively treat ulcers caused by prostaglandin inhibitors and reduce pain. Ranitidine, rabeprazole, and pantoprazole do not reduce gastric ulcers by antagonizing prostaglandin inhibitors.

Misoprostol

A patient asks the nurse if there is a medication to help decrease the risk of a peptic ulcer due to long-term nonsteroidal antiinflammatory drug (NSAID) use. Which drug does the nurse identify as a possibility? Cimetidine (Tagamet HB) Misoprostol (Cytotec) Pantoprazole (Protonix) Metoclopramide (Reglan) Rationale Misoprostol (Cytotec) is used to prevent and treat gastric ulcers caused by prostaglandin inhibitors such as NSAIDs. Cimetidine (Tagamet HB), pantoprazole (Protonix), and metoclopramide (Reglan) are not used for this purpose.

Misoprostol (Cytotec)

Which medication is contraindicated in pregnancy? Cimetidine (Tagamet) Misoprostol (Cytotec) Esomeprazole (Nexium) Metoclopramide (Reglan) Rationale Misoprostol (Cytotec) is a gastrointestinal prostaglandin inhibitor prescribed to treat gastric ulcers. However, this medication is contraindicated in pregnant women because it may cause a miscarriage as a result of its uterine stimulant activity. Cimetidine may cause gynecomastia. Esomeprazole may cause hypomagnesemia. Metoclopramide may cause drowsiness, fatigue, lethargy, and dizziness.

Misoprostol (Cytotec)

A patient taking cimetidine presents with bradycardia, hypotension, and fatigue. Which additional patient medications may be responsible for these effects? Select all that apply. Warfarin Nifedipine Misoprostol Imipramine Diltiazem Rationale Cimetidine inhibits the metabolism of nifedipine and diltiazem. This drug-drug interaction may lead to symptoms of bradycardia, hypotension, and fatigue in patients taking these medications concurrently. Cimetidine may enhance the anticoagulant effects of warfarin, which can cause bleeding symptoms, but not bradycardia, hypotension, or fatigue. Cimetidine taken concurrently with misoprostol is not known to cause symptoms of bradycardia, hypotension, or fatigue. Cimetidine taken concurrently with imipramine may cause increased anticholinergics effects such as dry mouth, constipation, urinary retention, and dilated pupils.

Nifedipine Diltiazem

Which antiulcer medications act by antagonizing histamine-2 (H 2) receptors? Select all that apply. Nizatidine (Axid) Famotidine (Pepcid) Misoprostol (Cytotec) Cimetidine (Tagamet) Esomeprazole (Nexium) Rationale Antiulcer medications such as nizatidine (Axid), famotidine (Pepcid), and cimetidine (Tagamet) antagonize H 2 receptors and therefore decrease the volume of acid a secretion. Misoprostol (Cytotec) is synthetic prostaglandin that acts by inhibiting gastric acid and pepsin secretion. Esomeprazole (Nexium) acts by inhibiting proton pumps.

Nizatidine (Axid) Famotidine (Pepcid) Cimetidine (Tagamet)

Which type of ulcer has misoprostol been known to reduce? Stress Esophageal Helicobacter pylori Nonsteroidal antiinflammatory drug (NSAID)-induced Rationale Misoprostol increases the level of prostaglandin E, which inhibits gastric acid and pepsin secretion. This medication counteracts the effects of NSAIDs, including aspirin, which will decrease the amount of prostaglandins in the stomach, thus predisposing an individual to gastric ulcers. Misoprostol is not effective against H. pylori ulcers, stress ulcers, or esophageal ulcers.

Nonsteroidal antiinflammatory drug (NSAID)-induced

Which medication might cause increased bruising and increased prothrombin time when taken with warfarin? Diazepam Sucralfate Omeprazole Metoclopramide Rationale Omeprazole inhibits the metabolism of warfarin; therefore the tendency to bleed increases and may result in an increased prothrombin time. The metabolism and excretion of diazepam is increased coadministration with omeprazole, but this will not increase the incidence of bruising. Sucralfate inhibits the absorption of omeprazole. Metoclopramide decreases the effects of levodopa.

Omeprazole

Which medication when given with phenytoin can cause rapid involuntary eye movements, reduced irritability, and lack of energy? Clopidogrel Sucralfate Warfarin Omeprazole Rationale Rapid involuntary movement of the eyes, reduced irritability, and a lack of energy may occur when omeprazole slows the metabolism of phenytoin, which may cause nystagmus, sedation, and lethargy. A combination of clopidogrel and omeprazole may increase the risk of gastrointestinal bleeding. Sucralfate inhibits the metabolism of omeprazole. The metabolism of warfarin is reduced when coadministered with omeprazole and may increase the risk of bleeding tendencies.

Omeprazole

Which medications reduce gastric ulcers by inhibiting hydrogen ion pumps? Select all that apply. Amoxicillin (Amoxil) Cimetidine (Tagamet) Misoprostol (Cytotec) Pantoprazole (Protonix) Dexlansoprazole (Dexilant) Rationale Proton pump inhibitors such as pantoprazole (Protonix) and dexlansoprazole (Dexilant) reduce the risk of gastric ulcers by inhibiting hydrogen ion pumps. Amoxicillin (Amoxil) treats Helicobacter pylori infections by inhibiting the bacterial growth. Cimetidine (Tagamet) treats gastric ulcers by antagonizing H 2 receptors. a Misoprostol (Cytotec) is gastrointestinal prostaglandin that inhibits gastric acid and pepsin secretion and therefore protects the stomach and duodenal lining against ulceration.

Pantoprazole (Protonix) Dexlansoprazole (Dexilant)

Which medication when given to a patient taking a proton pump inhibitor may cause nystagmus? Clopidogrel (Plavix) Phenytoin (Dilantin) Sucralfate (Carafate) Warfarin (Coumadin) Rationale Simultaneous use of proton pump inhibitors and phenytoin (Dilantin) can cause nystagmus (involuntary eye movements). Simultaneous use of clopidogrel (Plavix) and proton pump inhibitors will not result In nystagmus. Sucralfate (Carafate) inhibits the absorption of proton pump inhibitors but will not cause nystagmus. Warfarin (Coumadin) use along with a proton pump inhibitor can increase the risk of bleeding, but this combination will not cause nystagmus.

Phenytoin (Dilantin)

Which condition is a contraindication for prescribing a patient misoprostol? Glaucoma Pregnancy Hypothyroidism Diabetes mellitus Rationale Misoprostol is a uterine stimulant and is contraindicated during pregnancy. Misoprostol is not contraindicated for patients with diabetes mellitus, glaucoma, or hypothyroidism.

Pregnancy

Which drug class hastens emptying of the stomach when administered to a patient for treatment of a stomach disorder? Antacids Prokinetic agents Proton pump inhibitors Histamine-2 antagonists Rationale Prokinetic agents hasten stomach emptying by lowering esophageal sphincter muscle pressure and peristalsis. Antacids neutralize acid, thus leading to less acidity. Proton pump inhibitors block the formation of hydrochloric acid leading to less irritation. Histamine-2 antagonists decrease the volume of hydrochloric acid, thus increasing pH.

Prokinetic agents

Which category of gastroesophageal medications could have placed the patient at a higher risk for fractures? Antacids Histamine-2 (H 2)-receptor antagonists Synthetic prostaglandin Proton pump inhibitor Rationale Patients over the age of 50 who take proton pump inhibitors for more than a year may have an increased risk for hip and spinal fractures. Antacids and H 2-receptor antagonists may cause diarrhea or constipation. Synthetic prostaglandin E drugs can cause diarrhea.

Proton pump inhibitor

Which medication class can be used in combination with antimicrobial agents to eradicate a Helicobacter pylori infection? Antacids Prokinetic agents Proton pump inhibitors Gastrointestinal prostaglandins Rationale Proton pump inhibitors inhibit the gastric secretion of hydrochloric acid, reducing irritation caused by an infection. These medications are used in combination with antimicrobial agents such as amoxicillin, tetracycline, metronidazole, clarithromycin to eradicate this infection. Antacids are used to treat heartburn and neutralize acidic conditions. Prokinetic agents are used to treat GERD. Gastrointestinal prostaglandins are used to prevent and treat gastric ulcers caused by prostaglandin inhibitors.

Proton pump inhibitors

Which class of medication is beneficial for the treatment of Zollinger- Ellison syndrome? Antacids Coating agents Gastrointestinal prostaglandin Proton pump inhibitors

Proton pump inhibitors Rationale Zollinger-Ellison syndrome occurs because of an overproduction of gastric acid. Proton pump inhibitors are used to treat Zollinger-Ellison syndrome by reducing the hyperacidity. Antacids neutralize gastric acid, which causes the gastric contents to be less acidic. Coating agents are used to treat existing ulcer craters on the gastric mucosa. Gastrointestinal prostaglandins are used to prevent and treat gastric ulcers caused by prostaglandin inhibitors (e.g., NSAIDs, including aspirin).

Which medication is prescribed when a patient is diagnosed with Helicobacter pylori infection but is asymptomatic? Select all that apply. Ranitidine (Zantac) Amoxicillin (Amoxil) Clarithromycin (Biaxin) Esomeprazole (Nexium) Dexlansoprazole (Dexilant) Rationale Histamine-2 antagonists such as ranitidine (Zantac) and proton pump inhibitors such as esomeprazole (Nexium) and dexlansoprazole (Dexilant) are used to treat Helicobacter pylori infection in asymptomatic patients. Antibiotics are not recommended in asymptomatic patients to reduce the development of more resistant strains of bacteria; amoxicillin (Amoxil) and clarithromycin (Biaxin) should not be prescribed.

Ranitidine (Zantac) Esomeprazole (Nexium) Dexlansoprazole (Dexilant)

Which laboratory test does the nurse review before a patient takes a magnesium-based over-the-counter antacid for heartburn? Gastric pH Electrolytes Liver function Renal function Rationale Renal function test results should be reviewed to ensure that renal function is normal. If renal failure is present, magnesium and potassium ions cannot be excreted, possibly leading to hypermagnesemia, hyperkalemia, and toxicity. Gastric pH, electrolytes, and liver function test results would not need to be reviewed before antacid use.

Renal function

For which condition is esomeprazole (Nexium) typically prescribed? Select all that apply. Dysphagia Crohn's disease Severe esophagitis Zollinger-Ellison syndrome Gastroesophageal reflux disease (GERD) Rationale Esomeprazole is a proton pump inhibitor often used to treat severe esophagitis, GERD, and Zollinger-Ellison syndrome. Esomeprazole is not indicated for the treatment of Crohn's disease or dysphagia.

Severe esophagitis Zollinger-Ellison syndrome Gastroesophageal reflux disease (GERD)

Which medication should be prescribed with caution for a patient taking tetracycline? Sucralfate Warfarin Imipramine Cimetidine Rationale Sucralfate may interfere with the metabolism of tetracycline. Tetracyclines should be administered 1 hour before or 2 hours after sucralfate. The metabolism of warfarin is reduced when coadministered with omeprazole. Cimetidine will inhibit the excretion of imipramine.

Sucralfate

Which statement is true regarding sucralfate (Carafate)? Sucralfate (Carafate) can induce diarrhea as an adverse effect. Sucralfate (Carafate) is a prokinetic agent that is used to treat duodenal ulcers. Sucralfate (Carafate) treats ulcers by inhibiting gastric secretions and altering gastric pH. Sucralfate (Carafate) is prescribed to patients who cannot tolerate other forms of antiulcer therapy. Rationale Sucralfate (Carafate) is used to treat duodenal ulcers, especially in patients who are unable to tolerate other forms of antiulcer therapy. Sucralfate (Carafate) may induce constipation, not diarrhea. Sucralfate (Carafate) is a coating agent that treats ulcers by forming a complex that adheres to the crater and protects it from acids, pepsins, and bile salts.

Sucralfate (Carafate) is prescribed to patients who cannot tolerate other forms of antiulcer therapy.

Which action by the patient can increase the risk of having diarrhea while taking misoprostol? Taking the medication at bedtime Not taking the medication on an empty stomach Taking the medication with magnesium-containing antacids Including fresh fruits and whole-grain products in the diet Rationale Simultaneous use of misoprostol (Cytotec) with magnesium-containing antacids can increase the patient's risk of diarrhea. Therefore the patient should avoid taking these medications together. Taking the medication at bedtime reduces the risk of diarrhea. Taking misoprostol (Cytotec) on an empty stomach increases the risk of diarrhea. Including sufficient roughage such as fresh fruits and whole-grain products in the diet reduces the risk of diarrhea.

Taking the medication with magnesium-containing antacids

Which action does the nurse anticipate to be beneficial for a pregnant patient in her first trimester who is prescribed misoprostol? Verify the order with the healthcare provider. Instruct her to take the medication at night. Give half of the dose of the medication immediately. Instruct her to take the medication with large amounts of water. Rationale Prostaglandin E analogs such as misoprostol can be used to treat gastric ulcers, but they may also induce uterine contractions and result in a miscarriage. Therefore the prescription should be questioned and verified with the healthcare provider to ensure the patient's safety. Taking misoprostol at night would not prevent miscarriage. Halving the dose and taking the medication with large amounts of water will also not reduce the risk of a miscarriage.

Verify the order with the healthcare provider.

Which condition is an adverse effect of omeprazole? Tachycardia Constipation Blurred vision Vesicular rash Rationale A persistent vesicular rash from omeprazole may be the cause for discontinuing therapy. Blurred vision and tachycardia are not adverse effects associated with omeprazole. Diarrhea, not constipation, is an adverse effect associated with omeprazole.

Vesicular rash

At which time should a patient take misoprostol to minimize the incidence of diarrhea? With meals Between meals One hour before meals At bedtime with magnesium hydroxide (Milk of Magnesia) Rationale Taking misoprostol with meals and at bedtime and avoiding magnesium-containing antacids will help decrease diarrhea. The nurse should encourage the patient not to discontinue therapy without first contacting the healthcare provider. Taking misoprostol between meals or 1 hour before meals will not decrease the incidence of diarrhea. Taking misoprostol at bedtime will decrease the incidence of diarrhea, but it should not be taken with magnesium containing antacids such as magnesium hydroxide (Milk of Magnesia) because these antacids increase the incidence of diarrhea.

With meals