PrepU Chapter 57
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 should crush the medication and mix it into apple sauce." "I need to swallow the drug whole." "It is important that I take the drug after each meal." "I'll have to stop using antacids."
"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.
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." 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.
A nurse is teaching a client about his prescribed lansoprazole. The nurse instructs the client to take the drug at which time? first thing on arising at bedtime 1 hour before eating 2 hours after a meal
1 hour before eating 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.
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs? Seizures Hypoxia Gynecomastia Hypertension
Gynecomastia Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.
A client is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition? Diabetes mellitus Cancer Hepatic disease Hypertension
Hepatic disease No contraindications exist, but the use of cimetidine should be used cautiously in clients with impaired hepatic and renal function. The client with cancer, hypertension, and diabetes mellitus can take cimetidine safely.
A patient is prescribed esomeprazole. The nurse would understand that this drug would be given by which route? (Select all that apply.) Intravenous Oral Transdermal Intramuscular Topically Subcutaneous
Oral Intravenous Esomeprazole is available for use in delayed release oral form and as IV preparation.
The client has Maalox ordered for administration before meals. Which condition is contraindicated with the administration of Maalox?
Renal dysfunction Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.
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.
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:
an hour before meals. Sucralfate, a gastrointestinal protectant, must be given time to act before significant gastric activity, and it requires an acidic environment to be effective. For these reasons, sucralfate should be given an hour before meals and antacids.
What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection? decreases pepsin production protects ulcer craters assists in eliminating the bacteria decreases production of gastric secretions
decreases production of gastric secretions Several types of drugs are used, alone and in various combinations. Antacids neutralize gastric acid and decrease pepsin production, antimicrobials and bismuth can eliminate H. pylori infection, histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) decrease gastric acid secretion, sucralfate provides a barrier between mucosal erosions or ulcers and gastric secretions, and misoprostol restores prostaglandin activity.
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:
interfere with the metabolism of other drugs. Unlike cimetidine, ranitidine does not affect the cytochrome P450 drug-metabolizing system in the liver and therefore does not interfere with the metabolism of other drugs by that system.
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? the importance of taking prescribed medication until symptoms subside the connection between smoking and chronic pain smoking effects on the healing of ulcers general health dangers research has proven to be associated with smoking
smoking effects on the healing of ulcers Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of nonsmokers. The treatment is focused on healing, and smoking will impede the achievement of that goal. Acute not chronic pain is the focus of the client's concerns. Medication should be taken until discontinued by the health care provider. While a discussion concerning the health dangers associated with smoking is appropriate, such information is not related to the client's current health issue.
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 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.
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.)
Flatulence Excessive vaginal bleeding Dyspepsia Dysmenorrhea Flatulence is a possible adverse effect. Excessive vaginal bleeding is a possible adverse effect of misoprostol. Dyspepsia is a possible adverse effect of misoprostol. Dysmenorrhea is a possible adverse effect of misoprostol. Dizziness is not associated with misoprostol. Vertigo is not associated with misoprostol.
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.
A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the midepigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?
Infection with H. pylori Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic? Cimetidine Omeprazole Sucralfate Magaldrate
Omeprazole Omeprazole is a proton pump inhibitor which is used as part of combination therapy to treat H. pylori infections. Magaldrate is an antacid that is used to relieve GI hyperacidity. Sucralfate is a GI protectant that is used as short-term treatment of duodenal ulcers. Cimetidine is a H-2 receptor antagonist used to treat duodenal and benign gastric ulcers.
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 Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.
The nurse should be aware that ranitidine achieves a therapeutic effect by which means? inhibiting the secretion of gastric acid decreasing gastric motility raising the pH of gastric secretions binding to proton pumps
inhibiting the secretion of gastric acid 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.
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:
renal disease. H2RAs must be used with caution in clients with renal disease. Since these drugs are eliminated through the kidneys, dosages are reduced to avoid adverse effects.
A client has a magnesium-based antacid prescribed for administration as needed. Which condition contraindicates the administration of this classification of medications?
renal dysfunction Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.
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 Hyperactive gastric mucosa Gastric reflux Hypocalcemia
Rebound acidity Calcium antacids have high neutralizing capacity and rapid onset. They may cause rebound acidity and hypercalcemia.
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? exerting an antibiotic effect healing damaged cells inhibiting acid secretion increasing mucus secretion
inhibiting acid secretion Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.
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.
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 Lansoprazole Pantoprazole Esomeprazole
Omeprazole Omeprazole is considered the prototype proton pump inhibitor.
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? No antacids, because they are contraindicated in the elderly Larger than the average prescribed dose Smaller than the average prescribed dose The same as the average prescribed dose
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.
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: have arthritis. are pregnant. have diabetes. are hypertensive.
are pregnant. Misoprostol is contraindicated during pregnancy because it may cause abortion, premature birth, or birth defects. It is also contraindicated in women of childbearing potential who are not using effective contraception.
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 shellfish. pork. ragweed. pollen.
pork Pancrelipase is contraindicated in patients who are hypersensitive to pork protein or enzymes because the drug is derived from pork. Allergies to ragweed, pollen, and shellfish are not associated with the use of the drug.
A female client has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse? "Sure, you may take an antacid with ranitidine." "No, the two drugs will work against each other." "Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine." "I wouldn't advise it. You may experience severe constipation."
"Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine." If both ranitidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of ranitidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the ranitidine. The other three statements are not true.
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 The required dosage is 200 mcg. Available tablets contain 100 mcg of the drug. Therefore, the nurse should administer two tablets each time to the client.
A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to clients with which condition? hypertension cancer diabetes mellitus hepatic disease
hepatic disease No absolute contraindications exist, but cimetidine should be used cautiously in clients with impaired hepatic and renal function. The client with cancer, hypertension, and diabetes mellitus can take cimetidine safely.
Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection? Famotidine Calcium carbonate Omeprazole Sucralfate
Omeprazole Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
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 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? Bowel obstruction Peptic ulcer disease Liver cancer Esophageal cancer
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.
Which of the following best reflects the rationale for using histamine-2 receptor antagonists for stress ulcer prophylaxis?
Protects the stomach lining via acid blockage Histamine-2 receptor antagonists are used for stress ulcer prophylaxis because the drugs block the production of acid thereby protecting the stomach lining, which is at risk because of decreased mucus production. Reducing the overall acid level is the rationale for use as short-term treatment of active duodenal ulcer. Blocking the overproduction of hydrochloric acid is the rationale for treatment of pathologic hypersecretory conditions. Decreasing the acid being regurgitated into the esophagus is the rationale for treatment of erosive gastroesophageal reflux.
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? Do not chew, open, or crush the tablet. Use a reliable contraceptive. Swallow the tablet one hour before eating. Administer the drug one hour before travel.
Use a reliable contraceptive. 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.
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 Calcium carbonate Famotidine Sucralfate
Omeprazole Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
The client has Maalox ordered for administration before meals. Which condition is contraindicated with the administration of Maalox? Heart rate of 68 Renal dysfunction Hypertension Stress ulcer
Renal dysfunction Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.
A male client has liver disease and is diagnosed with esophageal reflux. He asks the health care provider to prescribe PPIs. The nurse is aware that PPIs given in conjunction with liver disease may result in what issue for this client?
Transient elevations in liver function tests PPIs are metabolized in the liver and may cause transient elevations in liver function tests.
Pancrelipase would most likely be used to treat a patient with cystic fibrosis.
True
An older adult's 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 With the antacid which contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.
The nurse should be aware that the combination of omeprazole and warfarin creates a risk of what adverse reaction? hemorrhage rebound gastroesophageal reflux disease (GERD) venous thromboembolism fluid volume excess
hemorrhage Omeprazole increases blood levels of the anticoagulant warfarin thus creating a risk for bleeding. Such an elevation in warfarin would not increase the risk for the development of any of the other options.
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: cause macular rash and cough. cause diarrhea. result in hypotension. interfere with the metabolism of other drugs.
interfere with the metabolism of other drugs. Unlike cimetidine, ranitidine does not affect the cytochrome P450 drug-metabolizing system in the liver and therefore does not interfere with the metabolism of other drugs by that system.
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. pollen. shellfish. ragweed.
pork
A client has a magnesium-based antacid prescribed for administration as needed. Which condition contraindicates the administration of this classification of medications? stress ulcer heart rate of 68 hypertension renal dysfunction
renal dysfunction Magnesium-based antacids are contraindicated in clients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.
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? "Famotidine is more expensive than omeprazole." "Omeprazole is taken at bedtime making it easier to remember." "Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." "Famotidine and omeprazole are both histamine-2 antagonists and could be used interchangeably."
"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." 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.
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. Monitor the patient for reports of pain or sour taste. Inform the PHCP if the patient exhibits tardive dyskinesia symptoms. Monitor the patient for concentrated urine and restlessness.
Closely monitor the patient for confusion and dizziness. 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.
The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects? Constipation Flatulence Diarrhea Dehydration
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.
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? Risk for injury related to the side effects of the drug therapy Alteration in comfort related to the drug therapy and the adverse effect of a headache Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes Alterations in elimination related to the disease process
Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes Pancrelipase is administered as enzymatic replacement therapy for patients with deficient exocrine pancreatic secretions; cystic fibrosis; chronic pancreatitis; ductal obstructions caused by cancer of the pancreas or common bile duct; pancreatic insufficiency; or steatorrhea from malabsorption syndrome and after pancreatectomy, gastrectomy, or post-GI surgery, such as Billroth II gastroenterostomy. Caution must be used with large doses because they may cause nausea, abdominal cramps, and diarrhea. Hyperuricosuria and hyperuricemia have occurred with extremely high doses. Less often, allergic reactions have occurred.
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis? Abdominal pain Diarrhea Headache Increased fracture risk
Increased fracture risk An increase in fractures of the hip, wrist, and spine have been seen in clients taking high doses of PPIs and undergoing treatment of osteoporosis with bisphosphonates.
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 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.
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 dental health integumentary system joint mobility
bone density 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.
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 measuring the pH of urine after each void by swabbing the client's buccal mucosa and testing for pH daily by aspirating stomach contents and measuring the pH by assessing the pH of a 24-hour urine sample
by aspirating stomach contents and measuring the pH 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.
