Chapter 57 GI Secretions
The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions?
Renal disease
A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the patient's safety. Which of the following would be an appropriate nursing diagnosis?
Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations
You are teaching your 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 he understands proper use of the drug?
"I need to swallow the drug whole."
Which statement by a patient receiving pancrelipase indicates that the patient has understood his instructions?
"Pancrelipase is given with meals and snacks so that the enzyme is available when it is needed."
A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, "I take it as soon as I feel heartburn coming on, but it doesn't seem to help at all." How should the nurse best respond to this patient's statement?
"Prilosec will help your heartburn but it's not designed to provide immediate relief of specific episodes of heartburn."
A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following 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 nurse assists the client in understanding that PPIs are considered drugs of choice for treatment of what conditions?
- Duodenal ulcers • Zollinger-Ellison syndrome • Gastric ulcers - GERD
Which of the following reduce the secretion of gastric acid by inhibiting the action of histamine at H2 receptors in the stomach?
- Famotidine (Pepcid) • Ranitidine (Zantac)
The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when?
1 hour before or 2 hours after meals and at bedtime
What nursing interventions are included in the plan of care for a patient receiving antacids to relieve GI discomfort?
Administer the antacid 1 hour before or 2 hours after other oral medications.
An 86-year-old client has been prescribed ranitidine (Zantac). The nurse knows that an older adult who takes H2RAs may experience what adverse effect?
Agitation
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
AlopeciaRationale: Alopecia can occur with proton pump therapy, but it is not a common adverse effect. Common adverse effects include dizziness, headache, and cough.
A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid?
Aluminum salts
Which of these patients would the nurse expect to be the best candidate for misoprostol
An 83-year-old man with rheumatoid arthritis
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?
Antacids are best administered one to two hours after meals and at bedtime. No oral drugs should be administered within one to two hours of an antacid.
The nurse admits a patient who reports having taken a proton pump inhibitor for more than a decade. What assessment question will the nurse ask this patient?
Are you experiencing diarrhea?
The nurse should warn a patient taking aluminum and calcium containing antacids about which of the following adverse effects?
Constipation
A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient's safety, which of the following would be a priority nursing action?
Coordinate bone density testing for the patient.
If a patient is receiving sucralfate and omeprazole, the doses can be taken together.
FalseRationale: Sucralfate is not absorbed well in the presence of proton pump inhibitors and doses should be spaced at least 30 minutes apart if both drugs are prescribed.
The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse will inform the patient that common adverse effects related to this medication include what?
Headache
The physician has prescribed ranitidine for a patient in your unit. Prior to administering the drug for the first time, which of the following adverse effects should you mention to the patient?
Headache
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
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?
Increased fracture risk
Ms. Law has been taking omeprazole for the last 10 years. What is the risk to the patient from long-term use of omeprazole?
Increased risk of gastric cancer
Ranitidine is a histamine2 receptor antagonist (H2RA) prescribed for treatment of peptic ulcer disease and gastric reflux. Dosage of ranitidine must be reduced in patients with what condition?
Renal disease
A client is receiving sodium bicarbonate orally. Which of the following would lead the nurse to suspect that the client is developing systemic alkalosis?
Indications of systemic alkalosis include headache, confusion, irritability, tetany, nausea, and weakness.
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
A patient is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
Omeprazole
A patient is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which of the following diseases is a result of cellular destruction of the gastrointestinal tract from this medication?
Peptic ulcer disease
The clinic nurse is caring for a 78-year-old male patient who is taking a proton pump inhibitor. What condition is this patient at increased risk for developing?
Pernicious anemia
The nurse would question an order for misoprostol if the patient was diagnosed with what condition?
Pregnancy
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
The nurse is providing education for a patient with peptic ulcer disease resulting from chronic nonsteroidal anti-inflammatory drug (NSAID) use who will begin a prescription of misoprostol (Cytotec). The nurse evaluates that the patient understands the actions of this drug when he or she says it does what?
Protects the stomach's lining
The 59-year-old patient has peptic ulcer disease and is started on sucralfate (Carafate). What is an appropriate nursing diagnosis related to this medication?
Risk for constipation related to GI effects
The nurse is caring for a patient requiring digestive enzyme replacement therapy and establishes what appropriate nursing diagnosis for this patient?
Risk for imbalanced nutrition
A nurse is caring for a patient who is prescribed omeprazole for a duodenal ulcer. The patient is also taking benzodiazepines for the management of a seizure disorder. Which of the following should be the effect of the interaction between these two drugs?
Risk for toxic level of benzodiazepines
Your patient arrives at his sick call reporting chronic abdominal pain. Having a 40-pack year history, he reports his smoking has decreased to approximately ½ pack/day. The physician, after thorough assessment and evaluation and labs, prescribes a treatment regimen for duodenal ulcer. What important teaching would you include in relation to treatment?
Smoking's effects on healing
Which of the following antacids is contraindicated in patients with congestive heart failure?
Sodium bicarbonate (Bellans)
The nurse questions an order for a proton pump inhibitor when the patient is known to take what other medication?
Theophylline
A 23-year-old female patient is prescribed misoprostol (Cytotec). Which of the following patient teaching interventions is most important?
Use effective contraceptive measures
The nurse, caring for a patient with cystic fibrosis, administers pancreatic enzymes on what schedule?
With meals and snacks
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?
You will need to use a barrier-type contraceptive
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered
an hour before meals.
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
are pregnant.
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.
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
Pancrelipase would most likely be used to treat a patient with cystic fibrosis.
true
A patient is in the intensive care unit and being administered ranitidine (Zantac) parenterally. How long will it take for ranitidine (Zantac) to reach peak blood levels?
15 minutes
For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be?
20 mg b.i.d
The nursing instructor is discussing the use of histamine2 receptor antagonists in the treatment of peptic ulcer disease. According to the instructor, which of the following is a typical dosing schedule of famotidine during the first few weeks of treatment for gastric ulcer in patients with normal renal function?
20 mg bid
A patient comes to the clinic complaining of acid indigestion and tells the nurse he is tired of buying over-the-counter (OTC) antacids and wants a prescription drug to cure the problem. What would the nurse specifically assess for?
Alkalosis
A common drug regimen for eradication of H. pylori includes a proton pump inhibitor (PPI) and two antibiotics. Which of the following is one of the preferred antibiotics?
Amoxicillin
When caring for a patient diagnosed with a peptic ulcer, the nurse administers omeprazole (Prilosec) along with what antibiotic to eradicate Helicobacter pylori?
Amoxicillin
The nurse develops a discharge teaching plan for a patient who was prescribed pancreatic enzyme replacement and includes what important teaching point?
Avoid spilling the powder on the skin because it may be irritating.
What priority teaching point does the nurse include when instructing patients about the use of antacids?
Be aware of risk of acid rebound with long-term use.
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
Your patient, a 35-year-old man who works on the stock exchange, is at his follow-up visit for GERD. Antacids have not been effective for his reflux, and the physician is prescribing a proton pump inhibitor. Why might he prescribe a PPI, rather than an H2RA?
PPIs suppress acid more strongly and for a longer time.
A 32-year-old female executive comes to the clinic with severe heartburn. The physician prescribes omeprazole (Prilosec). The patient asks the nurse when the pain will go away. What is an appropriate response by the nurse?
Recommended time for therapy is usually between 2 and 8 weeks.
What action does the histamine-2 antagonist administered by the nurse have on the human body that will help to prevent peptic ulcer disease?
Reduces the amount of hydrochloric acid secreted
When caring for an older adult client taking an antacid, the nurse should institute which safety precautions?
• Fall risk • Bed alarm • Strict intake and output
