Chapter 37: Drugs Therapy for Peptic Ulcer Disease and Hyperacidity

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? A) "I should crush the medication and mix it into apple sauce." B) "I'll have to stop using antacids." C) "It is important that I take the drug after each meal." C) "I need to swallow the drug whole."

"I need to swallow the drug whole." Explanation: 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.

__________ provides a barrier between ulcers and gastric secretions.

Sucralfate

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." Explanation: Sucralfate must be taken for 4 to 8 weeks to ensure healing of the ulcer has occurred.

Hypersecretion of gastric acid can be compounded by ________.

Calcium

Herbal supplements are safe to take and have no effect on GERD drugs. TRUE OR FALSE

False

Women are more prone to develop duodenal ulcers. TRUE OR FALSE

False

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? A) Lansoprazole B) Omeprazole C) Esomeprazole D) Pantoprazole

Omeprazole Explanation: Omeprazole is considered the prototype proton pump inhibitor.

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is: A) headache. B) heart palpitations. C) irritability. D) dry mouth.

headache. Explanation: Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the client to adjust lights or temperature and avoid noise if headaches occur and to contact the health care provider if the headache becomes intolerable. Irritability, dry mouth, and heart palpitations are not associated with this drug.

Which client being treated for peptic ulcers or GERD will the nurse monitor most closely for potential drug-drug interactions as a result of therapy? A) the client taking omeprazole B) the client taking rabeprazole C) the client using over-the-counter antacids D) the client taking cimetidine

the client taking cimetidine Explanation: Proton pump inhibitors set the client at risk for C. difficile but carry few interaction issues. Cimetidine contributes to multiple-drug interactions.

Clients with renal failure should not take _________ -based antaicids.

Magnesium

Aluminum hydroxide-magnesium hydroxide-simethicone mixture (Mylanta) is safe for children and infants. TRUE OR FALSE

True

A student asks the pharmacology instructor why bismuth is sometimes added to H. pylorieradication regimens. Which of the following responses accurately answers the student's question? A) "Bismuth is antibacterial." B) "Bismuth decreases gastric secretion." C) "Bismuth increases pepsin activity." D) "Bismuth prevents metabolic alkalosis."

"Bismuth is antibacterial." Explanation: Bismuth exerts antibacterial effects against H. pylori by disrupting bacterial cell walls. It also increases secretion of mucus and bicarbonate and inhibits pepsin activity.

The nurse is preparing to administer a prescribed medication to a client diagnosed with GERD. If the nurse discovers the client has a history of vitamin B12, which medication(s) will the nurse administer cautiously? Select all that apply. -Sucralfate -Metoclopramide -Rabeprazole -Pantoprazole -Promethazine

-Rabeprazole -Pantoprazole Explanation: The nurse should administer proton pump inhibitors, like rabeprazole and pantoprazole, cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12.

Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori organisms? A) Accumulates in ulcer craters B) Inhibits pepsin activity C) Antibacterial effects D) All of these

All of the above Explanation: A bismuth preparation is added to some regimens. Bismuth exerts antibacterial effects against H. pylori. It also increases secretion of mucus and bicarbonate, inhibits pepsin activity, and accumulates in ulcer craters.

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? A) Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. B) Is 15 pounds over ideal weight C) Eats spicy food at least twice a week. D) Has a stressful job as an air traffic controller.

Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. Explanation: 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? A) Larger than the average prescribed dose B) The same as the average prescribed dose C) Smaller than the average prescribed dose D) No antacids, because they are contraindicated in the elderly

Smaller than the average prescribed dose Explanation: Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.

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 Explanation: PPIs are metabolized in the liver and may cause transient elevations in liver function tests.

For clients with nasogastric (NG) tube, antacid dosing is based on PH level. TRUE OR FALSE

True

Gastric and duodenal ulcers are more common the esophogeal ulcers. TRUE OR FALSE

True

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? A) Two different microbes are involved, requiring two different antimicrobials. B) Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms. C) A single antimicrobial is generally not strong enough to eradicate the infection. D) One antimicrobial tends to alter the action of the adjunct medications.

Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms. Explanation: 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.

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?

inhibiting acid secretion Explanation: 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 client about lansoprazole prescribed for treatment of gastric ulcer. By what mechanism of action does lansoprazole help treat the disease? A) exerting an antibiotic effect B) increasing mucus secretion C) healing damaged cells D) inhibiting acid secretion

inhibiting acid secretion Explanation: Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.

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? A) "Eat breakfast, then take the sucralfate, and then an hour later take the ciprofloxacin." B) "Both medications should be taken together on an empty stomach." C) "Take the ciprofloxacin 2 hours before the sucralfate." D) "Take the sucralfate 30 minutes before the ciprofloxacin."

"Take the ciprofloxacin 2 hours before the sucralfate." Explanation: It is important for the client to take the ciprofloxacin 2 hours prior to taking sucralfate to ensure full absorption of the ciprofloxacin.

A female client has GERD and is taking cimetidine. She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse? A) "No, the two drugs will work against each other." B) "I wouldn't advise it. You may experience severe constipation." C) "Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine." D) "Sure, you may take an antacid with cimetidine."

"Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine." Explanation: If both cimetidine and antacids are prescribed, give them at least 2 hours apart to prevent decreased absorption of cimetidine. The nurse should advise the client to wait at least 2 hours between doses and to take the antacid after the cimetidine. The other three statements are not true.

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? A) "You will take it for 5 days, then skip 5 days, then take it for another 5 days and you will be done with it." B) "You will need to take this medication for the rest of your life." C) "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred." D) "You must take this medication for the full 10 days."

"You will need to take this medication for 4 to 8 weeks to ensure healing has occurred." Explanation: Sucralfate must be taken for 4 to 8 weeks to ensure healing of the ulcer has occurred.

A client has sought care because of symptoms of gastroesophageal reflux disease (GERD). When teaching the client ways to minimize acid reflux, the nurse will include which recommended practice(s)? Select all that apply. -Avoid lying down for an hour or two after meals. -Eat smaller meals rather than a smaller number of large meals. -Include acidic foods in the diet to reduce the quantity of gastric acid released. -Avoid the use of over-the-counter antacids. -Keep the head of the bed elevated when sleeping.

-Avoid lying down for an hour or two after meals. -Eat smaller meals rather than a smaller number of large meals -Keep the head of the bed elevated when sleeping. Explanation: Small meals, sitting up after eating, and sleeping with the head of bed elevated can reduce acid reflux. For most clients, over-the-counter antacids can be used safely as part of a management strategy. Highly acidic foods do not reduce gastric acid secretion and intake should be minimized.

A female client comes to the clinic with reports of burning pain in the stomach. She states that she thinks she had a virus 48 hours ago and she vomited many times. She hasn't vomited in 24 hours. She asks the health care provider to give her a prescription for omeprazole because she saw an ad on TV that said it would heal stomach pain. The nurse assists the client in understanding that PPIs are considered drugs of choice for treatment of what conditions? (Select all that apply.) -Duodenal ulcers -Gastric ulcers -Anaphylactic shock -Esophageal varices -Zollinger-Ellison syndrome

-Duodenal ulcers -Gastric ulcers -Zollinger-Ellison syndrome Explanation: PPIs are considered drugs of choice for treatment of heartburn, gastric and duodenal ulcers, GERD, esophagitis, and hypersecretory syndromes such as Zollinger-Ellison syndrome. It is not used in the treatment of anaphylaxis.

A group of nursing students are analyzing the various categories of upper gastrointestinal system drugs. The instructor determines the session is successful when the students correctly choose which drug(s) as an example of a proton pump inhibitor? Sucralfate Misoprostol Esomeprazole Nizatidine Omeprazole

-Omeprazole -Esomeprazole Explanation: Omeprazole and esomeprazole are examples of proton pump inhibitors. Nizatidine is a histamine H2 receptor antagonist. Sucralfate and misoprostol are examples of miscellaneous acid reducers.

When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common? A) Headache B) Dizziness C) Alopecia D) Cough

Alopecia Explanation: 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? A) Amoxicillin B) Gentamicin C) Ketoconazole D) Vancomycin

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

____________ may decrease the effects of drugs that require an acidic environment.

Cimetidine

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. Explanation: 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.

___________ is the causative agent in most cases of chronic gastritis.

H. pylori

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 Explanation: 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 male client is receiving morphine sulfate for pain after an accident. The health care provider has also ordered cimetidine IV to assist in preventing a stress ulcer. The nurse will monitor for what effect that is caused by the interaction of these two drugs? A) Increased reports of pain B) Increased incidence of respiratory depression C) Increased symptoms of GERD D) Increased nausea and vomiting

Increased incidence of respiratory depression Explanation: The combination of an opioid analgesic and cimetidine will cause an increase in respiratory depression

The nurse is providing care for a 51-year-old client who has been taking cimetidine for several months. When monitoring for adverse effects, the nurse should perform what assessment? A) Inspect the client's chest for the development of gynecomastia. B) Assess the client's blood pressure while lying, sitting, and standing. C) Inspect the client's torso for the presence of a rash. D) Assess the client's sleep pattern for insomnia.

Inspect the client's chest for the development of gynecomastia. Explanation: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Rashes, insomnia, and orthostatic hypotension are not typical adverse effects.

A client is brought to the emergency department for a drug overdose. The nurse concludes the emetic is safe to give to the client if which client assessment finding is noted?

Mental status is intact. Explanation: The client can be administered an emetic only if the client does not have an altered mental status or is not comatose. A client who is comatose has an increased risk of aspiration of stomach contents. Clients with an existing condition of severe hypertension, a medical history of convulsions, or an existing condition of hemorrhagic diathesis should not be given an emetic as these conditions may be exacerbated by vomiting.

A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic? A) Omeprazole B) Sucralfate C) Magaldrate D) Cimetidine

Omeprazole Explanation: 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 client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?

Proton pump inhibitors Explanation: The treatment of choice for Helicobacter pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.

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? A) Administer the drug one hour before travel. B) Swallow the tablet one hour before eating. C) Do not chew, open, or crush the tablet. D) Use a reliable contraceptive.

Use a reliable contraceptive. Explanation: 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.

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered: A) an hour before meals. B) with meals. C) with an antacid. D) immediately after each meal.

an hour before meals. Explanation: 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.

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: A) are pregnant. B) are hypertensive. C) have arthritis. D) have diabetes.

are pregnant. Explanation: 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.

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 Explanation: 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? A) by measuring the pH of urine after each void B) by swabbing the client's buccal mucosa and testing for pH daily C) by aspirating stomach contents and measuring the pH D) by assessing the pH of a 24-hour urine sample

by aspirating stomach contents and measuring the pH Explanation: 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.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection? A) decreases pepsin production B) protects ulcer craters C) assists in eliminating the bacteria D) decreases production of gastric secretions

decreases production of gastric secretions Explanation: 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.

The client will receive cimetidine 800 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include: A) headache. B) anxiety. C) tremors. D) visual disturbances.

headache. Explanation: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists.

The client will receive cimetidine 800 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include: A) tremors. B) headache. C) visual disturbances. D) anxiety.

headache. Explanation: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists.

A client presents to the clinic reporting vomiting and burning in the mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm this, the primary health care provider is likely to prescribe a diagnostic test to detect the possible presence of what? A) upper gastrointestinal bleeding B) gastric irritation caused by nonsteroidal anti-inflammatory drugs C) decreased stomach acid secretion D) infection with Helicobacter pylori

infection with Helicobacter pylori Explanation: Peptic ulcers may result from increased acid production, a decrease in the protective mucus lining of the stomach, infection with Helicobacter pylori bacteria, or a combination of these. Peptic ulcers do not result from decreased acid secretion. While gastric irritation can be caused by NSAIDs, gastric irritation can result from many different causes, so this would not be specifically assessed for unless the client was found to use NSAIDs frequently, which is not indicated by the question.

The nurse administers ranitidine cautiously to clients with evidence of what condition? A) pregnancy B) diabetes mellitus C) pulmonary disease D) migraine headaches

pregnancy Explanation: Caution should be used during pregnancy or lactation because of the potential for adverse effects on the fetus or nursing baby and with hepatic or renal dysfunction, which could interfere with drug metabolism and excretion. No caution is necessary with ranitidine therapy in clients with diabetes, pulmonary disease, or migraine headaches.

The nurse administers ranitidine cautiously to clients with evidence of what condition? A) migraine headaches B) pregnancy C) diabetes mellitus D) pulmonary disease

pregnancy Explanation: Caution should be used during pregnancy or lactation because of the potential for adverse effects on the fetus or nursing baby and with hepatic or renal dysfunction, which could interfere with drug metabolism and excretion. No caution is necessary with ranitidine therapy in clients with diabetes, pulmonary disease, or migraine headaches.

The 59-year-old client who has been diagnosed with peptic ulcer disease is started on sucralfate. What is an appropriate nursing concern related to this medication? A) nausea B) risk for bleeding C) fluid volume deficit D) risk for constipation

risk for constipation Explanation: The adverse effects associated with sucralfate are primarily related to its gastrointestinal effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug.