Pharm 57 Drugs Affecting GI Secretions

A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms most likely be resolved? A. 1 to 2 weeks B. 1 month C. 6 weeks D. 4 weeks

A. (1-2 weeks)

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? A. allergy status B. cognition C. immunization history D. normal bowel pattern

Allergy status, antacids are contraindicated in the presence of any known allergy to antacid products or any component of the drug to prevent hypersensitivity reactions)

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered: A. an hour before meals. B. with meals. C. immediately after each meal. D. with an antacid.

An hour before meals; Sucralfate forms a protective barrier over ulcers, so it makes sense to take it before you eat so that the food you consume does not irritate the ulcer)

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

B (Alopecia)

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? A. Esophageal cancer B. Peptic ulcer disease C. Bowel obstruction D. Liver cancer

B (PUD or peptic ulcer disease)

Because of the possible adverse effects of long-term proton pump inhibitor (PPI) use, the nurse practitioner should focus on what assessment in a 72-year-old client? a. dental health b. bone density c. joint mobility d. integumentary system

BONE DENSITY (PPIs can cause increased risk of bone fractures so the bone density of pts should be monitored closely)

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? A. "I should crush the medication and mix it into apple sauce." B. "I need to swallow the drug whole." C. "I'll have to stop using antacids." D. "It is important that I take the drug after each meal."

"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 physician may instruct the patient to take the two medications at different times during the day.

The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects? A. Constipation B. Flatulence C. Diarrhea D. Dehydration

(aluminum or calcium based antacids cause constipation, magnesium based antacids cause diarrhea)

How should the critical care nurse most accurately titrate the dose and frequency of administration of an intragastric drip of an antacid through a nasogastric tube? A. by assessing the pH of a 24-hour urine sample B. by measuring the pH of urine after each void C. by aspirating stomach contents and measuring the pH D. by swabbing the client's buccal mucosa and testing for pH daily

(by aspirating stomach contents and measuring the pH)

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? A. Rabeprazole B. Lansoprazole C. Esomeprazole D. Omeprazole

(omeprazole aka Prilosec)

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? A. omeprazole B. lansoprazole C. rabrprazole D. pantoprazole

(omeprazole)

What type of medication might be included in the medication therapy to treat a peptic ulcer by serving as a barrier to gastric secretions? A. proton pump inhibitors (PPIs) B. antacid C. sucralfate D. histamine2 receptor antagonists (H2RAs)

(sucralfate or Carafate aka "Cara's Coat")

A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic? A. Omeprazole B. Cimetidine C. Magaldrate D. Sucralfate

A (omeprazole)

An older client has been prescribed omeprazole for the treatment of gastroesophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine? A. "Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." B. "Famotidine is more expensive than omeprazole." C. "Omeprazole is taken at bedtime making it easier to remember." D. "Famotidine and omeprazole are both histamine-2 antagonists and could be used interchangeably."

A "Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." ; H2 antagonist like famotidine can cause CNS effects in elderly pts)

The nurse instructs the patient to use over-the-counter ranitidine (Zantac) instead of cimetidine (Tagamet). What risk is decreased when using ranitidine over cimetidine? A. Drug-to-drug interaction B. Bradycardia C. Diarrhea D. Headache

A (drug-drug interaction)

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: A. metabolic alkalosis. B. hypercholesterolemia. C. hypocalcemia. D. metabolic acidosis.

A (metabolic alkalosis; Alkalosis with resultant metabolic changes (nausea, vomiting, neuromuscular changes, headache, irritability, muscle twitching, and even coma) may occur)

A client has a history of liver dysfunction. Which histamine-2 receptor antagonist would the nurse expect to be prescribed? A. Nizatidine B. Ranitidine C. Famotidine D. Cimetidine

A (nizatidine)

Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply: A. Omeprazole (Prilosec) B. Ondansetron (Zofran) C. Metoclopramide (Reglan) D. Lansoprazole (Prevacid) E. Promethazine (Phenergan)

A&D (omeprazole aka Prilosec & lansoprazole aka Prevacid)

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? A.Monitor the patient for the development of diarrhea. B. Teach the patient to take omeprazole 1 hour before meals. C. Emphasize that the drug should not be crushed or chewed. D. Coordinate bone density testing for the patient.

Coordinate bone density testing for the pt; PPIs can cause increase risk of bone fracture so bone density needs to be monitored)

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform? A. Monitor the patient for concentrated urine and restlessness. B. Inform the PHCP if the patient exhibits tardive dyskinesia symptoms. C. Monitor the patient for reports of pain or sour taste. D. Closely monitor the patient for confusion and dizziness.

D (cimetidine and other H2 antagonist have been assoc w/ CNS effects & should be used cautiously with the elderly)

The nurse should be aware that ranitidine achieves a therapeutic effect by which means? a. raising the pH of gastric secretions b. decreasing gastric motility c. binding to proton pumps d. inhibiting the secretion of gastric acid

D (H2 antagonists all inhibit gastric acid secretion)

A 30-year-old nonpregnant patient is prescribed misoprostol. Which of the following should the nurse instruct the patient as part of the teaching plan? A. Do not chew, open, or crush the tablet. B. Administer the drug one hour before travel. C. Swallow the tablet one hour before eating. D. Use a reliable contraceptive.

D (because it cause uterine contractions, you should avoid getting pregnant) CATEGORY X

The nurse should be aware that the combination of omeprazole and warfarin creates a risk of what adverse reaction? A. rebound gastroesophageal reflux disease (GERD) B. fluid volume excess C. venous thromboembolism D. hemorrhage

D (hemorrhage; PPIs can increase the concentration of anticoagulants and therefore cause a bleed risk or hemorrhage)

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? A. Imbalanced Nutrition related to abdominal discomfort B. Deficient Fluid Volume C. Risk for Injury: Bleeding D. Impaired Bowel Elimination: Constipation

D (Impaired Bowel Elimination: Constipation)

T/F If a client is receiving sucralfate and omeprazole, the doses can be taken together.

FALSE Sucralfate is not absorbed well in the presence of proton pump inhibitors and doses should be spaced at least 30 minutes apart if both drugs are prescribed.

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? a. Headache b. Tremor c. Anxiety d. Visual disturbances

HEADACHE* HA, H2 antagonist adverse affects include: GI effects of diarrhea or constipation; CNS effects of dizziness, headache, somnolence, confusion, or even hallucinations; cardiac arrhythmias and hypotension; and gynecomastia and impotence.)

A client is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition? A. Cancer B. Hepatic disease C. Diabetes mellitus D. Hypertension

Hepatic disease can cause a change in metabolism which will prevent the liver from metabolizing drugs correctly

A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to clients with which condition? a. hypertension b. hepatic disease c. diabetes mellitus d. cancer

Hepatic disease; these are liver diseases and the liver is where drugs are metabolized therefore the drug metabolism would be altered in hepatically diseased pts)

Ranitidine and cimetidine are both H2RAs used in the treatment of peptic ulcer disease. Of the two, ranitidine is preferred in critically ill clients because it is less likely to: A. cause macular rash and cough. B. cause diarrhea. C. interfere with the metabolism of other drugs. D. result in hypotension.

Interfere w/ metabolism of other drugs; Ranitidine is less likely to cause with drug-to-drug interactions or interfere with drug metabolism

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 A. pork. B. pollen. C. shellfish. D. ragweed.

PORK pancrelipase is produced in porcine creatures and therefore can cause hypersensitivity reactions in pts allergic to pork)

A client is prescribed ranitidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has: A. renal disease. B. diabetes mellitus. C. migraine headaches. D. pulmonary disease.

RENAL DISEASE (renal disease cause ineffective renal clearance, in other words, you can't excrete the drug effectively)

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? A. Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. B. Is 15 pounds over ideal weight C. Has a stressful job as a air traffic controler. D. Eats spicy food at least twice a week.

Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily; NSAIDs can cause peptic ulcers)

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? A. Client may take an average dose B. Larger than average dose prescribed dose C. Smaller than average prescribed dose D. Do not take as it is contraindicated in the elderly

Smaller than the average prescribed dose; Older adults are more likely to have renal and/or hepatic impairment related to underlying medical conditions, which could interfere with the metabolism and excretion of these drugs. The dose for older adults should be started at a lower level than recommended for younger adults. Patients should be monitored very closely, and dose adjustment should be made based on patient response.)

What is an effect of histamine release that is related to ulcer formation? A. stimulates denaturing of gastrin B. destroys parietal cells C. initiates pepsin synthesis D. stimulates gastric acid secretion

Stimulates gastric acid secretion; ulcers can be caused by your stomach being too acidic)

T/F The use of calcium carbonate is associated with the development of acid rebound.

True

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

True (pancrelipase is used to treat digestive enzyme dysfunctions like cyistic fibrosis and chronic pancreatitis)

What is the rationale for using two antimicrobials when treating a Helicobacter pylori infection? A. Two antimicrobials are needed to prevent the emergence of drug-resistant H. pylori organisms. B. Two different microbes are involved, requiring two different antimicrobials. C. One antimicrobial tends to alter the action of the adjunct medications. D. A single antimicrobial is generally not strong enough to eradicate the infection.

Two antimicrobial's are needed to prevent the emergence of drug-resistant H. pylori organisms

The client has Maalox ordered for administration before meals. Which condition is contraindicated with the administration of Maalox? A. Renal dysfunction B. Heart rate of 68 C. Hypertension D. Stress ulcer

a (renal dysfunction; it has a high sodium content so if someone has impaired renal function, they cannot excrete the sodium as easily which cause it to build up in the body. It is also not used for pts with cardiac dysfunction - sodium = salt = bad for the heart)

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

b (30 minutes)

A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication? A. H2 Antagonist B. PPI C. Antacid D. Laxative

b (PPI or proton pump inhibitor; usually omeprazole, lansoprazole, rabeprazole)

A 23-year-old female client is prescribed misoprostol (Cytotec). Which client teaching intervention is most important? A. Report postmenopausal bleeding B. Use effective contraceptive measures C. Administer the drug one time per day D. Supplement therapy with magnesium antacids

b (because it cause uterine contractions, you should avoid getting pregnant)

A nurse is teaching a client about his prescribed lansoprazole. The nurse instructs the client to take the drug at which time? A. first thing on arising B. at bedtime C. 1 hour before eating D. 2 hours after a meal

c (1 hour before meals)

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis? A. Abdominal pain B. Diarrhea C. Headache D. Increased fracture risk

d (Increased fracture risk; PPIs can increase risk for fractures like osteoporosis and osteopenia)

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? A. Gastric reflux B. Hyperactive gastric mucosa C. Hypocalcemia D. Rebound acidity

d (Rebound acidity; when a pt stops uses an antacid, the production of gastric acid resumes and the body can OVER produce gastric acid to make up for the lack of production)

Which adverse effect is more likely to be caused by cimetidine than by other H2RAs? A. Hypertension B. Gynecomastia C. Seizures D. Hypoxia

gynocomastia - growth of breast tissue in males - is more common with long tern use of cimetidine)

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? A. healing damaged cells B. exerting an antibiotic effect C. increasing mucus secretion D. inhibiting acid secretion

inhibiting 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? A. omeprazole B. sucralfate C. sodium bicarbonate D. famotidine

omeprazole

A client has a magnesium-based antacid prescribed for administration as needed. Which condition contraindicates the administration of this classification of medications? A. heart rate of 68 B. stress ulcer C. renal dysfunction D. hypertension

renal dysfunction; Caution should be used in the following instances: Any condition that can be exacerbated by electrolyte or acid-base imbalance to prevent exacerbations and serious adverse effects; any electrolyte imbalance, which could be exacerbated by the electrolyte-changing effects of these drugs; GI obstruction, which could cause systemic absorption of the drugs and increased adverse effects; renal dysfunction, which could lead to electrolyte disturbance if any absorbed antacid is not neutralized properly; and pregnancy and lactation because of the potential for adverse effects on the fetus or neonate.

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: A. serum phosphate level. B. aspartate transaminase levels. C. blood glucose level. D. urine specific gravity.

serum phosphate level; The adverse effects associated with these drugs relate to their effects on acid-base and electrolyte balance; Hypophosphatemia can occur with the use of aluminum salts.)