Chapter 78 Drugs for Peptic Ulcer Disease

Chapter 78: Drugs for Peptic Ulcer Disease Test Bank MULTIPLE CHOICE 1. A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication? a. Antibiotics b. Histamine-2 receptor antagonists c. Proton pump inhibitors d. Mucosal protectants ANS: C Patients taking NSAIDs should use proton pump inhibitors for ulcer prophylaxis. The other agents are not used for prophylaxis. PTS: 1 DIF: Cognitive Level: Application REF: pp. 947-948 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do? a. Ask the provider about ordering an endoscopic examination. b. Contact the provider to discuss serologic testing and an antibiotic. c. Contact the provider to discuss switching to a proton pump inhibitor. d. Counsel the patient to avoid beverages containing caffeine. ANS: B The recommendation for all patients with gastric or duodenal ulcers and documented Helicobacter pylori infection is treatment with antibiotics. The nurse is correct to ask about serologic testing for this organism and to suggest adding an antibiotic to this patient’s regimen. An endoscopic examination is not recommended. Changing to a proton pump inhibitor may not change the symptoms. There is no evidence that caffeine contributes to peptic ulcer disease (PUD). PTS: 1 DIF: Cognitive Level: Application REF: p. 949 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 3. A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to: a. change the meal pattern to five or six smaller meals per day. b. discontinue taking aspirin, because it can irritate the stomach. c. stop drinking wine or any other alcoholic beverage. d. switch to a decaffeinated coffee and reduce the number of servings. ANS: A Consumption of five or six smaller meals a day can reduce fluctuations in the intragastric pH, which may facilitate recovery. ASA should be avoided, along with other NSAIDs except for lowdose ASA used for the prevention of cardiovascular disease. No hard data implicate alcohol as a contributor to PUD. No data indicate that caffeine contributes to PUD. PTS: 1 DIF: Cognitive Level: Application REF: p. 950 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 4. A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? a. Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] b. Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet] c. Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec] d. Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid] ANS: A The regimen recommended for the treatment of PUD includes two antibiotics and an antisecretory agent. Amoxicillin, clarithromycin, and omeprazole would meet this recommendation. Patients taking metronidazole cannot consume alcohol, as this would precipitate a disulfiram-like reaction. The last option does not include two antibiotics. PTS: 1 DIF: Cognitive Level: Application REF: pp. 948-949 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen? a. Black discoloration of the tongue and stools should be reported immediately. b. Central nervous system depression and confusion are likely to occur. c. Decreased libido, impotence, and gynecomastia are reversible side effects. d. Staining of the teeth may occur and is an indication for discontinuation of these drugs. ANS: C Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are side effects associated with bismuth but are not harmful. Central nervous system (CNS) depression and confusion are not likely. Staining of the teeth associated with tetracycline use occurs only in developing teeth; it is a problem in children younger than 8 years and in pregnant woman because of this risk to the fetus. PTS: 1 DIF: Cognitive Level: Application REF: pp. 950-951 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what? a. Avoid any alcoholic beverages b. Avoid foods containing tyramine c. Take the drug on an empty stomach d. Take the drug with food ANS: A The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol. Nothing indicates that the patient should avoid foods containing tyramine. Metronidazole may be taken with or without food. PTS: 1 DIF: Cognitive Level: Application REF: p. 950 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications? a. “Take the antacid 1 hour after the ranitidine.” b. “The antacid and ranitidine should be taken at the same time for better effect.” c. “Take the antacid 15 minutes before the ranitidine.” d. “Take the antacid 30 minutes after the ranitidine.” ANS: A Because antacids raise the gastric pH, they can affect the dissolution and absorption of ranitidine; therefore, 1 hour should separate administration of antacids and ranitidine. Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced. One hour should separate administration of antacids and ranitidine; intervals of 15 minutes and 30 minutes are not long enough. PTS: 1 DIF: Cognitive Level: Application REF: pp. 951-952 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient? a. Cimetidine [Tagamet] b. Esomeprazole [Nexium] c. Ranitidine [Zantac] d. Sucralfate [Carafate] ANS: C Ranitidine is used to treat Zollinger-Ellison syndrome. Although cimetidine can also be used, ranitidine is more potent and therefore is preferred. Esomeprazole and sucralfate are not indicated. PTS: 1 DIF: Cognitive Level: Application REF: p. 953 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient? a. A complete cure is expected with this medication. b. Lifestyle changes can be as effective as medication therapy. c. Long-term therapy may be needed. d. The medication will be used until surgery can be performed. ANS: C Proton pump inhibitors, such as omeprazole, are much better than H2RAs for treating GERD. For patients with severe GERD, long-term maintenance therapy is recommended. These drugs do not cure GERD; relapse is common when the drugs are discontinued. Lifestyle changes can help but should not be considered a substitute for drugs. Surgery is reserved for young, healthy patients who cannot or will not stick to a drug regimen. PTS: 1 DIF: Cognitive Level: Application REF: p. 955 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 10. A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: a. come to the clinic to be tested for Clostridium difficile. b. resume taking the PPI, because long-term therapy is necessary. c. resume taking the PPI until symptoms resolve completely. d. try an antacid to see whether it relieves these symptoms. ANS: D When patients stop taking a PPI, a rebound hypersecretion of gastric acid can cause dyspepsia. This can be managed with an antacid. Although C. difficile infection is associated with doserelated increases in PPIs, the symptoms include diarrhea, not dyspepsia, so testing is not indicated for this patient. Resuming the PPI is not indicated, because these symptoms can be managed with antacids. PTS: 1 DIF: Cognitive Level: Application REF: pp. 954-955 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching? a. “Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions.” b. “Sucralfate and ciprofloxacin should be administered 1 hour apart.” c. “Sucralfate does not cause systemic side effects.” d. “Sucralfate has a moderate acidneutralizing capacity.” ANS: D Sucralfate does not have any acid-neutralizing capacity, so this statement is incorrect. The other statements about sucralfate are correct. PTS: 1 DIF: Cognitive Level: Application REF: p. 957 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 12. A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug? a. “The FDA has determined that there is a gastric cancer risk with this drug.” b. “This drug will be given on a short-term basis only.” c. “You may experience hypermagnesemia when taking this drug.” d. “You should report any fever and cough to your provider.” ANS: D PPIs can increase the risk of community-acquired and hospital-acquired pneumonia in the first few days of use and patients should be taught to report symptoms to their provider. The FDA has concluded that there is no increased risk of gastric cancer associated with PPIs. PPIs are often used long-term to treat GERD, since the risk of relapse is greater than 80%. There is a risk of hypomagnesemia, not hypermagnesemia with long-term use. PTS: 1 DIF: Cognitive Level: Application REF: p. 949 | pp. 954-945 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. Which non-pharmaceutical intervention can be used to reduce symptoms of gastroesophageal reflux disease? (Select all that apply.) a. Avoiding late-night meals b. Consuming a glass of wine with meals c. Drinking soft drinks d. Losing weight e. Stopping smoking ANS: A, E Avoiding late-night meals and stopping smoking may help with symptoms of GERD. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 955 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply.) a. Gastric cancer b. Headaches c. Medication interactions d. Osteoporosis e. Vitamin and mineral deficiencies ANS: C, D, E Older patients who take PPIs have increased risks for medication interactions, osteoporosis, and vitamin and mineral deficiencies. Headache is a common side effect early in treatment but is not serious. The FDA has concluded that there is no increased risk of gastric cancer associated with PPIs. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 957 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies