Pharmacology Ch 57 (2)
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." Rationale: Metronidazole should not be combined with alcohol, which could cause severe adverse effects: patients are advised to avoid alcohol for at least 3 days after treatment has ended.
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." Rationale: 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.
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?
"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." Rationale: Proton pump inhibitors like omeprazole may be the best choice for treating GERD in older patients because of fewer adverse effects and better therapeutic response with these drugs. Famotidine is a histamine-2 antagonists. The cost of the medication is not a primary factor in prescribing therapy for GERD. It is not standardly recommended to take omeprazole at bedtime.
The nurse is educating a client diagnosed with peptic ulcer disease about the prescribed medications aluminum hydroxide-magnesium hydroxide-simethicone mixture and ranitidine. Which statement made by the client indicates the need for further clarification?
"To decrease interactions with other drugs I take, I will take the drug 30 minutes before taking the rest of my meds." Rationale: Antacids can greatly affect the absorption of drugs from the GI tract. Most drugs are prepared for an acidic environment, and an alkaline environment can prevent them from being broken down for absorption or can actually neutralize them so that they cannot be absorbed. Patients taking antacids should be advised to separate them from any other medications by 2 hours.
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 Rationale: Proton pump inhibitors such as lansoprazole should be swallowed whole at least 1 hour before eating. The proton pump inhibitors suppress gastric acid secretion by blocking the final step in the production of gastric acid by the gastric mucosa. After meals will inhibit suppression of gastric acid. On rising and at bedtime are not optimal times to take lansoprazole.
A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms most likely be resolved?
1 to 2 weeks Rationale: The symptoms of gastroesophageal reflux disease will be abolished in 1-2 weeks after the start of the proton pump inhibitor medication regime. It will not take 4 weeks, 1 month, or 6 weeks to see a change with the proton pump inhibitor.
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 Rationale: Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the patient to adjust lights or temperature and avoid noise if headaches occur and to contact his physician if the headache becomes intolerable. Irritability, dry mouth, and heart palpitations are not associated with this drug.
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
Omeprazole Rationale: Omeprazole is a proton pump inhibitor which is used as part of combination therapy to treat H. pylori infections.
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 Rationale: 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 Rationale: Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
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?
Use a reliable contraceptive. Rationale: The nurse should instruct the patient to use a reliable contraceptive to avoid pregnancy during the course of treatment as it can cause birth defects. The nurse should instruct the patient taking proton pump inhibitors not to chew, open, or crush the tablet but to swallow the tablet whole at least one hour before eating. The nurse needs to inform the patient to take the drug for motion sickness about one hour before travel.
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?
by aspirating stomach contents and measuring the pH Rationale: For clients with a nasogastric tube in place, antacid dosage may be titrated by aspirating stomach contents, determining pH, and then basing the dose on the pH. Accurate measurement of gastric pH cannot be determined from the buccal mucosa or urine.
The client will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include:
headache. Rationale: Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the patient to adjust lights or temperature and avoid noise if headaches occur and to contact his physician if the headache becomes intolerable.
The nurse should be aware that the combination of omeprazole and warfarin creates a risk of what adverse reaction?
hemorrhage Rationale: Omeprazole increases blood levels of the anticoagulant warfarin thus creating a risk for bleeding.
The nurse should be aware that ranitidine achieves a therapeutic effect by which means?
inhibiting the secretion of gastric acid Rationale: The histamine2 receptor antagonists (H2RAs) inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin. These drugs, such as ranitidine, do not change the pH of secretions, bind to the proton pumps, or decrease gastric motility.
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
Alopecia Rationale: Alopecia can occur with proton pump therapy, but it is not a common adverse effect. Common adverse effects include dizziness, headache, and cough.
A client is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition?
Hepatic disease Rationale: No contraindications exist, but the use of cimetidine should be used cautiously in patients with impaired hepatic and renal function. The patient with cancer, hypertension, and diabetes mellitus can take cimetidine safely.
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. Rationale: The nurse should closely monitor the elderly patient who has been administered cimetidine for confusion and dizziness. When the patient is receiving an antiemetic, the nurse monitors the patient frequently for continued reports of pain, sour taste, spitting blood, or coffee-ground-colored emesis. When antacids are given to the patient, the nurse should observe the patient for concentrated urine and restlessness. When the patient is administered prolonged doses of metoclopramide, the nurse reports any sign of tardive dyskinesia or extrapyramidal symptoms to the PHCP.
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?
Proton pump inhibitors Rationale: The treatment of choice for Helicobacter pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.
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?
bone density Rationale: Long-term use of PPIs is associated with increased risk of hip fractures in people older than 50 years of age; the risk of fractures increases the longer the medications are taken and is greater in people who take higher dosages of PPIs. Bone density assessment may thus be warranted. None of the other options are associated with this class of medications.