ch 37 prepU
A student asks the pharmacology instructor why bismuth is sometimes added to H. pylori eradication regimens. Which of the following responses accurately answers the student's question?
"Bismuth is antibacterial."
A client has been prescribed esomeprazole (Nexuim). What statement by the client indicates that the client has a good understanding of the newly prescribed drug?
"I need to swallow the drug whole and not chew the capsules." Esomeprazole must be swallowed whole, not cut, crushed, or chewed, which would interfere with its effectiveness. The drug should not be taken with an antacid, which could interfere with effectiveness. The drug is taken once a day, not with each meal.
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.
Omeprazole (Prilosec) may be used with what antibiotic in some H. pylori eradication regimens?
Amoxicillin
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."
A female client is currently taking sucralfate and has been given a prescription for ciprofloxacin for treatment of a urinary tract infection. The nurse will inform the client that she should take her medication in what way?
"Take the ciprofloxacin 2 hours before the sucralfate." It is important for the client to take the ciprofloxacin 2 hours prior to taking sucralfate to ensure full absorption of the ciprofloxacin.
A nurse is teaching a client who has just been prescribed lansoprazole (Prevacid). What statement would indicate that the client correctly understands the action of this medication?
"The medication inhibits acid secretions."
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?
"Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine."
The health care provider has prescribed sucralfate for a client with a gastric ulcer. The client asks how long he must take this medication. What is the nurse's best response to this client?
"You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."
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 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
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
Alopecia, Alopecia can occur with proton pump therapy, but it is not a common adverse effect. Common adverse effects include dizziness, headache, and cough.
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
Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms.
Antibacterial effects Accumulates in ulcer craters Inhibits pepsin activity
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 Classic quadruple therapy for H. pylori eradication (bismuth, a PPI, 1,500 mg of metronidazole, and 1,500 mg of tetracycline) is highly effective and is frequently the regimen of choice. A newer sequential therapy (PPI plus amoxicillin followed by a PPI plus clarithromycin plus metronidazole) has been proposed and is expected to replace legacy therapy.
An antacid has been added to the treatment regimen for a client on multiple medications. When is the best time for the nurse to administer the antacid?
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.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, The nurse should warn a client taking aluminum- and calcium-containing antacids about constipation, which can be associated with taking products containing either medication
Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?
Digoxin
Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?
Drug-drug interactions. Ranitidine, which is longer acting and more potent than cimetidine, is not associated with the antiandrongenic adverse effects or the marked slowing of metabolism in the liver, as cimetidine is, and therefore does not interfere with the metabolism of other drugs.
When comparing the H2RAs to each other, you would find that cimetidine (Tagamet) is more likely to cause which adverse effect?
Gynecomastia
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?
Gynecomastia, Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.
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 adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?
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.
The nurse is caring for a client with cystic fibrosis who has recently not been taking prescribed pancreatic enzymes recently. What is the primary assessment finding the nurse will see as a result of this noncompliance?
Malnutrition
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
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
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
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 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. Omeprazole is available over the counter; lansoprazole, rabeprazole, and esomeprazole are prescription medications.
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?
Proton pump inhibitors
Misoprostol is contraindicated for clients with what condition?
Pregnancy, This drug is contraindicated during pregnancy because it is an abortifacient.
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?
Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach. While the other situations may contribute to GI distress, NSAID used in primary risk factor for this client.
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, because they usually secrete less gastric acid than younger adults do.
Client teaching should include what instruction about antacids?
Take antacid 1 hour before other medications.
The nurse is caring for a 27-year-old female client who has just been prescribed misoprostol. What is a priority teaching point for this client?
The need to use a barrier-type contraceptive
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.
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.
A client's GI discomfort is prescribed antacids. Nursing interventions associated with this prescription should include to:
administer the antacid 1 hour before or 2 hours after other oral medications.
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. 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.
The nurse is caring for a patient who is going home on sucralfate (Carafate). The nurse would teach the patient to take sucralfate:
before meals. Administer drug before meals to ensure that the patient does not open, chew, or crush capsules; they should be swallowed whole to ensure the therapeutic effectiveness of the drug.
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 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. Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists.
The nurse should be aware that the combination of omeprazole and warfarin creates a risk of what adverse reaction?
hemorrhage
A client presents to the walk-in clinic reporting vomiting and burning in their mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the possible presence of:
infection with Helicobacter pylori.
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.
