Pharm Prep-U Ch. 57 Drugs Affecting GI Systems
The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects? Constipation Diarrhea Dehydration Flatulence
Constipation Explanation: The nurse should warn a client taking aluminum- and calcium-containing antacids about constipation, which can be associated with taking products containing either medication. Client taking magnesium- and sodium-containing antacids can have diarrhea. Dehydration can be seen with the use of diuretics. Increased flatulence can be seen with the use of fiber laxatives such as Metamucil.
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered: with meals. with an antacid. an hour before meals. 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.
An older client has been prescribed omeprazole for the treatment of gastresophageal reflux disease (GERD). What explanation should the nurse provide when asked by the client why they are not being treated with famotidine? "Omeprazole is taken at bedtime making it easier to remember." "Famotidine and omeprazole are both histamine-2 antagonists and could be used interchangeably." "Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." "Famotidine is more expensive than omeprazole."
"Proton pump inhibitors, like omeprazole, produce fewer adverse effects among the older population." Explanation: Proton pump inhibitors like omeprazole may be the best choice for treating GERD in older patients because of fewer adverse effects and better therapeutic response with these drugs. Famotidine is a histamine-2 antagonists. The cost of the medication is not a primary factor in prescribing therapy for GERD. It is not standardly recommended to take omeprazole at bedtime.
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? "Sure, you may take an antacid with cimetidine." "No, the two drugs will work against each other." "Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine." "I wouldn't advise it. You may experience severe constipation."
"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.
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 Ketoconazole Vancomycin Amoxicillin
Amoxicillin Explanation: The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.
A critical care nurse is preparing to administer an intragastric drip of an antacid to a client through a nasogastric tube. How should the nurse most accurately titrate the dose and frequency? By assessing the pH of a 24-hour urine sample By aspirating stomach contents and measuring the pH By measuring the pH of urine after each void By swabbing the client's buccal mucosa and testing for pH daily
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.
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. Metoclopramide Rabeprazole Sucralfate Pantoprazole Promethazine
Pantoprazole Rabeprazole 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.
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: Rebound hyperacidity Anorexia Headache Dehydration Confusion
Rebound hyperacidity headache confusion Adverse reactions of calcium carbonate (Mylanta) include rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment
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? Eats spicy food at least twice a week. Has a stressful job as a air traffic controller. Is 15 pounds over ideal weight Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily.
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 30-year-old nonpregnant patient is prescribed misoprostol. Which of the following should the nurse instruct the patient as part of the teaching plan? Swallow the tablet one hour before eating. Administer the drug one hour before travel. Do not chew, open, or crush the tablet. 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.
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 ragweed. pollen. pork. shellfish.
pork. Explanation: Pancrelipase is contraindicated in patients who are hypersensitive to pork protein or enzymes because the drug is derived from pork. Allergies to ragweed, pollen, and shellfish are not associated with the use of the drug.
A client is prescribed cimetidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has: renal disease. diabetes mellitus. pulmonary disease. migraine headaches.
renal disease. Explanation: H2RAs must be used with caution in clients with renal disease. Since these drugs are eliminated through the kidneys, dosages are reduced to avoid adverse effects.
The nurse is caring for a 78-year-old client who is taking a proton pump inhibitor. What assessment should the nurse perform when monitoring for conditions that this client risks developing? pain decreased oxygen saturation toxicity elevated folate levels
toxicity Explanation: Older adult clients are also more likely to have renal or hepatic impairment related to underlying medical conditions, which could interfere with the metabolism and excretion of these drugs. Some of the medications have recommended dosing adjustments if there is renal or hepatic impairment. The client's respiratory status, folate levels, and comfort are not threatened.
Pancrelipase would most likely be used to treat a patient with cystic fibrosis. True False
True
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? "I should crush the medication and mix it into apple sauce." "It is important that I take the drug after each meal." "I need to swallow the drug whole." "I'll have to stop using antacids."
"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.
A client with ulcers has asked the nurse if it would be acceptable to take bismuth subsalicylate. Before recommending an over-the-counter (OTC) formulation of bismuth subsalicylate, the nurse should conduct which client assessment? Immunization history Allergy status Cognition Normal bowel pattern
Allergy status Explanation: Because it is a salicylate, this drug can cause serious bleeding problems when used alone in clients with ulcers. People with an allergy to aspirin or other salicylates should not take bismuth subsalicylate. The client's bowel pattern, immunization history, and cognition are not central considerations.
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common? Dizziness Headache Alopecia 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 client with a diagnosis of peptic ulcer disease has begun taking sucralfate. The nurse should caution the client against the concurrent use of which classification of medications? Antacids NSAIDs Acetaminophen Probiotics
Antacids Explanation: Antacids decrease the effects of sucralfate, and people should not take them within 30 minutes before or after administration of sucralfate. None of the other options affect the effectiveness of sucralfate.
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? Before the 10 a.m. medication Before breakfast Before the evening meal At bedtime
At bedtime Explanation: 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.
What priority teaching point should the nurse include when instructing a client about the use of antacids? Reduce calorie intake to reduce acid production. Take before each meal and before bed. Be aware of risk for acid rebound with long-term use. Consider a liquid diet if diarrhea occurs.
Be aware of risk for acid rebound with long-term use. Explanation: Repeated use of antacids can result in rebound acid production because more gastrin is produced when pH of acid level decreases. Clients should be taught that long-term use of antacids requires follow-up care. Calorie and fluid intake does not need to be reduced because it is important to maintain nutrition, especially if diarrhea occurs. Antacids are taken at least 1 hour before or 2 hours after any other drug or meal.
An older adult has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect? Constipation Urinary frequency Fatty stools Nausea
Constipation Explanation: With the antacid that contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs? Hypoxia Hypertension Gynecomastia Seizures
Gynecomastia Explanation: Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.
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? Tremor Headache Visual disturbances Anxiety
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 75-year-old client is diagnosed with type 2 diabetes mellitus, hypertension, osteoporosis, and gastric ulcer disease. She is prescribed PPIs. The nurse is aware that long-term (greater than 1 year) administration of PPIs may increase the risk for which problem for this client? Liver cancer Peptic ulcer disease Hip fractures Hypercalcemia
Hip fractures Explanation: Proton pump inhibitors (PPIs) are known to decrease calcium absorption which can lead to hypocalcemia. This in turn affects the bones leading to osteoporosis. For clients over the age of 50, the long term use of PPIs (more than one year) will increase the risk for hip fractures due to the affect on the bones. PPTs can be used to treat gastric ulcers. It is not known to cause liver cancer.
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? 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 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 Explanation: 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.
A client with a gastrointestinal (GI) disorder is prescribed the proton pump inhibitor omeprazole. Which information would the nurse include when instructing the client about this medication? Encourage the client to eat three meals a day. Instruct the client to swallow the capsule whole. Remind the client to skip a dose if symptoms subside. Explain that the medication has minimal side effects.
Instruct the client to swallow the capsule whole. Explanation: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. The client should be instructed to swallow the capsule whole and not open, chew, or crush the capsule. Frequent small meals should be encouraged. The medication should be taken as prescribed and doses should not be skipped. Proton pump inhibitors can cause side effects that affect the central nervous system, gastrointestinal (GI) tract, upper respiratory tract, and skin rashes in addition to electrolyte imbalances.
Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply: Metoclopramide (Reglan) Omeprazole (Prilosec) Ondansetron (Zofran) Lansoprazole (Prevacid) Promethazine (Phenergan)
Lansoprazole (Prevacid) Omeprazole (Prilosec) The proton pump inhibitors, like omeprazole (Prilosec) and lansoprazole , are commonly used in combination with certain antibiotics in the treatment of H. pylori.
Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection? Famotidine Calcium carbonate Omeprazole Sucralfate
Omeprazole Explanation: Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the client's safety. What would be an appropriate nursing diagnosis? Diarrhea related to adverse effects of drug therapy Acute Pain related to adverse drug effects, headache Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy
Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations Explanation: The appropriate nursing diagnosis related to safety would be Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations. Diarrhea related to adverse effects of drug therapy and Acute Pain related to adverse drug effects, headache are appropriate nursing diagnosis for a patient taking ranitidine, but are not related to safety. Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy would be appropriate for a client taking an aluminum hydroxide with magnesium hydroxide antacid (Maalox, Mylanta).
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. A single antimicrobial is generally not strong enough to eradicate the infection. Two different microbes are involved, requiring two different antimicrobials. 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.
A nurse is providing education to an adult female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching? Supplement therapy with magnesium antacids. Report postmenopausal bleeding. Use effective contraceptive measures. Administer the drug one time per day.
Use effective contraceptive measures. Explanation: Misoprostol is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. While reporting postmenopausal bleeding, this medication is not associated with that adverse reaction. The medication should be administered two to four times per day.
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 exerting an antibiotic effect healing damaged cells increasing mucus 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.
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 diarrhea. interfere with the metabolism of other drugs. result in hypotension. cause macular rash and cough.
interfere with the metabolism of other drugs. Explanation: Unlike cimetidine, ranitidine does not affect the cytochrome P450 drug-metabolizing system in the liver and therefore does not interfere with the metabolism of other drugs by that system.
After teaching a client who is receiving sucralfate about the drug, which statement indicates that the teaching has been successful? "I need to avoid sugarless lozenges." "I need to limit my fluid intake." "I should eat a high-fiber diet." "I may need something to control diarrhea."
"I should eat a high-fiber diet." Explanation: Constipation is the most frequently seen adverse effect; thus, the client should increase his fiber intake to prevent constipation. Diarrhea is possible, but constipation is more likely. The client should drink fluids and use sugarless lozenges to help with a dry mouth. Fluid intake also will help to prevent constipation.
A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time? 1 hour before eating 2 hours after a meal first thing on arising at bedtime
1 hour before eating Explanation: Proton pump inhibitors such as lansoprazole should be swallowed whole at least 1 hour before eating. The proton pump inhibitors suppress gastric acid secretion by blocking the final step in the production of gastric acid by the gastric mucosa. After meals will inhibit suppression of gastric acid. On rising and at bedtime are not optimal times to take lansoprazole.
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis? Headache Abdominal pain Increased fracture risk Diarrhea
Increased fracture risk Explanation: 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 client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic? Omeprazole Magaldrate Sucralfate 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.
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 Esomeprazole Lansoprazole Pantoprazole
Omeprazole Explanation: Omeprazole is considered the prototype proton pump inhibitor.
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? Smaller than the average prescribed dose Larger than the average prescribed dose The same as the average prescribed dose 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.
The nurse develops a discharge teaching plan for a client who has been prescribed pancreatic enzyme replacement. What education should the nurse provide? Take the enzymes with food. Crush the capsules and take with food. Avoid spilling the powder on the skin. Pancreatin and pancrelipase are interchangeable.
Take the enzymes with food. Explanation: The enzymes should be taken with food and are often in a powder form. Clients receiving pancreatic enzymes should be taught to avoid spilling the powder on the skin because it can be very irritating. Pancreatin and pancrelipase are not interchangeable.
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: have diabetes. are hypertensive. have arthritis. are pregnant.
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 contraceptio
A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for: metabolic alkalosis. hypocalcemia. hypercholesterolemia. metabolic acidosis.
metabolic alkalosis. Explanation: Overuse of antacids containing calcium carbonate can cause alkalosis and raise urine pH.
A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease? Infection with H. pylori Decreased stomach acid secretion Excessive worrying Overconsumption of spicy foods
Infection with H. pylori Explanation: Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).
Mr. Palmer is scheduled to receive ranitidine at 9:00 am this morning. What is a correct explanation of the pharmacodynamics of ranitidine? It affects pepsin secretion. It has effects on fasting or postprandial serum gastrin secretion. It inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion. It has effects on prolactin levels, gonadotropins, thyroid-stimulating hormone, growth hormone, cortisol, aldosterone, androgen and estrogen levels, and sperm count.
It inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion. Explanation: Ranitidine inhibits both daytime and nocturnal basal gastric acid secretions as well as gastric acid secretion stimulated by food, betazole, and pentagastrin. Ranitidine does not affect pepsin secretion. It has little or no effect on fasting or postprandial serum gastrin secretion. It has no effect on prolactin levels, gonadotropins, thyroid-stimulating hormone, growth hormone, cortisol, aldosterone, androgen or estrogen levels, or sperm count.
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 dental health joint mobility integumentary system
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.
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: headache. irritability. dry mouth. heart palpitations.
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.