Charter College, Anchorage - NURSING NU1005

Chapter 23: Drug Therapy for Gastric Ulcers and Reflux

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)Which bacteria is often the cause of stomach ulcers?

1. 1. Escherichia coli
   2. Helicobacter pylori
   3. Staphylococcus aureus
   4. Streptococcus pneumoniae

2. Which problem indicates a gastric ulcer is getting worse?
   1. Gaining weight
   2. Abdominal gas
   3. Frequent diarrhea
   4. Blood in the stools

3. What is the most common symptom of gastroesophageal reflux disease (GERD)?
   1. Heartburn
   2. Drowsiness
   3. Constipation
   4. Bloody sputum

4. Which drug used to treat peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) is a histamine H2 blocker?
   1. Metoclopramide (Reglan)
   2. Esomeprazole (Nexium)
   3. Famotidine (Pepcid)
   4. Cetirizine (Zyrtec)

5. Which activity interferes with the action of histamine H2 blockers?
   1. Going to bed late
   2. Smoking cigarettes
   3. Eating dairy products
   4. Taking oral contraceptives

6. How do proton pump inhibitors work to treat peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD)?
   1. Forming a thick stomach coating
   2. Neutralizing acids in the stomach
   3. Blocking the production of stomach acid
   4. Decreasing the stimulation of H2 receptors

7. What is the common side effect of antacids containing calcium or aluminum?
   1. Allergies
   2. Bleeding
   3. Constipation
   4. Decreased urine output

8. Which drug forms a protective coating over an ulcer but does not coat normal stomach mucosa?
   1. Sucralfate (Carafate)
   2. Lansoprazole (Prevacid)
   3. Metoclopramide (Reglan)
   4. Bismuth subsalicylate (Pepto-Bismol)

9. Which antibiotic should be prescribed for H. pylori infection?
   1. Penicillin (Pen V)
   2. Ciprofloxacin (Cipro)
   3. Erythromycin (Erythrocin)
   4. Clarithromycin (Biaxin)

10. Which protective mechanism by the stomach protects it from stomach acids and the formation of gastric ulcers?
    1. Buffers such as bicarbonate neutralize stomach acids.
    2. The stomach secretes a thick gel-like mucus to coat itself.
    3. Acid secretion is decreased when food is not present in the stomach.
    4. Stomach secretions such as lipase digest foods and protect the stomach.

11. Which symptoms are associated with gastric ulcers?
    1. Constant bloating and diarrhea
    2. Shortness of breath in any position
    3. Burning pain that is relieved by eating
    4. Lower abdominal pain that is relieved by moving the bowels

ADVANCED CONCEPTS

12. Why does the backward flow of stomach contents into the esophagus cause tissue damage?
    1. No digestive processes occur in the esophagus.
    2. The esophagus does not have the thick gel-like mucus to protect it from acid.
    3. The esophagus secretes only bicarbonate, which is not strong enough to neutralize stomach acids.
    4. The esophagus cannot expand with extra volume and the excessive stretching damages the muscle layer.

13. A patient with a history of GI ulcers reports feeling new onset burning, gnawing stomach pain. What is your best action?
    1. Assess the patient’s abdomen for the presence of active bowel sounds.
    2. Administer the already ordered as-needed dose of liquid antacid.
    3. Offer the patient food to buffer excess stomach acid.
    4. Notify the prescriber immediately.

14. A patient who is prescribed sucralfate asks how this drug will help treat his gastric ulcer. What is your best response?
    1. “Sucralfate decreases secretion of gastric acids to help your ulcer heal.”
    2. “Sucralfate completely blocks the secretion of gastric acids so your ulcer can heal.”
    3. “Sucralfate treats the infection with H. pylori that is the major cause of gastric ulcers.”
    4. “Sucralfate forms a thick coating to cover the ulcer, protect it from further damage, and allow healing.”

15. How do histamine (H2) blockers help heal gastric ulcers?
    1. They promote cell division.
    2. They neutralize acids that are present in the stomach.
    3. They decrease the amount of acid secreted by stomach cells.
    4. They increase the rate that stomach contents move into the intestinal tract.

16. You are teaching an older adult patient who has been prescribed famotidine (Pepcid) and his or her family about the drug. Which common side effect should you instruct the patient’s family to watch for and report to the prescriber?
    1. Confusion
    2. Anxiety
    3. Depression
    4. Psychosis

17. A patient who has been taking nizatidine (Axid) for the last month has all of the following blood laboratory results. Which result must be reported to the prescriber as soon as possible?
    1. International normalized ratio (INR) of 0.9
    2. Red blood cell count of 2 million/mm³
    3. White blood cell count of 8000/mm³
    4. Platelet count of 150,000/mm³

18. A patient with gastroesophageal reflux disease is prescribed ranitidine (Zantac). Which statement by the patient indicates the need for additional teaching?
    1. “I will notify my prescriber if I need to use ranitidine for more than 2 weeks.”

1. 2. “I will look into a smoking cessation program when I go home.”
   3. “I will take the ranitidine first thing in the morning so that its effect will last all day and night.”
   4. “I will not drive until I know how the ranitidine affects me.”

19. A patient who has been prescribed ranitidine (Zantac) reports darkened stools. What is your best action?
    1. Hold the dose and notify the prescriber.
    2. Document the report as the only action.
    3. Reassure the patient that this is a common and harmless side effect.
    4. Ask the patient if he or she has been using aspirin or any other NSAID drug.

20. A patient who has been taking cimetidine (Tagamet) for a year has all of the following symptoms. Which symptom should be reported immediately to the prescriber?
    1. Darkened urine and white stool
    2. Altered food taste and dry mouth
    3. Weekly constipation with bloating
    4. Reduced interest in sexual activity

21. You are instructing a pregnant patient about how to manage reflux. Which point about histamine H2 blockers should you include in the teaching plan?
    1. They are safe for use during pregnancy.
    2. They may be used while breastfeeding.
    3. They should only be taken with a prescriber’s approval.
    4. They can be prescribed instead of lifestyle changes to control reflux.

22. Which precaution is most important to teach an older patient who is starting histamine H2 blockers for gastroesophageal reflux disease (GERD)?
    1. “Do not drink caffeine while taking this drug.”
    2. “Elevate the head of your bed by 6 to 10 inches.”
    3. “Take this drug with meals and before going to bed.”
    4. “Avoid driving until you know how this drug affects you.”

23. A patient who is prescribed omeprazole (Prilosec) asks why the drug should be taken before breakfast. What is your best response?
    1. “The intended action of this drug is best achieved when given before meals, preferably in the morning.”
    2. “It is best to take this drug in the morning so that antacids taken later in the day do not interfere with absorption.”
    3. “This drug should always be taken on an empty stomach for maximal action and for better absorption.”
    4. “Taking this drug early in the morning helps to minimize the occurrence of side effects or adverse effects.”

24. Which precaution is most important to teach a patient who is prescribed rabeprazole (Aciphex)?
    1. “Wear a hat and sunscreen outdoors to prevent sunburn.”
    2. “Take this drug 1 hour before or 2 hours after a meal.”
    3. “Drink at least 3 L of fluid daily to prevent constipation.”
    4. “Avoid eating raw fruits and vegetables while taking this drug.”

25. A patient who has been prescribed rabeprazole (Acipex) develops black, tarry stools. What is your best first action?
    1. Check the patient’s medication list for prescribed iron supplements.
    2. Teach the patient that this is an expected side effect of proton pump inhibitors.
    3. Send a stool sample to the laboratory to check for presence of occult blood.
    4. Keep track of the number of stools the patient has in a 24-hour period.

26. To prevent a common risk among older adults who are prescribed proton pump inhibitors, which safety precaution should you recommend?
    1. “Be sure to take a daily multivitamin.”
    2. “Use handrails when going up or down stairs.”
    3. “Take this drug with food or a full glass of fluid.”
    4. “Notify your prescriber if you develop belching or gas.”

27. Why are older patients who are prescribed proton pump inhibitors more at risk for drug- induced hip fracture?
    1. Induced drowsiness increases the risk for falling.
    2. Inhibited calcium absorption makes bones more fragile.
    3. Excessive potassium loss reduces muscle strength and balance.
    4. Anemia and fatigue prevent participation in exercise and reduce muscle weakness.

28. A patient with indigestion is prescribed aluminum hydroxide (Amphojel). To prevent the most common side effect of this drug, what should you teach the patient?
    1. “Take this drug 30 minutes before each meal.”
    2. “Do not drink fluids for at least 30 minutes after taking this drug.”
    3. “Be sure to consume a diet with lots of vegetables and other foods with fiber.”
    4. “Report any episodes of diarrhea immediately to your prescriber.”

29. Which precaution is most important to teach a patient who is prescribed an antacid?
    1. “Avoid using extra pepper on your food while taking this drug.”
    2. “If you become constipated, stop taking the antacid completely.”
    3. “Take this drug at least 2 hours before or after taking any other drug.”
    4. “Notify your prescriber if heartburn continues after you have taken the drug for 3 days.”

30. Why should parents be taught never to give bismuth subsalicylate (Pepto-Bismol) to a child?
    1. It contains aspirin that can cause Reye’s syndrome.
    2. It changes stool color making the identification of GI bleeding more difficult.
    3. It has such powerful antidiarrheal effects that toxic megacolon can occur.
    4. It produces a paradoxical reaction in children that results in worsening of the symptoms.

31. The spouse of an older adult with Alzheimer’s disease tells you that she has been giving him Amphojel (aluminum hydroxide) for heartburn. What is your best action?
    1. Ask the spouse how often the patient is taking the Amphojel.
    2. Suggest that the patient be given AlternaGEL instead.
    3. Teach the spouse that taking this drug can worsen the patient’s condition.
    4. Remind the spouse that giving this drug often can interfere with bowel function.

32. You are instructing a patient who has been prescribed sucralfate (Carafate) for peptic ulcer disease. Which statement by the patient indicates the need for additional teaching?
    1. “This drug coats my ulcer and protects it so that healing can occur.”
    2. “I should eat foods with lots of fiber while I’m taking this drug.”

1. 3. “If I feel dizzy, I will be sure to get up from bed slowly.”
   4. “Once I am feeling better I can stop taking the drug.”

33. A patient with gastroesophageal reflux disease (GERD) asks why metoclopramide (Reglan) has been prescribed. What is your best response?
    1. “The purpose of this drug for GERD is to prevent nausea.”
    2. “This drug has been prescribed to help move food along through your GI tract.”
    3. “Metoclopramide will prevent vomiting and the risk for aspiration.”
    4. “This drug causes growth of new cells to heal your esophagus.”

34. What common symptom do you expect to find in a patient with peptic ulcer disease?
    1. Frequently vomiting bright red blood
    2. Burning gnawing pain between the navel and sternum
    3. Nausea with reflux before and after all meals
    4. Dark coffee-ground textured stools

35. Why should a patient with GERD avoid substances such as chocolate, peppermint, alcohol, nicotine, and caffeinated drinks?
    1. These substances increase the pressure in the lower esophageal sphincter and lead to reflux.
    2. These substances decrease the pressure in the lower esophageal sphincter leading to reflux.
    3. These substances increase the pressure in the duodenal sphincter causing reflux and emesis.
    4. These substances decrease the pressure in the duodenal sphincter causing reflux and emesis.

36. A patient is prescribed omeprazole (Prilosec) 40 mg orally for 6 weeks. For which common side effects will you monitor after giving this drug?
    1. Shortness of breath and increased respiratory rate
    2. Burning and itching with urination attempts
    3. Muscle aches and pains
    4. Diarrhea and gas

37. An older adult is prescribed lansoprazole (Prevacid) 15 mg orally each day. The patient asks you why a daily multivitamin has also been prescribed. What is your best response?
    1. “As you get older you need vitamin tablets to ensure that you get the minimum daily requirements.”
    2. “Lansoprazole is a proton pump inhibitor (PPI) and these drugs interfere with absorption of all vitamins from the GI tract.”
    3. “Taking a daily multivitamin is important because proton pump inhibitor drugs decrease the absorption of vitamin B₁₂ and calcium.”
    4. “Older adults have more difficulty processing vitamins and minerals from the daily foods consumed.”

38. Which patient should always avoid taking sodium-containing antacids such as, Alka-Seltzer and Bromo-Seltzer?
    1. 55-year-old female with heart failure
    2. 65-year-old male with overactive bladder
    3. 8-year-old child with Crohn’s disease
    4. 25-year-old with leukemia

39. Which precaution is important to teach a patient who plans to use over-the-counter cimetidine to help control gastroesophageal reflux disease?

1. 1. “Watch your stools for changes that indicate bleeding such as bright red blood or a tarry appearance.”
   2. “Be sure to tell your health care provider that you are taking this drug.”
   3. “Avoid taking antacids while taking cimetidine.”
   4. “Always take cimetidine with a full meal.”

MULTIPLE RESPONSE

ADVANCED CONCEPTS

1. Which foods, activities, and drugs should you teach the patient with peptic ulcer disease to avoid? (select all that apply)
   1. Alcohol
   2. Caffeine
   3. Dairy products
   4. Exercising
   5. Smoking
   6. Spicy food
   7. Nonsteroidal anti-inflammatory drugs (NSAIDs)

2. What should you teach a patient about smoking and peptic ulcer disease? (select all that apply)
   1. Smoking increases acid secretion.
   2. Smoking is not a cause of ulcer formation.
   3. Smoking slows ulcer healing.
   4. Smoking is related to the reoccurrence of ulcers.
   5. Smoking decreases stomach mucus production.
   6. Smoking stimulates scar tissue formation in the stomach.

3. Which are risk factors for an individual to develop GERD? (select all that apply)
   1. Being underweight
   2. Being pregnant
   3. Taking NSAID drugs
   4. Eating foods high in alkaline content
   5. Drinking caffeinated beverages
   6. Eating spicy foods
   7. Drinking 2 L of water daily.

4. Which are intended responses for histamine (H₂) blockers? (select all that apply)
   1. Decreased gastric acid secretion
   2. Increased gastric acid secretion
   3. Esophageal reflux is decreased
   4. White blood cells are decreased
   5. Gastric ulcers are healed
   6. Occult bleeding is detected early

5. For which occurrences should you teach a patient taking drugs for PUD or GERD to notify the prescriber? (select all that apply)
   1. Difficulty swallowing
   2. Persistent belching
   3. Vomiting bright red blood
   4. Brown formed stools
   5. Coffee ground appearing emesis
   6. Bright yellow urine
   7. Dry mouth
   8. Fissured tongue

COMPLETION

ADVANCED CONCEPTS