Pharma Chap 57
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 aspirating stomach contents and measuring the pH
Which agent would a nurse identify as the prototype histamine-2 receptor antagonist?
Cimetidine
A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms be resolved?
1 to 2 weeks
Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?
Drug-drug interactions
After teaching a client who is receiving sucralfate about the drug, which statement indicates that the teaching has been successful?
"I should eat a high-fiber diet."
A client has been prescribed omeprazole by the primary health care provider. When the nurse asks whether the medication is providing relief, the client replies, "I think it's working quite well, and I've gotten in the routine of taking it every morning before breakfast." How should the nurse respond?
"I'm glad to hear that. It sounds like you're taking it exactly like it should be taken."
A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?
"Quitting smoking will significantly increase the chance that this drug will heal your ulcer."
The nurse is caring for a patient who has been prescribed a saliva substitute . The patient asks why this medication is necessary. What would be the most appropriate response?
"This medication helps people that have a condition that creates a lack of saliva."
A client is in the intensive care unit and being administered ranitidine parenterally. How long will it take for ranitidine 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 bid
A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?
30 minutes
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
Alopecia
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?
Amoxicillin
The nurse is caring for four clients. Which client would benefit most from misoprostol, a synthetic prostaglandin E analog?
An 83-year-old male with rheumatoid arthritis
Which agent is associated with antiandrogenic effects?
Cimetidine
Which would a nurse anticipate as having antiandrogenic effects?
Cimetidine
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
A nurse is preparing to administer a drug that reduces the secretion of gastric acid by inhibiting the action of histamine at H2 receptors in the stomach. Which medication might the nurse be preparing to administer? Select all that apply.
Famotidine Ranitidine
A male client is taking cimetidine. Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?
Gynecomastia
Which adverse effect is more likely to be caused by cimetidine than by other H2RAs?
Gynecomastia
A client is taking an antacid that contains aluminum salts. The nurse would monitor the client for:
Hypophosphatemia
The nurse is caring for a client who has been prescribed sucralfate for treatment of peptic ulcer disease. Which nursing diagnosis may relate specifically to administration of this medication?
Impaired Bowel Elimination: Constipation
Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?
Increased fracture risk
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
The nurse should be aware that ranitidine achieves a therapeutic effect by which means?
Inhibiting the secretion of gastric acid
Which of the following would be the proton pump inhibitor of choice for a child with GERD?
Lansoprazole
Which drug treats heartburn by neutralizing the acidity of the stomach by combining with hydrochloric acid (HCL) and increasing the pH of the stomach acid?
Magaldrate (Riopan)
A nurse is preparing to administer a prostaglandin drug used to reduce the risk of NSAID-induced gastric ulcers in high-risk clients, such as an older adult or a client who is critically ill. Which medication will the client administer?
Misoprostol
A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
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?
Omeprazole
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 histamine2 receptor antagonist (H2RA)?
PPIs suppress acid more strongly and for a longer time.
A female client is self-administering cimetidine. What is the home care nurse's most important assessment of this client?
Potential drug-drug interactions
A client is diagnosed with Helicobacter pylori infection. The health care provider will order amoxicillin and what other type of medication?
Proton pump inhibitors
A nurse in a health care facility is caring for a patient who is administered milk of magnesia to control constipation. Which nursing diagnosis should the care plan for this patient include?
Risk for imbalanced fluid volume
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
Pancrelipase would most likely be used to treat a patient with cystic fibrosis.
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?
Two antimicrobials help prevent the emergence of drug-resistant H. pylori organisms.
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?
Use a reliable contraceptive.
A nurse is providing education to an adult female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching?
Use effective contraceptive measures.
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered:
an hour before meals.
The nurse is caring for a client who is prescribed esomeprazole. The client informs the nurse that they are also taking sucralfate. The nurse would anticipate which effect as a possibility when these two drugs are administered?
decreased absorption of the esomeprazole
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.
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
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 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.
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.
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.
A client who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess:
serum phosphate level.
A client, with recent abdominal pain and a 40-pack per year smoking history, is prescribed a treatment regimen for a diagnosis of duodenal ulcer. What important teaching would the nurse include in relation to treatment?
smoking effects on the healing of ulcers
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
A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?
2 tablets
A client is receiving sodium bicarbonate orally. Which of the following would lead the nurse to suspect that the client is developing systemic alkalosis? (Select all that apply.)
Headache Confusion Irritability Tetany
A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition?
Hepatic disease
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?
Hip fractures
