Chapter 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity, NCLEX-Style Chapter Review Questions

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regimen for an H. pylori bacterial infection?

Decreases production of gastric secretions Rationale: PPIs decrease gastric acid secretion. Antimicrobials and bismuth can eliminate H. pylori infection. Sucralfate provides a protective barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production.

While reviewing the medication history of a client newly prescribed omeprazole, the nurse sees that the client is also taking warfarin. What potential interaction should the nurse account for when developing the plan of care for this client?

Hemorrhage Rationale: 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.

Why are histamine2 receptor antagonists preferred in the treatment of upper gastrointestinal (GI) disorders over traditional histamine1 receptor antagonists?

Histamine1 receptor antagonists do not block histamine effects on gastric acid production. Rationale: Traditional antihistamines or histamine1 receptor antagonists prevent or reduce other effects of histamine but do not block histamine effects on gastric acid production. Histamine2 receptor antagonists inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin.

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: Consuming alcohol while using metronidazole has long been thought to have a disulfiram-like reaction with effects that can include flushing, tachycardia, diaphoresis, nausea, vomiting, or headache if alcohol ingestion occurs with use. It is important to tell the client that even a very small amount of alcohol can produce the reaction; the risk persists for up to 48 hours after completion of treatment. If a culture confirms that the infection is still present, the health care provider will likely prescribe a different antimicrobial. Alcohol consumption will not result in reinfection.

Antacids have not been effective in managing a client's gastroesophageal reflux disease, so the health care provider is prescribing a proton pump inhibitor. Why might the health care provider prescribe a proton pump inhibitor (PPI) rather than a histamine

PPIs suppress acid more strongly and for a longer time. Rationale: Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases.

A client who has reduced cigarette consumption from 1 pack per day to 1 pack per week has been prescribed treatment for duodenal ulcer. What teaching would be most important for the nurse to include in relation to treatment?

Smoking's effects on healing Rationale: Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of nonsmokers. Medication should be taken according to the instructions of the prescribing health care provider; suggesting that the client alter or terminate the schedule based on other factors is inappropriate. Describing the overall dangers of smoking is appropriate, but it is not as important to the treatment as is describing the impact on healing.

How does histamine release contribute to ulcer formation?

Stimulates gastric acid secretion Rationale: Vagal stimulation causes release of histamine from cells in the gastric mucosa. The histamine then acts on receptors located on the parietal cells to increase production of hydrochloric acid, which is a factor in stomach ulcer formation. Histamine is not associated with either pepsin or gastrin, and it does not destroy the parietal cells.

What type of medication might be included in the medication therapy to treat a peptic ulcer because it acts as a barrier to gastric secretions?

Sucralfate Rationale: Sucralfate provides a barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production. Histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) decrease gastric acid secretion.

A client has been diagnosed with a duodenal ulcer caused by H. pylori infection. What medication regimen does the nurse expect the health care provider to prescribe?

Two antimicrobials and proton pump inhibitor Rationale: Therapy with a proton pump inhibitor and two antimicrobial drugs is the most effective regimen in the treatment of H. pylori-associated ulcers. The other options lack either the second antimicrobial necessary to reduce the risk of microbial resistance or a medication that will reduce gastric acid secretion.

A client diagnosed with an H. pylori-associated ulcer has been prescribed treatment that includes two antimicrobials. What does the nurse identify as the reason for using multiple antimicrobials?

Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms. Rationale: Effective treatment of an H. pylori-associated ulcer involves two antimicrobials—including amoxicillin, clarithromycin, metronidazole, or tetracycline—to reduce the risk of resistance. None of the other options present accurate information regarding the basis for treatment.

An older adult client has been on long-term proton pump inhibitor (PPI) therapy. The nurse practitioner should focus on what assessment related to adverse effects?

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.

Of the commonly used antacids, which is rarely used in the treatment of peptic ulcer disease (PUD) because of its effect on gastrin release?

Calcium compounds Rationale: Calcium compounds have a rapid onset of action but may cause hypercalcemia and hypersecretion of gastric acid (''acid rebound'') due to stimulation of gastrin release, if large doses are used. Consequently, calcium compounds are rarely used in peptic ulcer disease. None of the other options are associated with this effect on gastrin.