Karch Chapter 57: Drugs Affecting GI Secretions Prep u

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."

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? a) "Prilosec won't really decrease the sensation of heartburn, but it is still minimizing the damage to your throat and stomach that can be caused by the problem." b) "A better strategy is to take a dose of Prilosec 15 to 30 minutes before meals or drinks that cause you to get heartburn." c) "It could be that Prilosec isn't the right drug for you, so it would be best to talk this over with your care provider." d) "Prilosec will help your heartburn but it's not designed to provide immediate relief of specific episodes of heartburn."

"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? a) "I wouldn't advise it. You may experience severe constipation." b) "No, the two drugs will work against each other." c) "Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine." d) "Sure, you may take an antacid with ranitidine."

"Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine."

You are 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? a) By healing damaged cells b) By increasing mucus secretion c) By exerting an antibiotic effect d) By inhibiting acid secretion

By inhibiting acid secretion

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

Closely monitor the patient for confusion and dizziness.

A male patient is taking cimetidine (Tagamet). Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists? a) Seizures b) Gynecomastia c) Hypoxia d) Hypertension

Gynecomastia

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis? a) Abdominal pain b) Diarrhea c) Headache d) Increased fracture risk

Increased fracture risk

A 25-year-old patient arrives at the walk-in clinic complaining of vomiting and a burning sensation in the midepigastric region. The nurse suspects that the patient has peptic ulcer disease. Which of the following is a potential cause of peptic ulcer disease? a) Infection with H. pylori b) Excessive worrying c) Decreased stomach acid secretion d) Overconsumption of spicy foods

Infection with H. pylori

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? a) Lansoprazole b) Rabeprazole c) Omeprazole d) Esomeprazole

Omeprazole

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) Pantoprazole c) Esomeprazole d) Omeprazole

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? a) None of these b) PPIs suppress acid more gently and for a longer time. c) PPIs suppress acid more strongly and for a shorter time. d) PPIs suppress acid more strongly and for a longer time.

PPIs suppress acid more strongly and for a longer time.

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? a) Liver cancer b) Esophageal cancer c) Bowel obstruction d) Peptic ulcer disease

Peptic ulcer disease

Which of the following best reflects the rationale for using histamine-2 receptor antagonists for stress ulcer prophylaxis? a) Decreases the acid being regurgitated into the esophagus b) Reduces the overall acid level, promoting healing and comfort c) Protects the stomach lining via acid blockage d) Blocks the overproduction of hydrochloric acid

Protects the stomach lining via acid blockage

A female client presents to the physician's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client? a) Hyperactive gastric mucosa b) Rebound acidity c) Gastric reflux d) Hypocalcemia

Rebound acidity

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? a) Migraine headaches b) Renal disease c) Diabetes mellitus d) Pulmonary disease

Renal disease

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

Renal dysfunction

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? a) Increased risk of respiratory depression b) Decreased absorption of the proton pump inhibitor c) Risk for toxic level of benzodiazepines d) Increased risk of bleeding

Risk for toxic level of benzodiazepines

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

True

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) Use a reliable contraceptive. b) Swallow the tablet one hour before eating. c) Administer the drug one hour before travel. d) Do not chew, open, or crush the tablet.

Use a reliable contraceptive.

A 23-year-old female patient is prescribed misoprostol (Cytotec). Which of the following patient teaching interventions is most important? a) Supplement therapy with magnesium antacids b) Report postmenopausal bleeding c) Administer the drug one time per day d) Use effective contraceptive measures

Use effective contraceptive measures

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered a) with an antacid. b) with meals. c) an hour before meals. d) immediately after each meal.

an hour before meals.

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 a) cause diarrhea. b) cause macular rash and cough. c) interfere with the metabolism of other drugs. d) result in hypotension.

interfere with the metabolism of other drugs.

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

true

The nurse should warn a patient taking aluminum and calcium containing antacids about which of the following adverse effects? (Choose one) a) Constipation b) Dehydration c) Flatulence d) Diarrhea

Constipation

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? a) Headache b) Visual disturbances c) Tremor d) Anxiety

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? a) Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes b) Alteration in comfort related to the drug therapy and the adverse effect of a headache c) Alterations in elimination related to the disease process d) Risk for injury related to the side effects of the drug therapy

Imbalanced nutrition: less than body requirements, related to impaired digestion secondary to insufficient pancreatic enzymes

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? a) General health dangers of smoking b) Only take the medication when experiencing stomach pain c) Smoking's effects on healing d) Take the medication until feeling better

Smoking's effects on healing

Your 32-year-old patient tells you that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, you caution the patient that overuse could place him at risk for a) hypercholesterolemia. b) metabolic acidosis. c) metabolic alkalosis. d) hypocalcemia.

metabolic alkalosis.

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 a) pollen. b) ragweed. c) shellfish. d) pork.

pork