NUR 2092 Pharmacology Ch 57 Drugs acting on the GI secretions

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 Rebound hyperacidity Headache

A group of students are reviewing the signs and symptoms of systemic alkalosis that can occur as a result of using sodium bicarbonate. The students demonstrate a need for additional teaching when they identify which as a possible manifestation?

Constipation

An older adult has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect?

Constipation

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

Constipation - The nurse should warn a client taking aluminum- and calcium-containing antacids about constipation, which can be associated with taking products containing either medication. Client taking magnesium- and sodium-containing antacids can have diarrhea. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.

A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient's safety, which of the following would be a priority nursing action?

Coordinate bone density testing for the patient.

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

Proton pump inhibitors

A client taking metronidazole informs the nurse that the medication will be finished today and they plan on drinking alcohol at a party tonight. What response by the nurse would be most helpful to prevent complications?

"Drinking within the next couple of days could cause a severe reaction."

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." - Omeprazole, a proton pump inhibitor, must be swallowed whole; it should not be cut, crushed or chewed. The drug should be taken approximately an hour before a meal, not after a meal. Concomitant use of antacids is common, though the health care provider may instruct the client to take the two medications at different times during the day.

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."

An older client has been prescribed omeprazole for the treatment of gastresophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine?

"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population."

Which instruction would be most important to give to a client who is receiving omeprazole?

"Swallow the tablet whole with a large glass of water." - The medication should be swallowed whole with a large glass of water. It should not be chewed, crushed, or opened. Antacids, if prescribed, should be taken 1 hour before or 2 hours after the omeprazole.

A female client has GERD and is taking cimetidine. She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse?

"Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine." - If both cimetidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of cimetidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the cimetidine.

A nurse is teaching a client about his prescribed lansoprazole. The nurse instructs the client to take the drug at which time?

1 hour before eating

A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms be resolved?

1 to 2 weeks

A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?

30 minutes

A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?

2 tablets

Which client is at risk for the development of an acute ulcer? select all that apply.

A client who is diagnosed with jaundice A client who experienced a stroke A client with 2nd degree burns over 50% of the body A client on a mechanical ventilator for 5 days

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

Alopecia

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?

Amoxicillin

The nurse is caring for four clients. Which client would benefit most from misoprostol, a synthetic prostaglandin E analog?

An 83-year-old male with rheumatoid arthritis

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? (Select all that apply.)

Antibiotics A PPI

A critical care nurse is preparing to administer an intragastric drip of an antacid to a client through a nasogastric tube. How should the nurse most accurately titrate the dose and frequency?

By aspirating stomach contents and measuring the pH

Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?

Drug-drug interactions

Which medication reduces the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells? Select all that apply.

Esomeprazole Lansoprazole The proton pump inhibitors, like esomeprazole and lansoprazole, reduce the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate enzyme system of the gastric parietal cells. Famotidine (Pepcid) and ranitidine are both histamine H2 antagonists decreasing stomach acid by inhibiting the action of H2 receptors in the stomach. Calcium carbonate is an acid neutralizer that reduces the pH of the acid in the stomach and duodenum.

There is a drug-drug interaction between the antipeptides and penicillin.

False

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

Gynecomastia

A client is receiving sodium bicarbonate orally. Which of the following would lead the nurse to suspect that the client is developing systemic alkalosis? (Select all that apply.)

Headache Irritability Confusion Tetany

While reviewing the medication history of a client newly prescribed omeprazole, the nurse sees that the client is also taking warfarin. What potential interaction should the nurse account for when developing the plan of care for this client?

Hemorrhage

A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to clients with which condition?

Hepatic disease - No absolute contraindications exist, but cimetidine should be used cautiously in clients with impaired hepatic and renal function.

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 fractures

Carter, age 2, is diagnosed with cystic fibrosis; the physician places him on pancrelipase. What would be the most appropriate diagnosis for Carter related to his medication regimen?

Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes

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?

Impaired Bowel Elimination: Constipation

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

Increased fracture risk

A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?

Infection with H. pylori

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

Inhibiting the secretion of gastric acid

A nurse assesses a client for signs and symptoms of tardive dyskinesia when the client is receiving which drug?

Metoclopramide

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

Omeprazole

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

Antacids have not been effective in managing a client's gastroesophageal reflux disease, so the health care provider is prescribing a proton pump inhibitor. Why might the health care provider prescribe a proton pump inhibitor (PPI) rather than a histamine2 receptor antagonist (H2RA)?

PPIs suppress acid more strongly and for a longer time.

A client is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which disease is a result of cellular destruction of the gastrointestinal tract from this medication?

Peptic ulcer disease - Cell destruction will occur from the ingestion of NSAIDs, which can lead to the development of peptic ulcer disease. Nonsteroidal anti-inflammatory agents do not cause esophageal cancer, bowel obstruction, or liver cancer.

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?

Rebound acidity

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

Drugs act in several ways on the secretions of the GI tract. Which action affects the GI secretions least?

Replaces secretions

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 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 - Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.

What type of medication might be included in the medication therapy to treat a peptic ulcer by serving as a barrier to gastric secretions?

Sucralfate

Client teaching should include what instruction about antacids?

Take antacid 1 hour before other medications.

Pancrelipase would most likely be used to treat a patient with cystic fibrosis.

True

A client diagnosed with an H. pylori-associated ulcer has been prescribed treatment that includes two antimicrobials. What does the nurse identify as the reason for using multiple antimicrobials?

Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms.

A nurse is providing education to a 23-year-old female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching?

Use effective contraceptive measures.

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

Use effective contraceptive measures.

An older adult client has been on long-term proton pump inhibitor (PPI) therapy. The nurse practitioner should focus on what assessment related to adverse effects?

bone density

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

decreases production of gastric secretions

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?

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

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.

A client is prescribed cimetidine 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.

How does histamine release contribute to ulcer formation?

stimulates gastric acid secretion

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."

Which statement by a patient receiving pancrelipase indicates that the patient has understood his instructions?

"I should take the drug with meals and snacks."

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."

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

Cimetidine

Which would a nurse anticipate as having antiandrogenic effects?

Cimetidine

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?

Closely monitor the patient for confusion and dizziness.

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

In preparing a teaching plan for a patient who is to receive misoprostol, which would the nurse include as possible adverse effects? (Select all that apply.)

Dyspepsia Flatulence Dysmenorrhea Excessive vaginal bleeding

A hospital client's current drug regimen includes antibiotics and proton pump inhibitors. When planning this client's care, the nurse should perform what action?

Ensure the client's meals are not spicy or highly acidic

The health care provider has prescribed ranitidine for a hospitalized client on a unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the client?

Headache - Adverse effects with H2RAs such as ranitidine are typically uncommon and mild with the usual doses and duration of treatment. However, effects can include diarrhea or constipation, headache, dizziness, muscle aches, and fatigue.

Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply:

Omeprazole (Prilosec) Lansoprazole (Prevacid)

After teaching a group of students about proton pump inhibitors, the instructor determines that the students have understood the information when they identify which agent as the prototype proton pump inhibitor?

Omeprazole - Omeprazole is considered the prototype proton pump inhibitor.

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.

The nurse is caring for an adult client presenting with recent heartburn, which the client treated with over-the-counter omeprazole 20 mg PO daily. After reviewing the client's current list of medications, the nurse should report which medication because concurrent use may increase blood levels of omeprazole?

Phenytoin Clarithromycin

A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to

Pork - Pancrelipase is contraindicated in patients who are hypersensitive to pork protein or enzymes because the drug is derived from pork.

The nurse is caring for a client who is prescribed esomeprazole. The client informs the nurse that he is also taking sucralfate. The nurse would anticipate which effect as a possibility when these two drugs are administered?

decreased absorption of the esomeprazole

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:

an hour before meals.

Misoprostol is a synthetic form of prostaglandin E prescribed to protect the gastric mucosa from erosion and ulceration. The drug is contraindicated in clients who:

are pregnant.

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:

headache.

The client will receive cimetidine 800 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include:

headache.

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:

serum phosphate level.

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