Chapter 36: Drugs Affecting the Upper Gastrointestinal Tract

A nurse is teaching a 47-year-old client about omeprazole, which the physician has 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." "It is important that I take the drug after each meal." "I'll have to stop using antacids." "I should crush the medication and mix it into apple sauce."

"I need to swallow the drug whole."

Ms. Kime is prescribed ranitidine in addition to the antacid that she already takes for gastric reflux. Which statement made by the patient indicates that she understood the teaching provided about taking these medications? "I should take ranitidine 2 hours before or after my antacid dosage." "The medications do not interact, so I can take them either at the same time or at different times." "I should take both medications in the morning before breakfast." "I should take both medications at the same time during the day."

"I should take ranitidine 2 hours before or after my antacid dosage."

A patient is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the patient's symptoms be abolished? 10 weeks 12 weeks 1-2 weeks 6 weeks

1-2 weeks

What disorder is a common adverse effect of the growth hormone antagonist, octreotide (Sandostatin)? Acute cholecystitis Headache Decreased glucose tolerance Sinus bradycardia

Acute cholecystitis Acute cholecystitis is a common adverse effect of octreotide. The patient may exhibit sudden pain in the upper abdomen, nausea, vomiting, and mild, but visible jaundice. Headache, sinus bradycardia, and decreased glucose tolerance are less common adverse effects of the drug.

A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid? AlternaGEL Tums Proton pump inhibitors Milk of magnesia

AlternaGEL If aluminum salts (AlternaGEL) are taken concurrently with sucralfate, there is a risk of high aluminum levels and related aluminum toxicity. The combination of sucralfate and asphodel should be avoided or used with extreme caution. Adverse reactions with sucralfate are not associated with milk of magnesia, Tums, or proton pump inhibitors.

A nurse educating a client on the antacid aluminum hydroxide (ALternaGEL) should warn the client of which of the following adverse reactions? Select all that apply: Bone pain Diarrhea Alopecia Anorexia Tremors

Anorexia Tremors Bone pain

A patient has been prescribed chlorpromazine hydrochloride for nausea. What assessment should the nurse perform before the drug is administered to the patient? Monitor continuous spitting of blood Give the patient mouthwash or frequent oral rinses Keep a record of the patient's bowel movements Assess signs of fluid and electrolyte imbalances

Assess signs of fluid and electrolyte imbalances

The nurse should warn a patient taking aluminum and calcium-containing antacids about which adverse effects? Dehydration Flatulence Diarrhea Constipation

Constipation

Administering an antacid to a patient taking which of the following medications will decrease the absorption of the medication and results in a decreased drug effect? (Choose one) Simvastatin Digoxin Quinidine Dextroamphetamine

Digoxin Administering an antacid to a patient taking digoxin will decrease the absorption of digoxin and result in a decreased digoxin effect.

Ms. Diniger is prescribed omeprazole for gastric reflux disorder. Which strategy would help minimize the risk of adverse effects associated with omeprazole? Divide daily dosage larger than 80 mg into smaller doses to be administered through the day. Advise the patient to chew the drug thoroughly before swallowing. Do not administer the drug for more than 1 week. Crush the capsule before administration.

Divide daily dosage larger than 80 mg into smaller doses to be administered through the day.

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? Headache Diarrhea Bradycardia Drug-to-drug interaction

Drug-to-drug interaction

The physician has prescribed ranitidine for a patient in your unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the patient? Tremor Headache Visual disturbances Anxiety

Headache

A 25-year-old 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? Overconsumption of spicy foods Excessive worrying Infection with H. pylori Decreased stomach acid secretion

Infection with H. pylori

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

Omeprazole (Prilosec) Lansoprazole (Prevacid)

A patient is prescribed misoprostol. The nurse would expect to administer this drug by which route? Intravenous Oral Subcutaneous Transdermal

Oral

A patient is prescribed esomeprazole. The nurse would understand that this drug would be given by which route? (Select all that apply.) Topically Subcutaneous Oral Transdermal Intramuscular Intravenous

Oral Intravenous

A patient 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 Bowel obstruction Esophageal cancer Liver cancer

Peptic ulcer disease

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: Dehydration Headache Anorexia Confusion Rebound hyperacidity

Rebound hyperacidity Headache Confusion Adverse reactions of calcium carbonate (Mylanta) include rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment.

Ranitidine (Zantac) should be cautiously administered to individuals with evidence of which of the following conditions? Diabetes mellitus Renal disease Pulmonary disease Migraine headaches

Renal disease

The patient has Maalox ordered for administration before meals. Which of the following conditions is contraindicated with the administration of Maalox? Renal dysfunction Heart rate of 68 Hypertension Stress ulcer

Renal dysfunction

The patient has Maalox ordered for administration before meals. Which of the following conditions is contraindicated with the administration of Maalox? Renal dysfunction Hypertension Stress ulcer Heart rate of 68

Renal dysfunction

After teaching a group of students about growth hormone agonists and antagonists, the instructor determines that additional teaching is needed when the students identify which agent as a growth hormone antagonist? Somatropin Pegvisomant Bromocriptine Octreotide

Somatropin

Why would a nurse encourage a patient to avoid using OTC medications to treat decreased acid? The drugs are no longer effective The drugs cause several drug-food interactions Some of these drugs can change the normal environment of the GI tract These drugs are too expensive

Some of these drugs can change the normal environment of the GI tract

Patient teaching should include what instruction about antacids? Take antacid 1 hour before other medications. Take antacid 1/2 hour after other medications. Take antacid only at bedtime. Take antacid with other medications.

Take antacid 1 hour before other medications.

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

True

The use of calcium carbonate is associated with the development of acid rebound. False True

True

In treating Helicobacter pylori infection, a physician prescribes two antimicrobials because: Two are needed to prevent the emergence of drug-resistant H. pylori organisms. One antimicrobial isn't strong enough. More than one microbe is involved in the infection. One antimicrobial alters the action of the PPI or H2RA.

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

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. Administer the drug one hour before travel. Swallow the tablet one hour before eating.

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.

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

The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse should inform the patient that common side effects related to this medication include: anxiety. headache. tremors. visual disturbances.

headache

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.

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? Gentamicin Amoxicillin Ketoconazole Vancomycin

Amoxicillin The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

What is currently the most commonly used therapy for peptic ulcers? Antibiotics and proton pump inhibitors Antibiotics and histamine2 antagonists Bicarbonate salts, antibiotics, and ZES H2 antagonists, antibiotics, and bicarbonate salts

Antibiotics and proton pump inhibitors Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics and proton pump inhibitors that suppress or eradicate H. pylori. H2 receptor antagonists are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection, but they are not the drug of choice, proton pump inhibitors are. Bicarbonate salts are not used. ZES is the Zollinger-Ellison syndrome and not a drug.

The nurse is teaching a 31-year-old patient about lansoprazole, which the physician has prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease? By healing damaged cells By inhibiting acid secretion By increasing mucus secretion By exerting an antibiotic effect

By 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 is teaching a 31-year-old patient about lansoprazole, which the physician has prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease? By exerting an antibiotic effect By increasing mucus secretion By inhibiting acid secretion By healing damaged cells

By 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 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.

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

Closely monitor the patient for confusion and dizziness.

A patient with GI upset is prescribed an antacid for outpatient use. Which of the following instructions should the nurse provide the patient and family members? Explain that the drug may change the color of the stool. Use mouthwash or frequent oral rinses. Make the environment as pleasant as possible. Remove items with strong smells and odors.

Explain that the drug may change the color of the stool. When antacids are prescribed for outpatient use, the nurse should explain to the patient and family members that the drug may change the color of the stool (white, white streaks). When caring for a patient with nausea, the nurse makes the environment as pleasant as possible to enhance the patient's appetite and removes items with strong smells and odors. The nurse gives the patient mouthwash or frequent oral rinses to remove the disagreeable taste that accompanies vomiting.

A nurse should recognize that a client taking antithyroid medication may be developing thyrotoxicosis if the client exhibits which of the following symptoms? Extreme tachycardia Sore throat Excessive fatigue Easy bruising

Extreme tachycardia Signs of thyrotoxicosis (increased hyperthyroidism) include high fever, extreme tachycardia, and altered mental status. A sore throat would alert the nurse to possible agranulocytosis. Fatigue is a sign of hypothyroidism. Bruising is a sign of increased bleeding tendency, not hyperthyroidism.

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 Dysmenorrhea Vertigo Excessive vaginal bleeding Dizziness Dyspepsia

Flatulence Excessive vaginal bleeding Dyspepsia Dysmenorrhea

A patient is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to patients with which of the following conditions? Cancer Hepatic disease Diabetes mellitus Hypertension

Hepatic disease

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 Risk for injury related to the side effects of the drug therapy Alterations in elimination related to the disease process 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 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.

Your 59-year-old client has peptic ulcer disease and is started on sucralfate (Carafate). What is a potential nursing diagnosis related to this medication? Imbalanced nutrition related to nausea Impaired bowel elimination: constipation Risk for injury: bleeding Deficient fluid volume

Impaired bowel elimination: constipation The adverse effects associated with sucralfate are primarily related to its GI effects. Constipation is the most frequently seen adverse effect.

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis? Diarrhea Abdominal pain 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.

A nurse is caring for a patient brought to the health care facility for a drug overdose. In which of the following cases can the patient be administered an emetic? Patient has a medical history of convulsions. Patient has an existing condition of severe hypertension. Patient has an existing condition of hemorrhagic diathesis. Patient is not having an altered mental status.

Patient is not having an altered mental status.

The nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has been newly prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug? Increases lower esophageal sphincter pressure Protects the stomach's lining Reduces the stomach's volume of hydrochloric acid Increases the speed of gastric emptying

Protects the stomach's lining

The nurse should monitor for which effect of drug interaction in a client taking thyroid hormones and a beta blocker? Hypoglycemia Tachycardia Prolonged bleeding Visual changes

Tachycardia Beta blockers and thyroid hormones interact, leading to decreased effectiveness of the beta blocker (i.e., cardiac drug, adrenergic blocker). Hypoglycemia may occur when thyroid hormones are taken with oral antidiabetic agents and insulin. Prolonged bleeding can occur when thyroid hormones and oral anticoagulants are taken together. Visual changes do not occur when beta blockers are taken with thyroid hormones.

The nurse is caring for a 27-year-old female patient who has just been prescribed misoprostol. What is a priority teaching point for this patient? The need to use a barrier-type contraceptive A warning against using NSAIDs Adverse effects include nausea and diarrhea It protects the lining of the stomach

The need to use a barrier-type contraceptive Women of childbearing age who use misoprostol should be advised to use barrier-type contraceptives. All other options are correct but are not the priority for this patient.

The nurse is administering an H-2 receptor antagonist to a patient with multiple burn trauma to prevent the development of stress ulcers based on the understanding that the drug: blocks overproduction of hydrochloric acid in the stomach. decreases the overall acid level to promote comfort. provides protection of the stomach lining via acid blockage. decreases the acid being regurgitated into the esophagus.

provides protection of 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. Decreasing the acid being regurgitated into the esophagus explains the reason for use of the drug to treat erosive gastroesophageal reflux. Reducing the overall acid level explains the reason for use of the drug as short-term treatment of active duodenal ulcer. Blocking the overproduction of hydrochloric acid is the rationale for treatment of pathological hypersecretory conditions.