PrepU Karch 57 Drugs Affecting Gastrointestinal Secretions
The nurse instructs the patient to use over-the-counter ranitidine (Zantac) instead of cimetidine (Tagamet). What risk is decreased when using ranitidine over cimetidine?
Drug-to-drug interaction Ranitidine causes fewer drug interactions than cimetidine. Ranitidine possesses the following adverse effects: headache, diarrhea, and bradycardia.
Saliva substitute is absorbed systemically.
False Saliva substitute is not generally absorbed systemically.
If a patient is receiving sucralfate and omeprazole, the doses can be taken together.
False 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.
Which of the following adverse effects is more likely to be caused by cimetidine than by other H2RAs?
Gynecomastia Cimetidine is more likely to cause gynecomastia and mental confusion than other H2RAs.
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." Smoking reverses the drug-induced inhibition of nocturnal gastric acid production and hinders ulcer healing. Cigarette smoking also is related closely to ulcer recurrence. Ranitidine should not be taken simultaneously with antacids and it does not eradicate H. pylori. It is not necessary to eat multiple small meals during the day. (less)
A client is taking an antacid that contains aluminum salts. The nurse would monitor the client for which of the following?
Aluminum binds dietary phosphates and causes hypophosphatemia, but they do not cause acid rebound like other antacids. Magnesium antacids cause diarrhea; calcium salts cause hypercalcemia. (less)
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?
By inhibiting acid secretion Lansoprazole is a proton pump inhibitor. Drugs in this class (sometimes known as gastric acid pump inhibitors) suppress gastric acid secretion.
A group of students are reviewing the signs and symptoms of systemic alkalosis that can occur as a result of using sodium bicarbonate. The students demonstrate a need for additional teaching when they identify which of the following as a possible manifestation?
Constipation Constipation is not considered a manifestation of systemic alkalosis. Confusion is a manifestation of systemic alkalosis. Muscle twitching is a manifestation of systemic alkalosis. Tetany is a manifestation of systemic alkalosis. (less)
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 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.
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 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 patient is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?
Omeprazole 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 patient is prescribed misoprostol. The nurse would expect to administer this drug by which route?
Oral Misoprostol is administered orally.
A client is diagnosed with Helicobacter pylori infection. The physician will order amoxicillin and what other type of medication?
Proton pump inhibitors The treatment of choice for Helicobacter pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.
The patient has Maalox ordered for administration before meals. Which of the following conditions is contraindicated with the administration of Maalox?
Renal dysfunction Magnesium-based antacids are contraindicated in patients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.
Pancrelipase would most likely be used to treat a patient with cystic fibrosis.
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?
Use a reliable contraceptive. 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.
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." 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 physician may instruct the patient to take the two medications at different times during the day.
A patient is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the patient's symptoms be abolished?
1-2 weeks The symptoms of gastroesophageal reflux disease will be abolished in 1-2 weeks after the start of the proton pump inhibitor medication regime. It will not take 4 weeks, 1 month, or 6 weeks to see a change with the proton pump inhibitor. (less)
When describing the possible adverse effects associated with omeprazole therapy, which of the following would the nurse identify as least common?
Alopecia 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. Which of the following is one of the preferred antibiotics?
Amoxicillin The treatment of choice for H. pylori infection is a PPI and clarithromycin plus either amoxicillin or metronidazole.
You are caring for four patients. Which of your patients would benefit most from misoprostol, a synthetic prostaglandin E analog?
An 83-year-old male with rheumatoid arthritis Misoprostol is prescribed for concurrent use with NSAIDs to prevent NSAID-induced erosion and ulceration of the gastric mucosa. The patient with rheumatoid arthritis likely uses NSAIDs frequently, placing him at risk of developing gastric ulcers and making him a candidate for misoprostol.
Which of the following would a nurse anticipate as having antiandrogenic effects?
Cimetidine Cimetidine has been associated with antiandrogenic effects such as gynecomastia and galactorrhea.
When caring for an older adult client taking an antacid, the nurse should institute which safety precautions? Select all
Correct response: • Fall risk • Bed alarm • Strict intake and output
A male patient is taking cimetidine (Tagamet). Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?
Gynecomastia Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine. (less)
A patient is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to patients with which of the following conditions?
Hepatic disease No contraindications exist, but the use of cimetidine should be used cautiously in patients with impaired hepatic and renal function. The patient with cancer, hypertension, and diabetes mellitus can take cimetidine safely.
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 lead to what problem for this client?
Increased risk for hip fractures Sucralfate is well tolerated by older adults. PPIs are also well tolerated, but long-term use (greater than 1 year) is associated with increased risk of hip fractures in adults older than 50 years of age. The risk of fractures increases the longer the medications are taken. The risk of hip fractures is also greater in those taking higher dosages of PPIs. (less)
The nurse should explain that metoclopramide (Reglan) decreases nausea and vomiting by which of the following actions?
Inhibiting stimulation of the vomiting center in the brain Reglan inhibits stimulation of the vomiting center in the brain. This medication also increases the amplitude of gastric contractions and gastric motility while decreasing gastric emptying time.
Which of the following would be the proton pump inhibitor of choice for a child with GERD?
Lansoprazole Lansoprazole is the only proton pump inhibitor approved for use in children and would be the drug of choice.
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 Omeprazole is considered the prototype proton pump inhibitor.
Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection?
Omeprazole -Proton pump inhibitors such as omeprazole are used as part of combination therapy with antibiotics for treatment of Helicobacter pylori infection.
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. Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases. (less)
A female client is self-administering cimetidine. What is the home care nurse's most important assessment of this client?
Potential drug-drug interactions The home care nurse can assist clients by providing information about taking the drugs correctly and monitoring responses. If cimetidine is being taken, the home care nurse needs to assess for potential drug-drug interactions.
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 H2RAs must be used with caution in patients with renal disease. Since these drugs are eliminated through the kidneys, dosages are reduced to avoid adverse effects.
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 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 patient taking an aluminum hydroxide with magnesium hydroxide antacid (Maalox, Mylanta). (less)
A 75-year-old client is treating his ulcer with antacids. Based on the client's age, the nurse expects the physician to prescribe a dose of antacid that compares with the average prescribed dose in what way?
Smaller than the average prescribed dose Smaller doses of antacids may be effective in older adults, because they usually secrete less gastric acid than younger adults do.
In treating Helicobacter pylori infection, a physician prescribes two antimicrobials. Why two?
Two are needed to prevent the emergence of drug-resistant H. pylori organisms. Effective combinations include two antimicrobials. For the antimicrobial component, two of the following drugs—amoxicillin, clarithromycin, metronidazole, or tetracycline—are used. A single antimicrobial agent is not used because of concern about emergence of drug-resistant H. pylori organisms. (less)
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. Even though ranitidine generally is well tolerated, headache is a common adverse effect that can be severe. The nurse will encourage the patient to adjust lights or temperature and avoid noise if headaches occur and to contact his physician if the headache becomes intolerable. Irritability, dry mouth, and heart palpitations are not associated with this drug.
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. 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.
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 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 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 physician 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 • Zollinger-Ellison syndrome • Gastric ulcers 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. (less)
Which of the following reduce the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells? (Select all that apply)
• Esomeprazole (Nexium) • Lansoprazole (Prevacid) The proton pump inhibitors, like esomeprazole (Nexium) and lansoprazole (Prevacid) reduce the secretion of gastric acid by inhibition of the hydrogen-potassium adenosine triphosphate (ATPase) enzyme system of the gastric parietal cells.
A nurse is assigned the responsibility to care for a patient with stomach hyperacidity. The physician has prescribed aluminum carbonate gel to the patient. For which of the following patients should the nurse administer the aluminum carbonate gel with caution?
Patients with upper GI bleeding The nurse should administer the aluminum carbonate gel with caution in patients with upper GI bleeding. Calcium-containing antacids are used with caution in patients with renal impairment. Dexpanthenol is contraindicated in patients with hemophilia or pheochromocytoma.
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 Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of non-smokers.
The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered
an hour before meals. Sucralfate, a proton pump inhibitor, 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.
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
metabolic alkalosis. Overuse of antacids containing calcium carbonate can cause alkalosis and raise urine pH.
Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of H. pylori? Select all that apply:
• Omeprazole (Prilosec) • Lansoprazole (Prevacid) The proton pump inhibitors, like omeprazole (Prilosec) and lansoprazole (Prevacid), are commonly used in combination with certain antibiotics in the treatment of H. pylori.
The nurse should administer which of the following medications cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12? Select all that apply:
• Pantoprazole (Protonix) • Rabeprazole (Aciphex) The nurse should administer proton pump inhibitors, like rabeprazole (Aciphex) and pantoprazole (Protonix), cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12.
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." 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. (less)
A client is receiving sucralfate. The nurse understands that this drug would begin to act within which time frame?
30 minutes Sucralfate has an onset of action of 30 minutes and a duration of 5 hours.
A patient 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 which of the following?
Serum phosphate level The nurse should monitor the patient's serum phosphate level because aluminum binds with phosphate. This can lower phosphate levels and cause an electrolyte imbalance. Blood glucose, urine specific gravity, and aspartate transaminase levels are not affected by this drug combination.
The nurse is preparing a teaching plan for a patient who is receiving sucralfate. Which of the following would the nurse need to address? Select all that apply.
• Eating a high fiber diet • Ensuring safety precautions • Taking the drug on an empty stomach • Encouraging frequent mouth care Constipation is the most common adverse effect. A high fiber diet is needed to prevent constipation. Dizziness and vertigo can occur with this drug; safety precautions would be important. The drug should be taken on an empty stomach, 1 hour before or 2 hours after meals to ensure therapeutic effectiveness. Frequent mouth care is important in combating dry mouth, which is associated with this drug. Constipation is the most common adverse effect. Increased fluid intake is needed to promote bowel elimination. It also helps to combat dry mouth. Diarrhea can occur, but it is not a common adverse effect and would most likely require dietary adjustments, not drug therapy. (less)
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 • Headache • Confusion Adverse reactions of calcium carbonate (Mylanta) include rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment. (less)
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." Optimal efficacy requires that omeprazole is taken daily, not just when the patient is symptomatic. A lack of immediate symptomatic relief does not necessarily indicate that the drug is ineffective.
The nurse should warn a patient taking aluminum and calcium containing antacids about which of the following adverse effects? (Choose one)
Constipation The nurse should warn a patient taking aluminum and calcium containing antacids about constipation that can be associated with taking products containing either medication.
The nurse is caring for a patient who is prescribed esomeprazole magnesium (Nexium) for the treatment of diarrhea. The patient informs the nurse that he is also taking sucralfate for GI distress. What effects of interaction between the two drugs should the nurse inform the patient about?
Decreased absorption of the esomeprazole magnesium The nurse should inform the patient that there will be decreased absorption of the esomeprazole magnesium as an effect of the interaction between esomeprazole magnesium (Nexium) and sucralfate. The interaction between the two drugs will not decrease the effectiveness of esomeprazole magnesium, increase the risk of a hypertensive episode, or increase the risk of sedation. There will be an increased risk of a hypertensive episode when the dexpanthenol is administered with monoamine oxidase inhibitors (MAOIs). There will be an increased risk of sedation when perphenazine is administered with CNS depressants.
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. Even though heartburn pain will decrease within a couple days of therapy and some patients are on long-term therapy for as long as 5 years, the most important response by the nurse should include that the patient should take the medication at the recommended time. Optimal efficacy requires that omeprazole is taken daily, not just when the patient is symptomatic. The nurse must stress that the patient take the medication as recommended, which could be between 2 and 8 weeks. Usually, it takes longer than a few minutes after the first dose for the pain to subside.
A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform?
confusion and dizziness 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.
